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Took Contraceptive pill after unprotected sex. Rashes appeared on forehead, chest and neck. Hives?

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Practicing since : 2006
Answered : 2015 Questions
had to take emergency contraception (morning after pill) 4 days ago because the condom my boyfriend and I were using broke. Ever since then, for the past 3 days, I am breaking out in a rash on my forehead, chest, neck around the same time everyday.

The rash feels hot, is on my forehead and chest and burns a little bit. My forehead also feels tight when this is happening. It stays around for a half hour and then disappears. Any idea what this could be? Could it be my hormones out of whack from the pill? The rash extends down my forehead, in between the bridge of my nose and then is on my chest and up the sides of my neck.

I have attached some pictures to this question. Could this be hives??? I am so upset about this- please help! Are my hormones trying to get back into balance?

I have a history of allergies and dermographism.

Posted Sun, 3 Mar 2013 in Skin Rash
Answered by Dr. Kalpana Pathak 45 minutes later
Thanks for writing to us.
Contraceptive pills are known to cause urticarial reactions and can also precipitate or exacerbate the same in patients with known urticaria.
I have seen the uploaded image and it looks like an urticarial rash only.
To treat the same,
Take oral antiallergic like cetirizine or loratidine two times in a day
Apply calamine lotion or calamine lotion with menthol to soothe the rashes.

If in case above two does not help, then a short course of oral steroid might be required. Usually prednisolone is given in tapering doses. But as it is a prescription drug, doctor's consultation is mandatory.

Urticarial rash become an emergency if associated with difficulty in swallowing or respiratory distress. As fortunately, you are not having these associated symptoms taking oral anti allergics alone should suffice.

Hope that answers your query. Should there be any doubt, feel free to write back.
Wish you a speedy recovery.
Above answer was peer-reviewed by
Follow-up: Took Contraceptive pill after unprotected sex. Rashes appeared on forehead, chest and neck. Hives? 16 minutes later
Thank you Dr. Pathak for your speedy response.

Why does oral conception cause urticaria? Or does it look like flushing?

It's quite scary when it occurs. It has already been a few days since I took the pill, are my hormones trying to get back to normal?

Answered by Dr. Kalpana Pathak 9 hours later
Thanks for writing back.
Drugs can induce urticaria by allergic reaction.
Urticarial rashes too can manifest as itchy burning rashes with feeling of tightness over skin and can resolve spontaneously.
Flushing too at times has similar features and can be associated with urticaria as a part of allergic reaction to drug.
So in simpler words, the rash that you are having is just because of allergic reaction to the pill that you took.
Morning after pills are basically progesterone pills that prevent release of egg from ovary and may also irritate the uterus lining to prevent fertilised egg from getting implanted. The effect of morning after pill may persist for upto 10 days.

Right now, I would advise you to start with antiallergic pill cetirizine, loratidine or Benadryl and apply calamine lotion too soothe area. Continue with the treatment and let me know in a day or two, if you are responding well.
Do not hesitate to write back, if any doubt exists.
Take care.
Above answer was peer-reviewed by
Follow-up: Took Contraceptive pill after unprotected sex. Rashes appeared on forehead, chest and neck. Hives? 8 hours later
Dear Dr. Pathak,

Thank you for writing back. I forgot to add that I was taking antibiotics for a sinus infection at the same time I took the emergency contraception. The rash also occurs about an hour after consuming caffeine and stays around for about a 1/2 hour. I then take some zyrtec and it clears up. Do you think the antibiotics and caffeine play a role?

If this was an allergic reaction, wouldn't it go away after I took the pill? Why do the affects persist so long?

Thanks again, XXXXXXX
Answered by Dr. Kalpana Pathak 5 hours later
Any drug can induce an allergic reaction and can manifest as urticarial drug rash with or without flushing. So basically hormonal pills and antibiotics both can be the culprit. But if you have taken the same antibiotic previously also many a times without any problem, chances are less that it could cause an allergic reaction. The same applies to hormonal pill also.

Caffeine is known to induce flushing but the point is do you have history of flushing previously too with intake of tea coffee or caffeinated drinks. If this is a phenomenon of recent occurrence, chances are more of it being due to allergic reaction. However avoid taking caffeine for few days.

Allergic reactions develop in our body when the body's immune system overreacts to a substance that is normally harmless. The immune system mistakenly identifies the medicine or drug taken as harmful substance. When the immune system starts to fight off by releasing histamine, allergy symptoms, which may include urticarial rash or facial flushing develop. This process may go on for few days even when drug intake has been withheld.
Lastly Zyrtec or cetirizine is an antihistaminic, its use and relief in your symptom is self explanatory that the rash you are having is allergic in nature.

So the whole point of discussion is take antihistaminics cetirizine or loratidine or Benadryl twice in a day irrespective of occurrence of rash for few days and apply calamine to soothe the area.

Hope that clears all your doubts.

Above answer was peer-reviewed by
Follow-up: Took Contraceptive pill after unprotected sex. Rashes appeared on forehead, chest and neck. Hives? 3 days later
Dr. Pathak,

Thank you for your response. The rash occurs on chest, neck and forehead in between eyebrows about two hours after drinking caffeine. It will also occur after being in hot sun or a hot shower. It goes away after about a half hour.. This is urticaria? I flush easy with alcohol and exercise.

