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  • Title: [Dermatological complications caused by oral contraceptives].
    Author: Deharo C, Berbis P, Privat Y.
    Journal: Fertil Contracept Sex; 1988 Apr; 16(4):299-304. PubMed ID: 12342376.
    Abstract:
    The incidence of cutaneous effects of oral contraceptives (OCs) is estimated at 2.7-5%. Secondary effects directly attributable to the hormonal action of OCs include melasma, acne and hyperseborrhea, alopecia, and cutaneous lesions of vascular origin. Melasma or chloasma accounts for about 2/3 of all cutaneous side effects of OCs. It appears from 1 month-3 years after the start of OC use, its frequency increasing with dose and duration of use. Pigmentation appears to accentuate the symptoms in brunettes rather than predisposing them to melasma. Exposure to the sun plays a certain role, but use of a low dose OC and effective sun protection are not enough to reverse the pigmentation. These melasmas regress more slowly than after pregnancy and many remain definitive. The influence of OCs on acne is variable, with some OCs provoking sebaceous hypersecretion and some improving acne enough to be used for treatment. For the therapeutic effect to be observed, the estrogen dose must be sufficient to offset the androgenic effect of the progestin. Combined pills containing the strong antiandrogen cyproterone acetate should control acne if other, less androgenic progestins fail. Alopecia is a very rare effect of OCs and its appearance may even reflect simple coincidence. Vascular complications of combined OCs are dependent on estrogens and may include such manifestations as telangiectasias, angiomas, and livedo reticularis. Some secondary cutaneous effects are probably not due to a hormonal influence. They are less well known than the direct hormonal effects, and publications concerning the often detail isolated observations that are difficult to interpret. Reactions of hypersensitivity or allergy to combined OCs may include urticaria and eczema. A history of OC use should be sought in all women presenting with erythema nodosum and the OCs should be discontinued. Pruritus and jaundice may be observed in 1 OC user in 100,000. They indicate a cholestatic hepatitis for which estrogens are responsible. Most patients developing the condition have already had pruritus or jaundice during pregnancy; such a history contraindicates OC use. Several dermatological and systemic disorders are aggravated by OC use. Hereditary angioedema, herpes gestationis, porphyries, and systemic lupus erythematosus are exacerbated by OC use. The role of OCs in malignant melanomas remains controversial.
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