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.
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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.