Acne does not commonly drive adolescents to remove reversible contraceptives

Key takeaways:

• 28.5% of adolescent patients experienced worsening acne following the use of a progestin-only long-acting reversible contraception.
• 3% of patients cited acne as a factor for their contraceptive removal.

A new study found that the development or worsening of acne was not a common cause of long-acting reversible contraception discontinuation among adolescents, according to a study.

“Previous studies have indicated that use of the progestin-only etonogestrel contraceptive implant and levonorgestrel intrauterine device is associated with an increased risk of acne, likely secondary to the androgenic properties of these progestins,” Markus D. Boos, MD, PhD, associate professor of dermatology in the department of pediatrics at University of Washington School of Medicine and attending pediatric dermatologist at Seattle Children’s Hospital, and colleagues wrote. “While informative, these studies are limited by their inclusion of only adults, despite acne being more prevalent in teenagers and young adults aged 12 [to] 24 years.”

To bridge this knowledge gap, the researchers conducted a secondary analysis of data from the Adolescent Medicine Long-Acting Reversible Contraception (LARC) Collaborative. A total of 1,319 adolescent patients (mean age, 18.6 years) who had completed a progestin-only LARC insertion were included, 47.5% of whom had an intrauterine device and 52.5% of whom had a contraceptive implant.

Results showed that 28.5% of patients experienced worsening acne following the use of a progestin-only LARC. Of these patients, 59.8% did not self-report acne as a concern at insertion but did report it as a concern at a follow-up visit or at LARC removal.

However, acne was cited as a contributing factor for LARC removal in 3% of cases and was cited as the sole reason for LARC removal in only 0.4% of cases.

Because this study was a secondary analysis, the authors noted that incomplete or inaccurate documentation of acne could have skewed the accuracy of these results. In fact, data on patients that underwent LARC insertions without follow-up/removal visits or those who had a follow-up/removal visit within 8 weeks of insertion were excluded from the study, which may have influenced the results.

Despite these limitations, the authors concluded that the development or worsening of acne was not a common cause of LARC discontinuation.

“Concerns about the development or worsening of acne should not be cause to avoid these forms of contraception,” the researchers wrote, including the caveat that providers should still have a thorough conversation with their patients about acne being a potential adverse event.

“Patients can be reassured that if acne does develop, it is typically not problematic enough to warrant discontinuation and can be effectively managed with appropriate step-wise therapy,” they concluded.