How Does Birth Control Affect My Eczema?

Finding the right birth control option for those with eczema may feel overwhelming. Many different birth control options are available, including hormonal birth control — like oral contraceptives (aka, the pill) and hormonal intrauterine devices (IUDs). There are also nonhormonal methods like condoms and spermicides. But do certain birth control options affect those with atopic dermatitis (AD)? Are some options better or worse than others?

We asked Dr. Zelma Chiesa Fuxench, assistant professor of dermatology at the Hospital of the University of Pennsylvania, to walk us through what people with eczema should consider when assessing birth control options.

Do hormonal contraceptives, like the pill, cause any known issues for female patients with eczema? 

“Oral contraceptives (or the pill) are an overall safe and effective form of contraception that has been around for many years,” Dr. Chiesa Fuxench explained. Interestingly, during menstruation there are fluctuations in sex hormone levels, which are known to influence skin barrier integrity and blood flow to the skin.¹

Is it common for women with eczema who are on the pill to have a flare during their period or when taking the pill?

“In my experience, most patients who are on oral contraceptives and have eczema tolerate them well and do not experience flares during their period,” said Dr. Chiesa Fuxench. “However, some patients can experience worsening of their eczema symptoms at different points throughout their menstrual cycle due to changing sex hormone levels (e.g., estrogen, progesterone, testosterone).”

What side effects are common for people who have eczema and take the pill and is there any research to support it?

“Most patients who take the pill will not experience any adverse reactions with their eczema,” said Dr. Chiesa Fuxench. 

Based on current research, Dr. Chiesa Fuxench pointed out that it’s unclear if people who take oral contraceptives may be at higher risk of developing AD. In a study of females in the U.K., researchers observed a potentially higher risk for AD among current oral contraceptive users compared to non-users.² However, Dr. Chiesa Fuxench pointed out that this study had limitations. There may have been the possibility of recall bias — when an inaccurate or incomplete recollection of events with study participants occurs. There was also the potential for misclassification of eczema diagnoses as the study was based solely on patient reports, which a physician did not confirm. Plus, some of the oral contraceptives included in this study contained higher doses of estrogen, which is not used as frequently in newer contraceptive options. Overall, Dr. Chiesa Fuxench emphasized newer research is needed with more diversity and detailed parameters to fully assess if there’s a risk for those with AD. 

Another study examined the risk of children developing AD if their mother took oral contraceptives before or after pregnancy. The study concluded that they did not find an increased risk of developing AD among children.³ 

In light of these studies, Dr. Chiesa Fuxench said, “I recommend that when starting any new medication, patients with atopic dermatitis should monitor the signs and symptoms closely. If it appears their eczema may be worsening, they’ll need to seek an evaluation with their dermatologist or physician as soon as possible.”

How can non-hormonal birth control methods like condoms or spermicides affect eczema? 

“One of the most important things to think about when using condoms is that these may cause problems for patients with sensitive skin, particularly those who have an allergy to rubber containing products or latex,” said Dr. Chiesa Fuxench. “Condoms made of polyurethane or nonlatex condoms may be an alternative in such cases.”⁴

As for spermicides, Dr. Chiesa Fuxench explained that they are overall safe for use by patients with AD. However, she suggested that people with AD read the packaging on spermicide carefully. Some patients may have a known contact allergen to some of the ingredients in spermicide. If you’re not sure or don’t know if you have an allergen, she recommended that you first do a spot test on another area of your body that can be more easily monitored (e.g., inner forearm) and assess if you develop an irritation.

Do you recommend that your patients talk to an obstetrician gynecologist (OB/GYN) about their birth control and eczema concerns?

“Absolutely,” Dr. Chiesa Fuxench confirmed. “I encourage my patients to seek counseling regarding birth control options with their OB/GYN.” OB/GYNs are experts in their field and can provide comprehensive advice on the current birth control options available. They can also help guide you to a birth control method that is best for your individual needs. They will consider your medical history and other risk factors, including any medications you are taking for AD. 

For example, if you take JAK inhibitors for AD treatment, it’s a good idea to let your OB/GYN know about that before starting a new birth control method. “JAK inhibitors have been associated with an increased risk for blood clots, and oral contraceptives have also been associated with an increased risk for blood clots,” said Dr. Chiesa Fuxench. She lets her eczema patients know about this potential for added risk when these medications are both taken at the same time. However, she stressed that this does not mean patients cannot take them together. But it is a worthwhile discussion to have with your OB/GYN so they are aware and to see if there are other birth control methods available.

Do any eczema treatments impact the effectiveness of birth control?

“Commonly used topical and systemic treatments for eczema are not thought to affect the effectiveness of birth control options and are an overall safe and reliable option for sexually-active patients seeking to prevent pregnancies,” Dr. Chiesa Fuxench said. “I recommend that patients discuss these options further with their OB/GYN.”

Is there a preferred birth control for people with eczema?

“In my opinion,” said Dr. Chiesa Fuxench, “the preferred method is the one that patients are most comfortable with and offers them a safe, reliable and affordable method for preventing pregnancies.”

Final takeaway 

It is important for sexually-active people with eczema who want to limit their chances of pregnancy to have frank discussions with their physicians — specifically their OB/GYN or primary care provider. These providers can help people with eczema consider their options based on their entire medical history and any other risk factors.

References:

1. Weare-Regales N, Chiarella SE, Cardet JC, Prakash YS, Lockey RF. Hormonal Effects on Asthma, Rhinitis, and Eczema. J Allergy Clin Immunol Pract. 2022;10(8):2066-2073. doi:10.1016/j.jaip.2022.04.002

2. Vessey MP, Painter R, Powell J. Skin disorders in relation to oral contraception and other factors, including age, social class, smoking and body mass index. Findings in a large cohort study. British Journal of Dermatology. 2000; 143 (4): 815–820. https://doi.org/10.1046/j.1365-2133.2000.03782.x

3. Bai XF, Wu ZX, Zhao CH, et al. Maternal oral contraceptive pill use and the risk of atopic diseases in the offspring: A systematic review and meta-analysis. Medicine (Baltimore). 2020;99(16):e19607. doi:10.1097/MD.0000000000019607 

4. Gallo MF, Grimes DA, Schulz KF. Nonlatex vs. latex male condoms for contraception: a systematic review of randomized controlled trials. Contraception. 2003;68(5):319-326. doi:10.1016/j.contraception.2003.08.015