I didnt drink caffeine the other day and I didn't get the rash. It's not something else? It flares up in between my eyebrows but is gone in half hour.

Answered by Dr. Kalpana Pathak 18 hours later
You seem to be getting confused and in the process have confused me too!
Flushing is basically increased vascular response over face, chest etc.
Now in your case, you have to be specifically clear whether you had earlier history of such redness over your face and chest on exposure to sun, hot spicy food, caffeine and alcohol or not. From what I gather from your response is that you had previous history of flushing irrespective of intake of hormonal pills and antibiotics and also that you have history of urticaria and dermographism.
Why did you feel at first place that these rashes were drug induced?

As I have already mentioned medicines too can cause urticarial reactions in form of flushing and hives

In your first query, you had mentioned that you developed this reaction after taking the pills without mentioning any previous history of flushing. So obviously one would think of allergic reaction with drugs.

But now as you say that you did not take any caffeinated drink and there is no rash, so I would like to conclude that medicines might not have been the reason for flushing over face at all

To treat the redness over your face,
Firstly avoid causative factors
Apply a sunscreen
If rash develops do cold water or ice compresses
Apply calamine to soothe area
If still not much response take tab cetirizine.

Above answer was peer-reviewed by
Follow-up: Took Contraceptive pill after unprotected sex. Rashes appeared on forehead, chest and neck. Hives? 46 minutes later
Dr. Pathak,

I am so sorry for the confusion.. I do not flush with spicy foods but sometimes get a little pink in the sun like anybody does. My mom is like that too. I do not really have a history of flushing, sometimes will develop blotches on chest and neck and cheeks get a little red when I drink alcohol. But again, many others do too and I feel that is normal.

Sometimes when I am I hot sun, I will get that forehead rash and it has occurred after drinking caffeine before but only on my chest. I did not put and 2 together when it recently happened because it has been so long... That is why I thought it was drug induced.

I am going to steer clear of caffeine, but am just wondering why it causes blotchy urticaria a couple hours after consuming it? I have a history of dermographism, allergies and anxiety.

Again, I'm so sorry for the confusion, you have been a big help!
Answered by Dr. Kalpana Pathak 17 hours later
It's true that many people get flushed when exposed to sun, alcohol and caffeine. It is not a big thing to worry about unless its bothering you. Flushing is just a body's response to certain stimuli that leads to increased blood flow or vascular response.
Many people get flushed with alcohol because they lack a liver enzyme to metabolise liver properly and hence concentration of acetaldehyde which is a byproduct of alcohol metabolism increases leading to flushing
Histamine is also known to induce flushing. People who tend to get urticaria have high levels of histamine release. Drug allergies also lead to flushing by histamine release
Caffeine too can increase flushing by causing blood vessels to dilate. Sometimes it is the hot temperature of the beverage that causes flushing. In your case you will have to see whether you get flushing with hot or cold caffeinated drink.

Certain foods like sea foods, preservatives like MSG, aspartame, very sugary foods, hot spicy foods like chillies, peppers etc and emotions like anger or anxiety may induce flushing too.

But all the above mentioned causes lead to physiological flushing and the treatment is to avoid causative agent, do cold compresses, apply calamine lotion to counter burning and take cetirizine if the need be.

One should worry if flushing is persistent and is associated with symptoms of respiratory distress, abdominal pain and diarrhoea as in such cases proper work up needs to be done.

I would advise you not to worry too much and avoid the precipitating factors as much as possible.

If there is any other query, do not hesitate in writing back.

Above answer was peer-reviewed by
Follow-up: Took Contraceptive pill after unprotected sex. Rashes appeared on forehead, chest and neck. Hives? 11 hours later
Dr. Patnak,

Thank you very much. I uploaded a new photo of my chest rash that I get when I consume caffeine, alcohol, etc. I have been told that it's a form of cholergenic urticaria. Does that sound about right?

I did not have any coffee today and didnt get the rash--I had tea (caffeine) and didnt get the rash either. So it isnt the heat. I did have decaf coffee yesterday and I did get the rash. I wonder if it could be an allergy to coffee? Oh well, I guess it's not really worth it to worry about it. It goes away really fast, i just worry that it could be something serious.
Okay, I did not have any caffeine... I have correlated the rash with stress... When I am nervous it happens. I get very blotchy on my chest and then my forehead and cheeks get a little blotchy. When I calm down and am not stressed about it, it subsides. Is this s form of hives? I notice that if I a, thinking or worrying about it, it gets worse.

What can I do??
Thank you, XXXXXXX
Answered by Dr. Kalpana Pathak 10 hours later
Though you might be having history of urticaria and dermatographism, the redness that you experience with stress, anxiety, alcohol or caffeine is flushing.

In cholinergic urticaria one usually gets small itchy red bumps over a red base and the images that you have attached are nothing close to it. One gets cholinergic urticaria on getting exposed to sun, hot spicy food, exercise etc

Unfortunately to relieve or prevent flushing, one has to keep away from exacerbating factors. There is no medicine to prevent physiological flushing as it is your body's response to particular stimulus. In your case I would advise you to avoid stress, alcohol, sun exposure etc.
If flushing develops, do ice compresses, apply calamine lotion.
Hope that answers all your queries.

Ps should there be no more queries we may close the discussion.
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