Moon Face Causes and Treatments

"Moon face" is a term used to describe swelling that makes the face puffy and round, like a full moon. It is often caused by long-term use of a steroid medication such as prednisone, but it can also be a symptom of a health condition like Cushing's syndrome or an underactive thyroid (hypothyroidism).

Moon face isn't painful, but it can be stressful and affect self-esteem. When caused by steroids, the swelling should go away if the medication is stopped. If this is not advised or there is another cause, there are things you can do to reduce the appearance of moon face.

This article explains how steroid medications and certain medical conditions cause facial swelling. It also looks at the emotional and physical effects of moon face and how it can be managed.

What Causes Moon Face?

Moon face can have several causes, with long-term use of corticosteroids being one of the most common.

Corticosteroids

Prednisone and other corticosteroids can increase appetite, leading to weight gain. Fat deposits can also shift as a result of using these drugs. Increased water retention, another side effect, can cause swelling and further weight gain.

All of these factors can make your cheeks get puffy and fill out your jawline, causing moon face.

The effects stem from the fact that corticosteroids act like cortisol, a stress hormone that the body produces naturally. Amongst its many roles, cortisol regulates insulin levels and balances fluid and salt.

Corticosteroids are used for several conditions, but moon face is most related to long-term use. Some of the conditions treated with steroids include:

• Severe hives
• Skin disorders, such as eczema
• Inflammatory diseases, including asthma, inflammatory bowel disease (IBD), ulcerative colitis, and arthritis
• Pain caused by an irritated or trapped nerve, such as severe sciatica
• Autoimmune diseases, like Addison’s disease, lupus, and multiple sclerosis
• Chronic obstructive pulmonary disease (COPD)
• Certain types of cancer, including lymphatic and blood cancers
  

Cushing's Syndrome

When cortisol levels are too high, Cushing’s syndrome (a hormonal disorder) can occur. Weight gain and facial rounding/swelling are common, which make moon face common too.

These are part of a group of symptoms known to cause what's called a Cushingoid appearance (or Cushingoid facies).

Most of the time, Cushing's syndrome is caused by long-term use of corticosteroids, but it can also be caused by a tumor.

There are three tumor types that can cause Cushing's syndrome:

• Pituitary adenomas: These non-cancerous growths develop on the pituitary gland, which sits at the base of the brain. They cause your body to produce excessive amounts of cortisol.
• Ectopic ACTH-producing tumors: These tumors develop outside of the pituitary gland, often in the lungs. They produce adrenocorticotropin hormone (ACTH), which tells your adrenal gland to make cortisol. These tumors can be cancerous.
• Adrenal tumors: These tumors form on an adrenal gland (you have one on top of each kidney). While usually benign, these growths can be cancerous.

The cortisol imbalance that characterizes Cushing's syndrome affects several body systems, which can lead to additional symptoms such as reddish-purple stretch marks, acne, thinning skin, and more.

Hypothyroidism

When you have hypothyroidism, your thyroid gland doesn't make enough thyroid hormone. This hormone helps metabolize sugar molecules, so a lack of it may cause them to build up in the skin.

Sugar molecules attract water. The more you have, the more fluid you can retain. This can make your face swell.

Hypothyroidism can also cause other symptoms, such as:

• Fatigue
• Weight gain
• Joint and muscle pain
• Cold intolerance
• Slowed heart rate
• Depression

Hypothyroidism can be autoimmune, meaning your body mistakenly sends antibodies to attack thyroid cells. It can also occur after you've had radiation treatment or because you had your thyroid gland removed.

Diabetes and Insulin Therapy

People who have diabetes or insulin resistance may also gain weight as the body stores excess blood sugar as fat. Over time, this weight gain may give the face a rounder, puffier appearance.

In rare cases, taking insulin to control diabetes can lead to a buildup of fluid in parts of the body, including the face.

Weight Gain

Any kind of weight gain can cause the face to have a rounder appearance.

How Moon Face May Affect You

In some instances, people’s faces seem to be dramatically altered by extra fat and water retention. You may feel like you don’t even recognize yourself in the mirror. This can cause low self-esteem and depression.

The emotional stress caused by moon face itself can be made worse by depression or mood changes that stem from the underlying cause. Corticosteroids and Cushing's syndrome, for example, can have these effects.  

While moon face does not pose any threats to your physical health, its causes can.

For example, corticosteroids change how your body stores fat. Moon face is one way this affects you. You may also develop a “buffalo hump,” extra fat on the back of the neck. Many people also gain weight around the abdomen and middle of the body.  

This abdominal body fat puts you at risk for metabolic syndrome. Metabolic syndrome is a group of conditions that increases your chances of developing heart disease, stroke, and type 2 diabetes.

Can You Get Rid of Moon Face?

How quickly moon face goes away depends on the cause, but it often resolves once the cause is treated. When corticosteroids are the cause, moon face typically resolves when you stop the medication. Other causes may require medication or, sometimes, surgery.

Stopping Corticosteroids

If you stop taking your corticosteroid, your face should eventually return to normal. However, it's extremely important that you do not stop them abruptly.

The dosage needs to be gradually reduced (tapered) under the guidance of a healthcare provider. If you stop all at once, your body may not have enough cortisol. This can lead to:

• Extreme tiredness
• Weakness
• Upset stomach
• Weight loss
• Changes in skin color
• Mouth sores
• Salt cravings
  

Tell your healthcare provider if moon face is bothering you. They can determine if stopping the medication is possible in your case and, if so, what tapering schedule you should follow.

How quickly the dosage is lowered depends on how long you've been taking the drug and at what dosage. If you've been taking corticosteroids for a long time at a high dose, you may need to lower the dose very slowly every week or every few weeks.

Medical Treatments

If moon face is caused by Cushing's syndrome and is unrelated to corticosteroid use, your healthcare provider may prescribe medication to control your body's production of cortisol. Some options include:

• Nizoral (ketoconazole)
• Lysodren (mitotane)
• Metopirone (metyrapone)

Most of the time, treatment cures Cushing's syndrome. If treatment is effective, all of the symptoms of the disease, including moon face, will eventually disappear.

When caused by a tumor, Cushing's is often treated with surgery to remove the tumor.

If moon face is caused by hypothyroidism, your healthcare provider may prescribe medications such as levothyroxine to replace the hormones your thyroid isn't making. Once the treatment is working, moon face should eventually go away.

Lifestyle Changes

Moon face caused by weight gain will resolve with weight loss. Since weight loss can't be targeted to certain parts of the body, facial exercises don't work to reduce moon face.

Instead, adopting a healthy diet and getting regular physical activity can help you lose weight all over your body, including your face.

You can reduce how much your face swells by:

• Reducing salt intake: Salt increases fluid retention.
• Drinking more water: Poor hydration makes your body hold onto fluid.
• Getting adequate sleep: A lack of sleep can cause inflammation which can lead to facial swelling.
  

Summary

Prednisone and other corticosteroid drugs can cause your face to swell and get rounder, a condition known as moon face. This can also be related to a health condition like Cushing's syndrome or hypothyroidism, as well as weight gain.

If your moon face is caused by corticosteroids, it will resolve when you stop taking the medication (which should only be done under the guidance of your prescriber). If it's caused by a health condition, your face should gradually return to normal with proper treatment of the condition.