Management of Localized Itching at Nexplanon Implant Site After One Year
For localized itching at the Nexplanon site after one year of use, start with symptomatic treatment using oral antihistamines and cold compresses; if symptoms persist despite conservative management or worsen, removal is indicated as this likely represents a delayed-type hypersensitivity reaction to the implant components.
Initial Assessment and Differential Diagnosis
The timing of symptom onset—over a year after insertion—is consistent with delayed-type hypersensitivity reactions, which can develop at any time during implant use 1. While extremely rare, allergic reactions to Nexplanon components (including barium sulfate or the ethylene vinyl acetate copolymer) have been documented 2, 3.
Key diagnostic considerations:
- Rule out infection first: Examine for signs of erythema, warmth, purulence, or systemic symptoms that would indicate implant site infection rather than hypersensitivity 1
- Assess for local hypersensitivity: Look specifically for localized dermatitis, eczema, or urticaria confined to the implant site 1
- Exclude trauma or mechanical irritation: Verify the implant hasn't migrated or become encapsulated in a way that causes mechanical irritation 4, 5
Conservative Management Approach
If examination reveals only localized itching without signs of infection or severe reaction:
- Oral antihistamines are the first-line symptomatic treatment for localized itching and can be continued for several days 1
- Cold compresses applied to the site may reduce local discomfort and itching 1
- Avoid topical corticosteroids initially unless there is visible dermatitis, as the evidence for their efficacy in implant-related reactions is limited 1
Indications for Removal
Removal should be performed if:
- Symptoms persist beyond 7-10 days despite conservative management with antihistamines 2, 3
- Symptoms progressively worsen or spread beyond the immediate implant site 1
- Signs of infection develop (warmth, erythema, purulence) requiring broad-spectrum antibiotics and surgical drainage 1
- The patient develops systemic symptoms suggesting widespread hypersensitivity 1
The evidence strongly supports that removal is curative for hypersensitivity reactions: In documented cases of delayed-type hypersensitivity to Nexplanon, symptoms resolved completely within 72 hours of implant removal 2, 3.
Important Clinical Considerations
- Contraceptive efficacy is NOT compromised by localized itching—this is purely a local tissue reaction and does not affect the implant's function 6
- Backup contraception is needed immediately if removal is performed, as fertility returns rapidly after explantation 7
- Alternative contraceptive counseling should be provided before removal, considering non-hormonal IUDs or other methods if hormonal implants are not tolerated 6
- The implant remains effective through year 3 and potentially into year 4, so if symptoms resolve with conservative management, continuation is reasonable from an efficacy standpoint 6
Common Pitfalls to Avoid
- Do not prescribe antibiotics empirically for localized itching without clear signs of infection—the reaction is immunologic, not infectious 1
- Do not delay removal if conservative measures fail after 7-10 days, as prolonged hypersensitivity reactions can worsen and affect quality of life 2, 3
- Do not confuse irregular bleeding (common with Nexplanon) with a local site reaction—these are separate issues 6