How do contraceptives effect rosacea?

[Guide]

As of this date, there are no reports in medical literature researching contraceptives and rosacea, however, there are plenty of discussions, articles and posts on this subject. We will use this FAQ as a source to keep this discussion in this thread. If you have anything to add please post in this thread. 

One of the rosacea triggers is menopause, so logically the hormones are somehow involved, but we have no clear understanding of how. [1] Some physicians prescribe antihistamines, antidepressants, low-estrogen birth control pills [2], diuretics, or an anti-dandruff shampoo containing zinc for the flushing that results from menopause. [3] Some anecdotal reports indicate that taking birth control pills improves rosacea. [4] Another anecdotal report indicates that going off birth control for one day improved rosacea. [5] Conversely, there are reports of women who go on birth control that increase rosacea flareups. [6]

From an article posted at the dermatologist

“We’re not certain of the clinical significance of the skin production of androgens because a lot is being made by the ovaries or testes. But, the skin is a large organ, so even if it’s involved in any respect in androgen metabolism, it could play a role in acne,” says Diane M. Thiboutot M.D., a Professor of Dermatology at the Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center. “It might be that women with acne may have greater local production of androgen in their skin that could in part account for the presence of acne. Many of our female patients with acne were found to have high levels of testosterone.

Agents that block adrenal production of androgens are oral contraceptives and low-dose glucocorticoids. “Most times we use prednisone at a low dose because there seems to be increased risk of adrenal suppression with dexamethasone,” says Dr. Thiboutot. “While we have patients on treatment with dexamethasone or prednisone for congenital adrenal hyperplasia, it’s important to know whether your therapy is actually reducing those androgens, so you may want to check the serum dehydroepiandrosterone sulfate (DHEAS) to see if you’re bringing that down into the normal range.” 

Even on low-dose prednisone, adrenal suppression could still occur, so you may want to refer to an endocrinologist or an internist to have cortisol checked or to check adrenal function in general."

Oral contraceptives contain a low-dose of an estrogen and a progestin. Studies show that most oral contraceptives used to treat acne have similar effectiveness, around a 45% reduction in inflammatory lesions. However, a novel progestin has been introduced called drospirenone, which is a derivative of 17-spironolactone, and it is found in the Yasmin brand oral contraceptive, which contains about 30 µg of estrogen. 

According to Dr. Thiboutot, a small trial for this contraceptive involving 128 women showed about a 60% lesion reduction over 9 months. Phase III trials for this therapy are in progress.

Many patients are concerned about the interaction between oral contraceptives and antibiotics. “The gut flora is needed to cleave estrogen from the conjugated estrogen in the oral contraceptives, and the risk of an interaction is greatest with tetracyclines,” says Dr. Thiboutot. “But the number of reports in the literature is actually small. However, I think that we should discuss this with our patients.” [7]

End Notes

[1] birth control
Q&A: Birth Control & Topical Medication, NRS 

[2] "The oral contraceptives chlormadinon acetate/mestranol (Ovosiston) and the antiandrogen agent cyproterone have been suggested as being effective hormonal treatments for rosacea."
P T. 2009 Jan; 34(1): 38–45.
Rosacea: A Review
Brittney Culp, BA and Noah Scheinfeld, MD

[3] Women May Need Added Therapy
Lynn Drake, MD, Editor, NRS Rosacea Revew

[4] sunshine12, Rashadooks, cas,

[5] lexiophile

[6] amethystice215

[7] What's New for Treating Acne
By Michael S. Krivda, the dermatologist