Hormonal Intrauterine Devices May Increase Rosacea Risk

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Women who use certain hormone-releasing intrauterine devices (IUDs) may be at increased risk for developing rosacea, according to a research letter published in the Journal of the American Academy of Dermatology (JAAD).¹ While rosacea affects both men and women, it is more common in women. For some women, the use of birth control may be helpful in easing rosacea symptoms by reducing hormonal fluctuations.² However, the role of hormones in the disease’s development is not yet clear. Only a handful of studies have looked at the relationship between hormonal contraception (in the form of birth control pills or a hormone-releasing IUD) and rosacea, and the results have been mixed.

In the new study, researchers followed 210,274 women between ages 18 and 50 years who were using IUDs, including 39,375 who were using nonhormonal copper IUDs and 170,899 who were using 1 of 3 brands of hormonal IUD: Liletta and Mirena, which each contain 52 mg of levonorgestrel, a type of progesterone, and Skyla, which contains 13.5 mg of levonorgestrel. The investigators also followed 319,105 women in the same age range who were taking oral birth control for comparison. New diagnoses of rosacea in each group were recorded at 1, 3, and 5 years postinsertion.

“Our previous study, published in the Archives of Dermatological Research,³ compared hormonal and nonhormonal IUDs to oral contraceptives and found a higher incidence of rosacea among IUD users,” said Alexis Arza, a medical student at Drexel University College of Medicine and study coauthor. “We were unable to distinguish between hormonal and nonhormonal IUDs in that analysis, which prompted our investigation published in JAAD, which revealed that hormonal IUD users had a higher incidence of rosacea compared to nonhormonal IUD users.”

The researchers found that patients using Liletta were 66.5% more likely to be diagnosed with rosacea compared to those using a copper IUD after 1 year; the risk increased to 75.1% after 3 years and 78.8% after 5 years. Mirena users were 38.9% more likely to be diagnosed with rosacea after 1 year compared to copper IUD users, and the risk increased to 44.0% after 3 years and 47.2% after 5 years. The increased risk for Skyla users was not significant, rising from 7.4% greater than those using a copper IUD after 1 year to 19.3% greater after 5 years.

According to the US National Center for Health Statistics, as of 2019 about 10.4% of American women between the ages of 15 and 49 years use an IUD or contraceptive implant, compared to 14% who use oral contraceptives.4 “In our experience managing IUD-associated rosacea flares, changing the form of contraception is rarely necessary,” said Arza. “For many of our patients, flares of rosacea represent a transitional phase as their skin adjusts to hormonal changes.”

She noted that treatment typically follows standard rosacea care, including oral or topical medications appropriate to each patient’s individual signs and symptoms. Once the initial flares are under better control, focusing on skin care routines and identifying other triggers can help maintain improvement. “For persistent flares, consulting a gynecologist about nonhormonal IUDs or alternative contraceptives may be an option,” she said. “However, IUDs remain a reliable, passive, long-term contraceptive option for those unaffected by or unbothered by rosacea.”

Andrew Huff is the president and executive director of the National Rosacea Society.

This article is reprinted with permission from https://www.rosacea.org/blog/2024/december/hormonal-iuds-may-increase-rosacea-risk.

References

1. Arza A, Stitzlein E, Gupta M, Ilyas EN. Incidence of rosacea associated with hormonal intrauterine devices: a comparative study with nonhormonal intrauterine devices. J Am Acad Dermatol. 2024:S0190-9622(24)03042-1. doi:10.1016/j.jaad.2024.10.029
2. Women may need added therapy. National Rosacea Society. 2008. Accessed December 6, 2024. https://www.rosacea.org/rosacea-review/2008/winter/women-may-need-added-therapy
3. Stitzlein E, Arza A, Gupta M, Ilyas EN. Incidence of rosacea after placement of intrauterine devices: a retrospective analysis. Arch Dermatol Res. 2024;316(9):650. doi:10.1007/s00403-024-03392-4
4. Daniels K, Abma JC. Current contraceptive status among women aged 15–49: United States, 2017–2019. National Center for Health Statistics. October 2020. Accessed December 6, 2024. https://www.cdc.gov/nchs/products/databriefs/db388.html