Steroid acne is a medical condition that people who have begun a course of steroidal treatment may encounter.
High amounts of circulating corticosteroids in the body are thought to be the source of this side effect resulting from steroids.
The reason that sets this type of acne apart from others is that this acne does not occur naturally and is instead induced because of steroids.
Adults or teenagers who have been on steroidal treatment for a few weeks are most commonly affected by these types of acne.
Although it may occur on the arms, back, neck, and face, steroid acne mainly affects the chest. Steroids could exacerbate acne if you already tend to have acne problems.
In contrast to regular acne, which varies in color, size, and intensity, steroid acne pimples and lesions usually have a uniform appearance.
Let’s look at everything else you need to know about steroids and acne.
What Is Steroid Acne?
Although it appears to be regular acne, steroid acne is a disorder of the skin brought on by excessive amounts of corticosteroids in the blood.
This might indicate the presence of an underlying cause, which could be
- Systemic steroid therapy
- Cushing’s illness
- The application of steroidal skin creams
- Anabolic steroid usage
The cause may determine the different treatment options. Acne caused by inhaled, oral, or topical corticosteroids is known[1] as steroid acne. The steroid acne’s pathophysiology is not entirely known.
Papulopustular and papules in steroid acne could be linked to the production of infundibular hyperkeratosis, resulting in follicular rupture and microcomedo formation.
The keratinocytes’ toll-like receptor 2 in humans could be enhanced by glucocorticoids, which are activated further by Cutibacterium acnes (also known as Propionibacterium acnes) and different other proinflammatory cytokines.
This bolsters the idea that the presence of corticosteroids may likely aggravate[2] acne that is already there and may also cause an acneiform eruption of the acne on its own.
The emergence of follicular pustules and papules in susceptible people could happen suddenly 3 to 4 weeks after starting the medicine.
In contrast to acne vulgaris, steroid acne lesions will have a symmetrical distribution and uniform size.
After using systemic steroids, the back and chest are the most preferred areas for acne to be formed.
Usually, steroid acne can clear up when the offending medication is stopped without leaving behind scars.
On the other hand, you need to be wary of other anabolic steroid side effects, which may be irreversible.
What Are The Types Of Steroid Acne?
Malassezia folliculitis and Acne vulgaris, sometimes also known as normal acne, are the two types of steroid acne:
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Acne Vulgaris
A chronic condition known as acne vulgaris develops in the follicles of the pilosebaceous.
The four interconnected mechanisms responsible for acne vulgaris are:
Inflammation, Follicular colonization by the Cutibacterium acnes, Aberrant follicular shedding of epithelium, and Sebum overproduction.
Lesions from acne may[3] commonly appear on the face, chest, or upper back.
The lesions could be one of the following:
- Inflammatory Papules
- Open comedones (i.e., blackheads or melanin deposition, oxidation of lipids, and the keratin-induced distension of your hair follicle resulting in the opening of the follicle).
- Noninflammatory closed comedones (i.e., whiteheads or papules formed by keratin and serum buildup within the hair follicle).
Follicle rupture could cause an inflammatory response that leads to inflammatory lesions.
Acne severity may be divided into three categories ranging from mild, moderate to severe depending on the type and size of lesions.
However, there isn’t a scale yet that is acknowledged throughout the world for grading acne.
The differential diagnosis of acne has to take several skin disorders into account.
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Malassezia Folliculitis
Hair follicles are often impacted by the relatively more common skin infection known as Malassezia folliculitis.
Monomorphic perifollicular itching and skin lesions without comedones are usually the symptoms of this disorder.
Although it may differ slightly from acne vulgaris and steroid acne, and could[4] also share many similarities, Malassezia folliculitis is treated differently.
The preferred prescribed form of treatment is oral antifungals which may significantly improve the state of the disease.
However, for positive clinical results, the detection of early illness is crucial.
Malassezia folliculitis usually affects[5] the torso, upper arms, and face and manifests itself as monomorphic papulopustular lesions of the skin.
