Pustular Acne Eruption After Nexplanon Fracture in an Active-Duty Service Member

Abstract

Introduction: Long-acting reversible contraceptives (LARCs) like Nexplanon are increasingly popular among active-duty service women for their convenience and benefits to women’s health and military readiness. While generally safe and effective, rare instances of Nexplanon fractures were asymptomatic and discovered during removal, with only two cases linking abnormal uterine bleeding to the broken device. In this unique case, a patient experienced a traumatic Nexplanon fracture during combat training leading to onset of pustular acne within 24 hours.

Case: A 21-year-old nulliparous active-duty service member presented to the ED with sudden onset of pustular acne on her face following Nexplanon fracture during combat training. Physical exam was significant for an extensive amount of pustular acne from her mental to infraorbital region. Palpation was significant for a midline defect in the Nexplanon, that was confirmed during removal by an OBGYN.

Discussion: Many synthetic progestins (P4), including etonogestrel found in the Nexplanon, are derived from 19-nortestosterone, and the association between synthetic P4 and acne is well-established. P4-only contraceptives having a stronger association with acne than contraceptives containing both estrogens and P4. Yet, the presence of a dose-dependent response between synthetic P4 and acne vulgaris remains inconclusive. The rapid onset of pustular acne in this patient suggests a potential dose-dependent reaction, especially since device breaks can lead to a slight increase in etonogestrel levels.