Steroid acne – caused by corticosteroids

by Abbas Jahangir · July 6, 2024

Steroid acne is an acne-like skin condition that occurs as a side effect of the use of corticosteroids or anabolic steroids.

Corticosteroids are a group of medications that are used to treat severe inflammatory diseases, autoimmune diseases, severe allergic reactions, and are also used in transplant patients. However, their use leads to many side effects, including acne.

Steroid acne occurs more often in people under the age of 30. Severity depends on the dose of the medication, duration of treatment and individual sensitivity.

It usually goes away after the corticosteroid is stopped, but topical treatment can help in the meantime.

What are the causes of steroid acne?

Steroid acne is caused by the use of systemic (oral, injectable, or inhaled) corticosteroids.

corticosteroids, such as prednisone

Steroid acne usually appears a few weeks after high-dose corticosteroid treatment.

anabolic steroids used in bodybuilding

Steroid acne occurs in many of the people who use anabolic steroids in high doses for bodybuilding.

How do corticosteroids cause acne?

The mechanisms by which corticosteroids lead to the development of acne are not fully understood. However, it is believed that corticosteroids can increase the production of sebum, which can lead to clogged pores and the development of acne. Corticosteroids can also affect the rate at which skin cells are shed, leading to a buildup of dead skin cells. They can mix with sebum and clog pores.

Anabolic steroids can cause a hormonal imbalance to trigger acne. It is similar to acne during puberty.

What are the symptoms of steroid acne?

Steroid acne most often appears on the face, chest, and back. The rash usually appears as small red bumps (papules) or pustules (pus-filled pimples) on the skin. In some cases, steroid acne can also manifest as comedones (open and closed).

The rash may be itchy or painful, and patients may experience swelling and tenderness in the affected area.

Types of steroid acne

Two forms are distinguished:

acne vulgaris ( a cne vulgaris)

In steroid acne of the acne vulgaris type, the spots may be more uniform than in regular non-steroidal acne.

malassezia folliculitis

Malassezia folliculitis or fungal acne presents with itchy papules and pustules on the chest and back. It is caused by an overgrowth of a yeast called Malassezia in and around the hair follicles.

In the fungal type of acne, most spots are the same size. Comedones (whiteheads and blackheads) are usually not visible.

How is the diagnosis made?

Diagnosing steroid acne involves a careful examination of the patient’s medical history and a physical examination of the skin. A key point for diagnosis is the establishment of a relationship between the use of corticosteroids and the appearance of acne symptoms.

What is the treatment?

Steroid acne is caused by the use of corticosteroids. Stopping or reducing the dose of the steroid will help the acne go away.

Stopping takes place only after consultation with a doctor, and the dose is gradually reduced. This can take weeks or even months.

However, it is not always possible to stop corticosteroid therapy. In these cases, the acne will be treated.

A variety of topical skin and oral antibiotics are used to treat steroid acne, like acne vulgaris.

antibiotic therapy

Oral antibiotics from the tetracycline group (doxycycline, tetracycline) are prescribed for severe and some moderate cases of steroid acne. These antibiotics kill the bacteria that make acne worse.

topical retinoid – isotretinoin

Retinoids are derivatives of vitamin A that are available as lotions, gels, and creams. They are the mainstay of acne care. However, it may take 3 months of regular use before effects are seen. Women who are pregnant or breastfeeding should not use retinoids.

benzoyl peroxide

Benzoyl peroxide is a very effective antiseptic that helps kill bacteria and reduce inflammation. It is recommended to be used together with oral antibiotics, as well as in mild cases that do not require antibiotics. When using any topical product on your face, it’s important to apply it to your entire face, not just the spots you see.

Do not scrub your face aggressively when cleansing or applying medication, as this can make acne worse.

salicylic acid – also helps treat acne by exfoliating the skin
phototherapy – improves the effect of drug treatment.

Steroid-induced fungal acne (malassezia folliculitis) is treated with topical antifungal agents (eg, ketoconazole) or with an oral antifungal agent, such as itraconazole.

Skin care is important in treating acne. For example, it is recommended: