Hormonal IUDs may trigger rosacea in women

Key takeaways:

• Women with Liletta and Mirena IUDs were more likely to have rosacea 1-year after insertion vs. those with copper devices.
• This was not seen with Skyla IUDs, which release a lower dose of levonorgestrel.

Hormonal intrauterine devices were associated with a higher incidence of rosacea in women compared with nonhormonal devices, according to a study.

“We know that female hormones, estrogen and progesterone, both play a role in hormonal acne, but they also play a role in the blushing and flushing mechanisms associated with rosacea,” Cameron Rokhsar MD FAAD FAACS, associate clinical professor of dermatology at Mount Sinai Hospital, told Healio. “For example, when women are going through menopause, many report blushing, flushing and heat sensations. That is all being mediated by fluctuations in estrogen and progesterone.”

Rosacea is a chronic skin condition characterized by facial erythema and inflammatory acne lesions. There are many environmental factors that can trigger a rosacea flare, including extreme heat or cold, alcohol consumption, spicy foods and hormonal intrauterine devices (IUDs), according to a study published in the Journal of the American Academy of Dermatology.

Cameron Rokhsar

Because of the connections between hormonal fluctuations and blushing, flushing and heat sensations, authors of this study analyzed the incidences of rosacea among women with hormonal IUDs compared with those with nonhormonal or copper IUDs.

Rosacea rates by IUD type

Women aged 18 to 50 years with a hormonal IUD — Liletta (AbbVie, Medicines360), Mirena (Bayer) or Skyla (Bayer) — were included in the study. The researchers evaluated the rates of rosacea incidence 1, 3 and 5 years after IUD insertion. Women with rosacea diagnosed before IUD insertion were excluded from the study.

Results showed that hormonal IUDs, specifically Liletta and Mirena, were associated with higher rates of rosacea incidence compared with copper IUDs.

Compared with women who received a copper IUD, the incidence rate ratio (IRR) for rosacea 1 year after insertion was 1.665 for women with a Liletta IUD (95% CI, 1.346-0.059). Similarly, the IRR for rosacea was 1.389 for women who received a Mirena IUD compared with women who received a nonhormonal IUD (95% CI, 0.752-1.533).

This trend continued at all times , according to the researchers. At 3 and 5 years after insertion, the IRR for rosacea was 1.751 (95% CI, 1.481-2.069) and 1.788 (95% CI, 1.530-2.089) for Liletta and 1.44 (95% CI, 1.250-1.656) and 1.472 (95% CI, 1.290-1.678) for Mirena, respectively.

Researchers did not observe an associations found between Skyla insertion and rosacea incidence, which could be due to the slower rate of levonorgestrel, they wrote..

When asked if the IUD was the cause or simply the trigger of rosacea among these women, Rokhsar explained that it was most likely the trigger.

“I don’t believe personally that rosacea is only caused by environmental factors,” Rokhsar said. “I believe that you need to have the genetic predisposition for rosacea.”

Treatment options

Although removing the IUD could alleviate the symptoms, Rokhsar emphasized that dermatologists are well equipped to treat rosacea without asking patients to make such a change.

“We have many, many medications and devices at our disposal to get rosacea under control,” Rokhsar said.

The acne that accompanies rosacea is best treated with oral antibiotics doxycycline, tetracycline and minocycline, as well as topical antibiotics like metronidazole lotion, clindamycin lotion and ivermectin. Cleansers such as sodium sulfacetamide will also help these inflammatory lesions subside.

Blushing and flushing can be partially alleviated through trigger avoidance. According to the National Rosacea Society, triggers may include certain foods, beverages, temperatures, emotions, skin care products and more.

Lycia Thornburg

Lycia Thornburg, MD, FAAD, a dermatologist at Rapid City Medical Center, told Healio that environmental triggers are often very specific to the individual.

“Patients should keep a good diary of what flares rosacea for them,” Thornburg said.

However, even after the acne and flushing are addressed, many patients often continue to experience telangiectasias. According to Thornburg, these should be treated with laser therapy.

“For a lot of patients, telangiectasias cause them a lot of psychosocial distress,” Thornburg said. “So, the next step is to use a laser that has a particular wavelength that treats those blood vessels.”

Thornburg uses a 420 nanometer, broadband laser for the first pass over the skin to treat the bacteria, followed by 560 nanometers to target the redness of the blood vessels. This is usually done in a series of three treatments, Thornburg said.

Rokhsar agreed, adding that dermatologists should use pulsed dye laser therapy to control redness, broken capillaries and even the overall symptoms associated with rosacea, including acne.

“Whenever somebody says they have rosacea, [dermatologists] may keep throwing antibiotics at patients, which doesn’t help them,” Rokhsar said. “The antibiotics only help the acne part of rosacea, but the redness and blushing are somehow intricately associated with the development of the acne part, so it should be emphasized that dermatologists should offer the pulsed dye laser.”

For more information:

Cameron Rokhsar MD FAAD FAACS, can be reached at cameron@post.harvard.edu.

Lycia Thornburg, MD, FAAD, can be reached at dermatology@healio.com.

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