In around 85% of instances, the lesions may be accompanied by itching.
Clinically, it resembles acne vulgaris which leads to its misdiagnosis[6] and often coexists with it. Antifungal drugs significantly improve this disease’s clinical condition.
It’s crucial to conduct regular follow-ups to check on patient adherence and clinical development to therapy.
What kind Of Steroids Causes Acne?
Numerous medications contribute to acne. Two steroid kinds could primarily result in steroid acne. These drugs are administered orally, intravenously, or both.
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Corticosteroids
Mineralocorticoids and glucocorticoids are two types of corticosteroids, which are steroidal hormones generated by the body’s adrenal cortex.
These lipophilic hormones are precursors to cholesterol, with aldosterone and cortisol being the two that are most commonly released by the body.
While corticosteroid hormone is produced in the adrenal cortex, they could,[7] however, be also created in a lab.
The body responds to corticosteroids in several ways, and they are commonly used to treat a wide range of ailments.
They may be utilized for the treatment of various adverse effects of cancer, hormone replacement therapy, and immune system suppression.
Additionally, certain lymphoid leukemias and lymphomas may also be treated with corticosteroids.
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Anabolic Steroids
A synthetic version of the naturally available male hormone testosterone is known as an anabolic steroid.
An androgenic anabolic steroid that promotes male traits is the official term used for this family of medications.
Both females’ and males’ bodies manufacture testosterone, with females doing so in their ovaries and males doing so in their testes.
Winstrol, Equipoise, Durabolin, and Deca-Durabolin are the most commonly abused[8] anabolic steroids.
Anabolic steroids are often referred to by their street names, such as Pumpers, Gym Candy, Arnolds, Juice, Roids, Weight Trainers, and Stackers.
Aggression, strength, and lean body mass are said to rise with the usage of anabolic steroids.
Fitness fanatics, athletes, and bodybuilders are the main users of anabolic steroids.
They often claim that these steroids improve their physical performance and provide them with a competitive edge.
Steroids are also thought in shortening the amount of time required to recuperate between exercises.
This allows the users to train even harder and develop their endurance and strength much more.
Some non-athletes could[9] also use steroids to enhance their endurance, size, and strength, as well as to eliminate excess body fat.
They believe that the use of steroids may enhance their physical appearance.
What Is The Treatment For Steroid-Induced Acne?
Steroid acne treatments function by reducing swelling, curing bacterial infections, and lowering sebum production.
For several weeks, you may need to wash the afflicted area and medicate it twice a day.
Results from the majority of steroid acne medications could take five to ten weeks to appear. Your acne might not even totally clear up for several months or worse, even years.
Depending on the severity and type of your acne along with your age, your doctor will propose a treatment plan.
Combinations of topical treatments and oral medicines are most commonly employed. Due to its possibility of adverse effects, pregnant women’s treatment may be constrained.
Discuss the possible advantages and disadvantages of the medications and therapies that you are considering with your doctor.
Also, until your skin gets better, make sure to schedule follow-up visits with your physician every two to four months.
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Retinoids
For mild steroid acne, medications that contain tretinoin or retinoic acids could[10] be very helpful.
This drug is usually applied in the evening hours, initially 3 times every week, then daily as your skin begins to adjust to it.
These are offered as creams, gels, or lotions. Tazarotene, Adapalene (Differin), and Tretinoin (Retin-A and Avita, among other brands) are among some examples of retinoids.
However, make sure to avoid applying benzoyl peroxide and tretinoin together as it is not recommended by doctors.
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Antibiotics
Antibiotics destroy the skin bacteria and also lessen redness and inflammation.
To lessen the possibility of the steroid acne’s resistance to antibiotics, benzoyl peroxide is also commonly added to antibiotics.
You may[11] use an antibiotic and a retinoid together in the first few months of treatment, applying the antibiotic medication in the morning hours and the retinoid medication in the evening hours.
