Treating Steroid Acne

Usually, acne is an inflammation of the oil glands in your skin and hair roots. The technical name is acne vulgaris, but it’s often just called pimples, spots, or zits. A bacterium (Propionibacterium acnes) combined with other factors causes inflammation of the oil glands.

Steroid acne has almost the same symptoms as typical acne. But with steroid acne, systemic steroid use is what makes the oil (sebaceous) glands susceptible to inflammation and infection. The steroids may be prescription medications, such as prednisone, or body-building formulations.

Another form of acne, known as malassezia folliculitis or fungal acne, is caused by a yeast infection of the hair follicles. Like acne vulgaris, it can occur naturally or as the result of oral or injected steroid use.

Both ordinary and steroid acne most often occur in adolescence, but can happen at any time of life.

Steroid acne is different from steroid rosacea, which results from long-term use of topical corticosteroids.

What are the symptoms?

Steroid acne most often shows up on your chest. Fortunately, there are several effective ways to eliminate chest acne.

It can also show up on the face, neck, back, and arms.

Symptoms can include:

• open and closed blackheads and whiteheads (comedones)
• small red bumps (papules)
• white or yellow spots (pustules)
• large, painful red lumps (nodules)
• cyst- like swellings (pseudocysts)

You may also have secondary effects from picking or scratching the acne. These can include:

• red marks from recently healed spots
• dark marks from old spots
• scars

If the steroid acne is of the acne vulgaris type, the spots may be more uniform than with ordinary, non-steroid acne.

If the steroid acne is of the fungal type (malassezia folliculitis), most of the acne spots will be the same size. Comedones (whiteheads and blackheads) are not usually present.

Common causes

Steroid acne is caused by the use of systemic (oral, injected, or inhaled) steroid drugs.

Anabolic steroids used in bodybuilding

Steroid acne appears in about 50 percent of people who use anabolic steroids in large doses for bodybuilding. The formulation known as sustanon (sometimes called “Sus” and “Deca”) is a common cause of steroid acne in bodybuilders.

High-dose testosterone may also contribute to acne outbreaks.

Prescription corticosteroids, such as prednisone

The increasing use of corticosteroids after organ transplant surgery and in chemotherapy has made steroid acne more common.

The steroid acne usually shows up after several weeks of treatment with prescribed steroids. It’s more likely in people under age 30. It’s also more common in those with lighter skin.

The severity depends on the size of the steroid dose, the length of treatment, and your susceptibility to acne.

Although steroid acne usually appears on the chest, use of a mask in inhalation therapy for corticosteroids may make it more likely to show up on your face.

How it happens

It’s not known exactly how the steroids increase your likelihood of developing acne. Several studies suggest that steroids may contribute to your body’s production of immune system receptors known as TLR2. Together with the presence of the bacteria Propionibacterium acnes, the TLR2 receptors may play a role in bringing on an acne outbreak.

Treatment options

The treatment for steroid acne, like that for ordinary acne (acne vulgaris), involves the use of various topical skin preparations and oral antibiotics.

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

Oral antibiotics

Oral antibiotics of the tetracycline group are prescribed for severe and some moderate cases of steroid acne, and for any case showing scarring. These include doxycycline, minocycline, and tetracycline.

These antibiotics kill the bacteria that aggravate acne and may also have some anti-inflammatory properties. Alternative antibiotics are prescribed for children under 8 years old.

It can take four to eight weeks of regular antibiotic use before you see the effects of skin clearing. The full response can take three to six months.

People of color are more susceptible to scarring from acne outbreaks and may be advised to take oral antibiotics, even for a mild case.

Because of the increased risk of antibiotic resistance and slow onset of action, specialists now discourage the use of topical antibiotics for acne.

Benzoyl peroxide

Benzoyl peroxide is a very effective antiseptic that helps to kill the acne bacteria and reduce inflammation. It’s recommended for use together with oral antibiotics, and also in mild cases that don’t require antibiotics.

Benzoyl peroxide is available in many over-the-counter acne treatments. It’s sometimes combined with salicylic acid.

When using any topical preparation on your face, it’s important to apply it to your whole face, and not just to the spots you see. This is because acne develops from microscopically small sites on your face that you can’t see.

Don’t scrub your face aggressively when cleaning or applying medication, as this can actually aggravate an acne outbreak.

Mild cases

For a mild case, your doctor may try to avoid use of oral antibiotics, and instead prescribe a type of skin preparation known as a topical retinoid. These include:

• tretinoin (Retin-A, Atralin, Avita)
• adalpene (Differin)
• tazarotene (Tazorac, Avage)

Topical retinoids are creams, lotions, and gels derived from vitamin A.

They work by helping production of healthy skin cells and reducing inflammation. They shouldn’t be used during pregnancy or breastfeeding.

Prevention tips

Steroid acne, by definition, is caused by the use of steroids. Stopping or reducing the steroid use will help to eliminate the acne.

But this isn’t always possible. If the steroids have been prescribed to prevent other serious consequences, such as rejection of a transplanted organ, there is no option to stop taking them. You’ll most likely have to be treated for the acne.

Oily foods, some dairy products, and especially sugar may contribute to acne outbreaks. You may want to try an anti-acne diet. Cosmetics containing lanolin, petrolatum, vegetable oils, butyl stearate, lauryl alcohol, and oleic acid may also contribute to acne.

While some foods and cosmetics may contribute to acne outbreaks, eliminating them won’t necessarily make your acne go away.

The takeaway

Steroid acne is a common side effect of prescription corticosteroids, such as prednisone, as well as use of anabolic steroids in bodybuilding.

Where possible, discontinuation of the steroid may clear up the outbreak. Otherwise, treatment with topical preparations, oral antibiotics, or antifungals should be effective.

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