Jul 25, 2019
Combined oral contraceptives (COCs) have
many uses in dermatology, but dermatologists often underutilize
COCs and don’t feel comfortable prescribing them. In this special
resident takeover of the podcast, three dermatology residents — Dr.
Daniel Mazori, Dr. Elisabeth Tracey, and Dr. Julie Croley — review
the basics of prescribing COCs for dermatologic conditions.
Beginning at 8:36, they discuss assessment of patient eligibility
and selection of COCs, proper use of COCs, and management of risks
and side effects.
We also bring you the latest in dermatology news and
Fetal exposure to isotretinoin continues
Although pregnancy-related adverse events have decreased,
pregnancies, abortions, and fetal defects associated with
isotretinoin exposure continue to be a problem.
shares contact dermatitis trends
Katta talks about what's happening in contact dermatitis,
including an uptick in allergic reactions to essential oils
contained in “all natural” products.
Things you will learn in this episode:
- Acne is the main indication for COCs in dermatology, but other
off-label uses include hidradenitis suppurativa, hirsutism, female
pattern hair loss, and autoimmune progesterone dermatitis.
- When prescribing COCs, it is important to consider absolute and
relative contraindications such as cardiovascular disease,
postpartum status, women 35 years and older and smoking more than
15 cigarettes per day, migraine with aura, and history of diabetes
for more than 20 years, plus others.
- Rule out pregnancy prior to starting COCs via a urine or serum
pregnancy test. Dr. Croley points out, “A pelvic exam is not
required to start combined oral contraceptives, as is sometimes
thought by providers.”
- Monophasic formulations are considered first-line therapy.
- For patients who are concerned about symptoms associated with a
hormone-free interval during treatment, choose a COC that does not
include placebo pills, or encourage the patient to skip the placebo
pills altogether and start the next pack earlier.
- Estrogen-related side effects are a consideration when
prescribing COCs. “In general, the lowest possible dose of estrogen
that is effective and tolerable should be prescribed,” Dr. Libby
- Combined oral contraceptives can be started on any day of the
patient’s menstrual cycle, but patients should be counseled to use
backup contraception for 7 days if the COC is started more than 5
days after the first day of their most recent period.
- At least 3 months of therapy can be expected to evaluate the
effectiveness of COCs for acne, potentially up to 6 months.
- Breakthrough bleeding is the most common side effect of COCs
and can be minimized by taking the COC at about the same time every
day and avoiding missed pills. If breakthrough bleeding persists
after 3 cycles, consider increasing the estrogen dose or referring
the patient to an obstetrician/gynecologist.
- Discuss the risk of venous thromboembolism with patients using
Hosts: Elizabeth Mechcatie, Terry Rudd
Guests: Daniel R. Mazori, MD (State University of New York
Downstate Medical Center, Brooklyn); Elisabeth "Libby" Tracey, MD
(Cleveland Clinic Foundation, Ohio); Julie Ann Amthor Croley, MD
(The University of Texas Medical Branch at Galveston).
Show notes by Alicia Sonners, Melissa Sears, and Elizabeth
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