From the Editor

Long-acting reversible contraceptives and acne in adolescents

How should you manage acne in an adolescent seeking progestin-based long-acting reversible contraception (LARC)?

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Examining the impact of contraception on acne in adolescents is clinically important because acne affects about 85% of adolescents, and contraceptives may influence the course of acne disease. Estrogen-progestin contraceptives cause a significant improvement in acne.1,2 By contrast, the levonorgestrel-releasing intrauterine device and the etonogestrel contraceptive implant may exacerbate acne. In this editorial we review the hormonal contraception−acne relationship, available acne treatments, and appropriate management.

Related article:
Your teenage patient and contraception: Think “long-acting” first

Combination oral contraception and acne

As noted, combination oral contraceptives generally result in acne improvement.1,2 Estrogen-progestin contraceptives improve the condition through two mechanisms. Primarily, estrogen-progestin contraceptives suppress pituitary luteinizing hormone secretion, thereby de­creasing ovarian testosterone produc­­tion. These contraceptives also increase liver production of sex hormone-binding globulin (SHBG), thereby increasing bound testosterone and decreasing free testosterone. The decrease in ovarian testosterone production and the increase in SHBG-bound testosterone reduce sebum production, resulting in acne improvement.

The US Food and Drug Administration has approved 4 estrogen-progestin contraceptives for acne treatment:

  • Estrostep (norethindrone acetate-ethinyl estradiol plus ferrous fumarate)
  • Ortho Tri-Cyclen (norgestimate-ethinyl estradiol)
  • Yaz (drospirenone-ethinyl estradiol)
  • BeYaz (drospirenone-ethinyl estradiol plus levomefolate).

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