Can Prednisone Give You Acne?

Corticosteroids, and especially prednisone, are often prescribed to treat many inflammatory conditions, including inflammatory bowel disease (IBD). Some people who take steroid medications, such as prednisone, can develop a type of acne commonly known as "steroid acne." 

Far from being a trivial adverse effect of a medication, acne breakouts can have a significant negative effect on the quality of life. People with IBD often feel that acne is a secondary condition not worth complaining about and may hesitate to bring it up with their healthcare providers. However, feeling good about oneself and one's appearance is also vital to coping with the IBD and keeping IBD flares under control. 

Prednisone is an inexpensive and effective medication prescribed by many physicians to keep Crohn's disease or ulcerative colitis under control. Ideally, it should only be used for a short amount of time but is sometimes used for longer periods in cases where the IBD symptoms aren't improving.

Prednisone is associated with many side effects, some of which are serious or intolerable. They include:

• Acne
• Nausea and vomiting
• Insomnia
• Headaches
• Blurred vision and eye pain
• Rapid weight gain
• Shortness of breath
• Fatigue
• Muscle weakness
• Slow wound healing
• Rapid or irregular heart rate
• Chest pain
• Increased urination
• Depression
• Anxiety
• Changes in personality or behavior
• Seizures
• Bloody or tarry stools
• Coughing up blood

Acne is often thought of as a problem for adolescents, but steroid acne can happen to anyone taking steroids regardless of age. That said, it tends to be more common in teens and adults. Steroid acne can appear on the face, chest, or back and is commonly associated with two forms: Acne vulgaris and Malassezia folliculitis.

• Acne vulgaris is the main type of acne in adults and teens and the one that occurs most commonly with high-dose prednisone therapy (usually within two weeks of starting treatment). It often appears as very uniform lesions and is prevalent in people who have a tendency towards acne in the first place.
• Malassezia folliculitis is a type of acne caused by a fungus present in and around hair follicles. It is estimated that anywhere from 75% to 98% of people have this type of fungus on their skin. While the presence of the yeast is normal, the overgrowth of it is not. M. folliculitis is most common on the chest and trunk and is characteristically itchy.

Steroid acne will begin to recede once prednisone is discontinued. During prednisone treatment, acne remedies can be used to help control outbreaks.

The type of treatment that is used will depend on the type of acne present as well as several other factors such as other medications that are being taken and the severity of the acne. 

Accutane (isotretinoin) is usually not recommended for treating acne in people with IBD as it may trigger diarrhea and rectal bleeding. Instead, topical cleansers and anti-acne agents such as benzoyl peroxide are recommended as the first step in treating acne.

For moderate to severe steroid acne, oral antibiotics like doxycycline, minocycline, and tetracycline are commonly prescribed. Fungal acne is best treated with topical antifungals, oral antifungals (like itraconazole), or shampoos containing ketoconazole.

Anyone who has concerns about acne that develops during prednisone therapy should consult a gastroenterologist or a dermatologist who has experience in treating people with IBD. Remember that even though acne, especially on the face, can be difficult to live with, the acne will clear up when you taper down off the steroids.

In the meantime, receiving treatment for the acne may help to clear up the skin until the prednisone is stopped.