Steroids are compounds that influence various bodily functions, and some types can cause acne as a side effect. This condition, known as steroid acne, develops due to their impact on the skin’s natural processes. This article explores the science behind steroid-induced acne, how to identify it, and strategies for its management.
Steroids and Acne Types
Steroids linked to acne fall into two categories: corticosteroids and anabolic-androgenic steroids (AAS).
Corticosteroids, such as prednisone or hydrocortisone, are prescription medications used to reduce inflammation and suppress the immune system for conditions like asthma, allergies, or autoimmune diseases. They can be administered orally, topically, or via injection.
Anabolic-androgenic steroids are synthetic versions of male hormones like testosterone, misused for muscle building and performance enhancement. Both types can trigger acne, though through different pathways. Corticosteroids are typically encountered through medical prescriptions, while AAS are associated with non-medical use.
Mechanisms of Acne Development
Steroids contribute to acne development through several mechanisms. Anabolic-androgenic steroids significantly increase levels of androgens, male hormones. These elevated androgen levels stimulate the sebaceous glands, leading to an overproduction of sebum, the skin’s oil. Excess sebum creates an environment where Cutibacterium acnes, a common skin bacterium, thrive and contribute to inflammation.
Corticosteroids also influence acne development, though mechanisms are complex. Some theories suggest corticosteroids may increase sebum production and interfere with normal skin cell turnover, leading to clogged pores. They can also alter the skin’s immune response, contributing to inflammation or promoting growth of yeasts, such as Malassezia, which can cause malassezia folliculitis. Changes in hair follicles and keratinization, skin cell maturation, further contribute to pore blockages and lesion formation.
Identifying Steroid-Induced Acne
Steroid-induced acne presents with distinct characteristics differentiating it from common acne. It appears suddenly after starting steroid treatment, within days or weeks. The lesions are uniform in appearance, consisting of small, red papules and pus-filled pustules. Unlike typical acne, blackheads and whiteheads (comedones) are less prominent or absent.
Common locations include the chest, back, and shoulders, also on the face and arms. For instance, inhaled corticosteroids might lead to acne around the nose and mouth. Distribution is symmetrical, and affected skin may appear red and inflamed. The sudden onset and uniform nature of lesions across these body areas indicate steroid-related acne.
Strategies for Management
Managing steroid-induced acne involves a multi-faceted approach, focusing on the steroid medication. Consult a healthcare provider before changing prescribed steroid dosages or discontinuing use. If steroid use cannot be stopped, professionals can help determine the best course to manage acne while treating the underlying condition.
Topical treatments are recommended, including over-the-counter options like benzoyl peroxide, killing acne bacteria and reducing inflammation, and salicylic acid, aiding in skin exfoliation. Prescription topical retinoids, such as tretinoin, adapalene, and tazarotene, promote cell turnover and prevent clogged follicles.
For more severe cases, a doctor might prescribe oral medications like antibiotics (e.g., doxycycline, minocycline) to reduce bacteria and inflammation, or isotretinoin. If the acne is identified as malassezia folliculitis, antifungal treatments like ketoconazole shampoo or oral antifungals may be prescribed. General skincare practices, such as gentle cleansing and using non-comedogenic products, support skin health. Patience is important, as improvement may take time after steroid adjustments.