Dozens of medications can trigger acne or acne-like breakouts, ranging from corticosteroids and hormonal treatments to certain vitamins, seizure medications, and cancer therapies. These drug-induced eruptions look different from typical acne: the bumps tend to be uniform in size, appear suddenly, and often show up in unusual locations like the chest, arms, or upper back rather than just the face.
Understanding which drugs are responsible matters because these breakouts usually respond to standard acne treatments without needing to stop the medication causing them.
How Drug-Induced Acne Differs From Regular Acne
Regular acne produces a mix of different lesion types: blackheads, whiteheads, red bumps, and sometimes deeper cysts, mostly concentrated on the face, chest, and upper back. Drug-induced acne looks noticeably different. The bumps tend to be monomorphic, meaning they’re all roughly the same size and shape, typically small inflammatory papules and pustules. One of the clearest giveaways is the absence of blackheads and whiteheads (comedones), which are a hallmark of ordinary acne.
Drug-induced breakouts can also appear on parts of the body where regular acne rarely shows up, like the arms and lower trunk. They can develop at any age, not just during the teenage and young adult years when typical acne peaks. The onset is often abrupt and clearly linked to starting a new medication, which is the biggest clue for both you and your doctor.
Corticosteroids
Steroid acne is one of the most common drug-induced skin eruptions. It typically appears within two weeks of starting high-dose oral corticosteroids, presenting as uniform, firm, red papules and pustules about 2 to 3 millimeters in size. When caused by oral or injected steroids, the breakout is most prominent on the upper trunk. Topical corticosteroids, especially fluorinated formulas applied to the face, tend to cause breakouts right where they’re applied, though this can take several months of use rather than days.
Prolonged use of topical steroids on the face can also lead to steroid rosacea and a condition called perioral dermatitis, where clusters of small red bumps form around the mouth and nose. These are distinct from steroid acne but often get lumped together as “steroid skin problems.”
Anabolic Steroids
Anabolic-androgenic steroids, the kind used for muscle building, cause acne in roughly 50% of users. These are sometimes called “bodybuilding acne” and tend to be severe, often appearing on the back, shoulders, and chest. The mechanism is straightforward: anabolic steroids flood the body with androgens, which directly stimulate the oil glands in your skin to overproduce sebum. In young men between 18 and 26, sudden severe acne on the trunk is considered a clinical red flag for steroid use.
Hormonal Contraceptives
Not all birth control affects your skin the same way. Combined oral contraceptives (the pill containing both estrogen and progestin) generally improve acne, which is why some are prescribed specifically for that purpose. The problem arises with progestin-only methods or when switching away from combined pills.
A large study of over 336,000 new contraceptive users found that levonorgestrel IUDs were associated with a higher risk of developing acne compared to combined oral contraceptives. For women who already had acne, the levonorgestrel IUD increased the likelihood of needing stronger acne treatment. The effect was even more pronounced for women who switched from a combined pill to another method: progestin-only pills carried a 70% higher risk of acne-related doctor visits, and levonorgestrel IUDs carried a 93% higher risk compared to staying on combined pills. The hormonal implant also showed an elevated risk, though somewhat lower.
This doesn’t mean these contraceptives cause acne from scratch in most users. Rather, the estrogen in combined pills actively suppresses acne, so removing that protective effect (by switching to a progestin-only method) can unmask or worsen breakouts.
Lithium
Lithium, a mood stabilizer widely used for bipolar disorder, causes skin-related side effects in an estimated 3% to 45% of users, with acne being one of the most common. Breakouts tend to appear within the first six months of treatment. Lithium promotes acne through several pathways: it increases the migration of white blood cells toward the skin, stimulates inflammatory enzyme release, and causes excess thickening of the skin lining inside hair follicles, which traps oil and bacteria.
The good news is that lithium-related acne can usually be managed with standard topical and oral acne treatments without needing to stop the lithium itself.
Seizure Medications
Among anti-seizure drugs, phenytoin has the strongest association with acne. It also causes gum overgrowth and excess hair growth, making it one of the most cosmetically problematic seizure medications. Valproate (valproic acid) is another commonly implicated drug, though it’s better known for causing hair loss. Several other anticonvulsants have been linked to acne as well, but the evidence is most robust for phenytoin and valproate.
Cancer Therapies
A class of cancer drugs called EGFR inhibitors causes acne-like rashes at remarkably high rates. Between 50% and 100% of patients on these drugs develop a papulopustular rash, making it the single most common side effect of this drug class. The rates vary by specific drug: cetuximab causes the rash in 75% to 91% of patients, while gefitinib triggers it in 24% to 62%. In one study of 120 patients on various EGFR inhibitors, 80% developed the rash.
These drugs work by blocking a growth signal that both cancer cells and skin cells depend on, so the skin reaction is almost an expected part of treatment. In fact, oncologists sometimes view the rash as a sign the drug is working. Treatment focuses on managing the rash with topical medications rather than stopping the cancer therapy.
Vitamin B12
High-dose vitamin B12 supplementation can trigger acne-like eruptions, particularly with intramuscular injections used to treat conditions like pernicious anemia. The risk appears to increase with higher doses, longer supplementation periods, and when B12 is combined with other B vitamins (B1, B2, or B6). This is worth knowing if you take a B-complex supplement or get regular B12 shots and have noticed new breakouts. The mechanism involves B12 altering the metabolic activity of skin bacteria, prompting them to produce more of the compounds that trigger inflammation in pores.
Halogens: Iodine and Bromine
Iodine and bromine, two halogen elements found in certain medications, supplements, and even some foods, can trigger a specific type of drug-induced acne. Iodine-containing products are the more common culprit. This includes iodine-based contrast dyes used in medical imaging, potassium iodide supplements, and high-iodine dietary sources like kelp tablets. Bromine exposure is less common but can occur through certain medications or occupational contact. The resulting breakouts, sometimes called halogenoderma, can range from typical-looking pimples to more severe, deep lesions.
Managing Drug-Induced Breakouts
The most important thing to know is that drug-induced acne can almost always be treated without stopping the medication responsible. This matters because many of the drugs on this list treat serious conditions: bipolar disorder, epilepsy, cancer, autoimmune diseases. Standard acne treatments, both topical (like benzoyl peroxide and retinoids) and oral options, work on drug-induced breakouts just as they do on regular acne.
If you suspect a medication is causing your breakouts, the timing is your best clue. A sudden eruption of uniform-looking bumps within days to weeks of starting a new drug, especially if the bumps lack blackheads and show up in unusual spots, strongly suggests a drug-related cause. Bringing this timeline to your dermatologist or prescribing doctor helps them confirm the connection and start appropriate skin treatment while you continue the medication you need.