Back acne can be a side effect of using certain types of steroids. This skin condition is directly linked to their use. Unlike common acne, steroid-induced acne is a specific reaction to steroid exposure, frequently appearing on the back.
Different Types of Steroids
In the context of muscle building or performance enhancement, “steroids” typically refers to anabolic-androgenic steroids (AAS). These are synthetic derivatives of testosterone, the male hormone. AAS can lead to acne, particularly on the chest, back, shoulders, and face, and it often appears more uniform than other acne types.
Another type, corticosteroids, are prescription medications used to treat various inflammatory conditions, autoimmune disorders, and to prevent organ transplant rejection. Steroid acne from corticosteroids appears after several weeks of treatment and is more common in individuals under 30 or those with lighter skin tones. The severity of corticosteroid-induced acne depends on the dosage, duration of treatment, and individual susceptibility.
How Steroids Influence Acne Development
Steroids contribute to acne development primarily by impacting hormone levels and increasing sebum production. Anabolic steroids elevate testosterone and other androgen levels, which stimulates the skin’s oil glands to produce more sebum. This excess oil can clog pores, creating an environment where acne-causing bacteria, such as Cutibacterium acnes, can thrive and lead to inflammation.
Beyond increased oil production, anabolic steroids can also affect skin cell turnover, making skin cells grow faster, which further contributes to clogged pores. The location of steroid acne, on the back, shoulders, and chest, corresponds to areas with a higher concentration of sebaceous glands.
Addressing Steroid-Related Back Acne
Managing steroid-related back acne involves a multi-faceted approach, with the most effective strategy being the discontinuation of the steroid, if medically appropriate. Once steroid use stops, the acne improves gradually as hormone levels normalize. However, for individuals who cannot discontinue their steroid medication due to underlying medical conditions, other treatments can help manage the breakouts.
General skincare practices play a supportive role in managing this type of acne. Using non-comedogenic products and avoiding harsh scrubbing or picking at lesions can help prevent further irritation and potential scarring. Over-the-counter treatments like benzoyl peroxide can help kill acne bacteria and reduce inflammation. Topical retinoids, such as tretinoin, adapalene, and tazarotene, promote cell turnover and prevent clogged hair follicles.
For more severe or persistent cases, professional medical consultation is advisable. A dermatologist can assess the specific type of steroid acne, which may include acne vulgaris or Malassezia folliculitis (a fungal form of acne), and recommend targeted treatments. Oral antibiotics, particularly from the tetracycline group like doxycycline or minocycline, may be prescribed for moderate to severe cases to reduce bacteria and inflammation. If the acne is identified as Malassezia folliculitis, antifungal medications, either topical or oral, would be the appropriate treatment. In very severe instances, oral isotretinoin may be considered, as it is effective for both types of steroid acne.