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Chronic Urticaria Suspected to be Caused by a 13.5 mg Levonorgestrel Intrauterine Device (Skyla®)

Summary

A woman developed a chronic hive-like rash that lasted for two years after having a hormone-releasing intrauterine device (Skyla®) implanted. Extensive medical testing ruled out common causes like vitamin D deficiency and allergies. When the device was removed, the rash gradually disappeared completely over two years. This case suggests that the progesterone released from the device may have triggered an allergic reaction in this particular patient.

Background

Chronic urticaria (CU) is a hive-like rash lasting over six weeks with various known associations including vitamin D deficiency, thyroid autoantibodies, and H. pylori infection. Progesterone, both endogenous and exogenous, has been documented to trigger CU in some patients. Intrauterine devices containing progesterone have rarely been reported to cause urticarial reactions.

Objective

To present a case of a 38-year-old female with progesterone-induced chronic urticaria suspected to be triggered by implantation of a 13.5 mg levonorgestrel intrauterine device (Skyla®). This is reported as the first case documenting the association between Skyla® and chronic urticaria.

Results

The patient’s chronic urticarial lesions began five months post-IUD implantation in 2014 and continued despite allergen avoidance and vitamin D supplementation. Following removal of the Skyla® device in 2016, the patient experienced gradual improvement with complete resolution of CU symptoms by 2018, supporting the temporal association with the IUD.

Conclusion

This case suggests that the 13.5 mg levonorgestrel IUD (Skyla®) may trigger chronic urticaria through exogenous progesterone sensitivity. Although confirmatory progesterone skin prick testing was not performed, the temporal relationship and resolution of symptoms after device removal support the diagnosis of progesterone-induced urticaria as a rare adverse effect.
  • Published in:Cureus,
  • Study Type:Case Report,
  • Source: PMID: 37609103, DOI: 10.7759/cureus.42287
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