Examples of antibiotics include clindamycin with benzoyl peroxide and erythromycin with benzoyl peroxide (Duac, Benzaclin, etc).
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Combined Oral Contraceptives
Your doctor might[12] also prescribe you combined oral contraceptives along with other acne medications in the treatment of your steroid acne.
Using this treatment for the first few weeks have shown to be effective at curing steroid acne among several individuals.
Combined oral contraceptives are usually drugs that mix estrogen and progestin. Common examples are Tri-Cyclen, Yaz, and Ortho, to name a few.
Conclusion
An adverse side effect of steroidal use is steroid acne. The symptoms may typically go away if the person quits abusing steroids or using them.
Steroid acne is treatable with the right medication and determination to cure them because once acne appears, the treatment is usually very long to get rid of them.
You should speak with your doctor about available prescription steroid acne medications and different treatments if at-home solutions are not able to relieve your symptoms.
References /Sources
- R M Hurwitz Steroid acne J Am Acad Dermatol. 1989 Dec;21(6):1179-81. doi: 10.1016/s0190-9622(89)70325-x. Available from:https://pubmed.ncbi.nlm.nih.gov/2531172/
- Sarah Purdy Acne BMJ. 2006 Nov 4; 333(7575): 949–953.doi: 10.1136/bmj.38987.606701.80
- Guy F Webster Acne vulgaris BMJ. 2002 Aug 31; 325(7362): 475–479.
- Richard M. Rubenstein and Sarah A. Malerich Malassezia (Pityrosporum) Folliculitis J Clin Aesthet Dermatol. 2014 Mar; 7(3): 37–41.
- Richard M. Rubenstein and Sarah A. Malerich Malassezia (Pityrosporum) Folliculitis J Clin Aesthet Dermatol. 2014 Mar; 7(3): 37–41.
- Vikas Malgotra and Harjap Singh Malassezia (Pityrosporum) Folliculitis Masquerading As Recalcitrant Acne Cureus. 2021 Feb; 13(2): e13534.Published online 2021 Feb 24. doi: 10.7759/cureus.13534
- Sivapriya Ramamoorthy and John A. Cidlowski Corticosteroids-Mechanisms of Action in Health and Disease Rheum Dis Clin North Am. 2016 Feb; 42(1): 15–31.doi: 10.1016/j.rdc.2015.08.002
- Kavitha Ganesan; Sajedur Rahman; Patrick M. Zito. Anabolic Steroids Last Update: July 4, 2022. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482418/
- Fred Hartgens, Harm Kuipers Effects of androgenic-anabolic steroids in athletes Review Sports Med. 2004;34(8):513-54. doi: 10.2165/00007256-200434080-00003. Available from:https://pubmed.ncbi.nlm.nih.gov/15248788/
- Siddharth Mukherjee,Abhijit Date,Vandana Patravale,et al. Retinoids in the treatment of skin aging: an overview of clinical efficacy and safety Clin Interv Aging. 2006 Dec; 1(4): 327–348.Published online 2006 Dec. doi: 10.2147/ciia.2006.1.4.327
- Andrea J. Wolf,George Y. Liu,and David M. Underhill Inflammatory properties of antibiotic-treated bacteria J Leukoc Biol. 2017 Jan; 101(1): 127–134.Published online 2016 Aug 30. doi: 10.1189/jlb.4MR0316-153RR
- Ayodele O Arowojolu,Maria F Gallo, Laureen M Lopez,et al. Combined oral contraceptive pills for treatment of acne Review Cochrane Database Syst Rev. 2012 Jul 11;(7):CD004425. doi: 10.1002/14651858.CD004425.pub6. Available from:https://pubmed.ncbi.nlm.nih.gov/22786490/
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Michael has been in the male wellness industry for 25+ years. Before joining Working For Health as a full-time male wellness journalist, he contributed to multiple online portals in the male wellness field. Before that, he has been an assistant to several sexologists.