Corticosteroids (Prednisone) and How They Cause Acne

Steroid acne is a skin breakout that occurs when you take prednisone or another corticosteroid. It's most common when you've been taking prednisone for several weeks, especially if you're on a high dosage. Research suggests that corticosteroids like prednisone increase the activation of immune system receptors that promote acne, known as Toll-like receptor 2 (TLR2).

The blemishes sometimes go away on their own, but you usually need to stop taking prednisone for your skin to clear up. If you're taking the drug for a chronic condition, this may be a big decision that's best made between you and your healthcare provider.

In this article, you'll learn what steroid acne looks like, plus the different types and treatment options.

What Does Steroid Acne Look Like?

Steroid or prednisone acne can appear on your face, chest, and back within two weeks of taking a corticosteroid like prednisone.

It may take one of several forms:

• Pustules: Red, inflamed, pus-filled pimples with white heads
• Papules: Red bumps caused by clogged hair follicles; may become a pustule
• Comedones: Small bumps on the skin plus blackheads and non-inflamed blemishes
• Nodular acne: Especially large, inflamed, painful pimples that can last for months

Types of Steroid Acne

Prednisone acne isn't just a problem for adolescents. It can happen to anyone taking steroids, regardless of age.

Steroid acne is commonly associated with two forms: Acne vulgaris and Malassezia folliculitis.

Acne Vulgaris

Acne vulgaris is the most common type of acne overall, and the most common type of acne from high-dose prednisone therapy. It often appears as uniform lesions.

Malassezia Folliculitis

Malassezia folliculitis, or fungal acne, is an itchy type of acne that's usually on the chest and trunk. It's caused by the overgrowth of a yeast called Malassezia in and around hair follicles.

It's natural to have some of this fungus on your skin—it's estimated that between 75% to 98% of people do. However, steroid use has been shown to be a predisposing factor to the overgrowth of Malassezia.

Treatment for Steroid Acne

Steroid acne usually goes away once you're off of prednisone. If you need to be on it long-term, you may want to use some acne remedies to help control outbreaks. Some at-home skin care and over-the-counter (OTC) remedies include:

• Gently washing your skin twice every day, preferably before going to bed at night and when you wake up in the morning
• Using a towel to wipe away sweat from your skin when working out
• Switching to a low glycemic index (GI) diet
• Applying topical cleansers and anti-acne agents such as benzoyl peroxide

For moderate to severe steroid acne vulgaris, common prescription treatments include oral antibiotics such as:

• Doxycycline
• Minocycline
• Tetracycline

Oral medications such as Accutane (isotretinoin) may also be an option for you. However, Accutane may not be recommended if you have inflammatory bowel disease (IBS) or are at high risk for the condition, as some research suggests it may trigger IBS symptoms.

Fungal acne is best treated with topical antifungals like ketoconazole and oral antifungals like itraconazole.

Your healthcare provider can help you find the right treatments for your prednisone acne. They can also help you decide whether to stay on prednisone or another corticosteroid.

Tapering off of Prednisone

Don't abruptly stop taking prednisone, as it can cause withdrawal symptoms. Depending on how long you've taken prednisone and in what dose, the tapering-off process can take weeks or even months.

If you feel that you need to stop taking prednisone to improve your skin, consult with your healthcare provider so that they can help guide you through the process.

Summary

Prednisone and other corticosteroid medications can cause acne. It can cause many types of blemishes, including blackheads and bumps, pustules, or more severe nodules.

People prone to acne vulgaris often get this type of acne due to steroid use. Other people have an overgrowth of a fungus on their skin.

Treatment for steroid acne is similar to that for acne from other causes. However, you and your healthcare provider should take care to choose a treatment that won't exacerbate any medical conditions you have.

A Word From Verywell

If you have steroid acne or are worried about getting it, talk to your primary healthcare provider or a dermatologist.

Remember that, while acne can be difficult to live with, it should clear up when you taper off the steroids. Meanwhile, acne treatments may help clear up your skin.