Dermatological Adverse effects

The   equilibrium   of   healthy   skin   and   mucosa   may   be   affected   by pharmaceutical   agents,  as   hormonal   contraceptives(HC)  causing   different manifestations.  Cutaneous adverse effects as melasma,  photosensitivity,  bullous eruptions and monilias are frequently reported in women taking hormonal contraceptives (1).  Melasma or Chloasma,  a dark brown hyperpigmentation, accounts for about 2/3 of all cutaneous side-effects of HCs and,appears frequently in women who have heavily pigmented nipples and eyes (2).

It may occur in these women when not protected fron sunlight and regress more slowly than after pregnancy, sometimes can be definitive (3). Progesterone activity changes the biochemistry and pH of the skin and sebacious glands,  thereby contributing to eruptions of acne vulgaris (4).

However,it is known that anti-androgen progestin and estrogen combinations are more effective than standard estrogen and progestagen (without anti-androgen property) contraceptive pill, to trat the acne (5). Particularly, a recent study carried out in 170 adolescent girls reported as very convenient the monophasic formulation containing ethinylestradiol 30 μg and chlormadinone acetate 2 mg for the acne vulgaris management (6).

Even though many believe that using combined oral contraceptives(  COCs)  cause hair loss, there is little evidence to support it.  Alopecia is very rare and may even reflect a simple coincidence. Reactions of hypersensitivity or allergy to COC may include urticaria and eczema. 

Rarely,  urticaria may be a life-threatening skin disease. The sympoms may range from pruritus to generalized skin eruptions, gastrointestinal,  bronchial problems to systemic anaphylaxis and cardiovascular emergencies(7). Dermatologic vascular manifestations of COCs are dependent on estrogens   and   include   telangiectasias,  angiomas   and   livedo   reticularis(8).

Although livedo reticularis or racemosa is commonly seen in women with antiphospholipid antibody syndrome or can be a non-specific lesion of systemic lupus erythematosus (9,10). Several dermatological and systemic disorders may be aggravated by COCs as Hereditary angioedema,  Herpes gestationis,  Porphyries, Systemic lupus erythematosus. 

Same condition for hidradenitis suppurativa, seborrhoea, and Fox-Fordyce disease(1), Acute intermittent porphyria is the most common type of porphyria. Aggravation or an attack of the disease is caused by many   endogenous   and   exogenous   factors,  among   others   by   hormonal contraceptives. There are few porphyrogenous factors whose action was observed, among which the most important was desogestrel. Due to this conclusion, a change in   contraceptive   therapy   that   would   exclude   hormonal   contraception   was suggested(11).

Generally,  HCs favor the formation of delta-aminolevulinic acid and should be avoided in case of Porphyrie. Drug exposure was a frequent precipitant of the acute attack in variegate porphyria, whereas hormonal factors were more important in acute intermittent porphyria (p<0.00001)(12).

Sporadic cases of Porphyria cutanea tarda caused by long–term use of oral HCs were reported in the Literature(13).

Severe seborrhoeic dermatitis was reported,  in the last years as rare side-effect of a levonorgestrel intrauterine system(LNG-IUS) in a 36–year-old woman, which resolved completely after removal of the IUS and the topical treatment(14)

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