Bodybuilding and Acne

Athletes and bodybuilders sometimes misuse anabolic steroids to increase performance. Or, the anabolic steroid Testosterone may be prescribed for hormone replacement therapy. Anabolic steroids are comprised of synthetic male sex hormones to create androgenic steroids.

Higher than normal levels of androgens have been linked to a higher instance of acne. About 50% of people who take anabolic steroids in large doses will develop steroid-induced acne. This is often called “bodybuilders acne”.

What is steroid acne?

Usually, acne is an inflammation of the oil glands in your skin and hair roots. The technical name is acne vulgaris, but it’s often just called pimples, spots, or zits. A bacterium (Propionibacterium acnes) combined with other factors causes inflammation of the oil glands.

Steroid acne has almost the same symptoms as typical acne. But with steroid acne, systemic steroid use is what makes the oil (sebaceous) glands susceptible to inflammation and infection. The steroids may be prescription medications, such as prednisone, or body-building formulations.

Another form of acne, known as malassezia folliculitis or fungal acne, is caused by a yeast infection of the hair follicles. Like acne vulgaris, it can occur naturally or as the result of oral or injected steroid use.

Mechanism of steroid acne:

Acne induction due to steroid administration is partly due to androgen receptor binding in the skin and hair follicles, leading to hypertrophy of the sebaceous glands with consequent increased sebum output and a concomitant increase in the population density of P. acnes. These contribute to the characteristic breakouts of steroid acne.

Features of Steroid-induced acne:

While steroid acne resembles the classical acne (acne vulgaris) at first glance, in reality, there are some differentiating features which can help in differentiating both these eruptions, which would be easily visible to any dermatologist. In predisposed individuals suspected of having steroid acne, there is often a sudden onset of follicular pustules and papules 2 to 5 weeks after starting oral corticosteroid treatment.

The lesions of steroid acne differ from those of acne vulgaris in the following ways –

• Uniformly sized spots (monomorphic)
• Symmetric distribution (usually on the neck, chest, and back)
• Comedones may form later
• They are often 1- to 3-mm, flesh-colored or pink-toned, dome-shaped papules and pustules. 

Acne vulgaris, on the other hand, is usually polymorphic, where there is a mixture of the lesions including comedones, papules, pustules, nodules seen at the same time. These develop over months, and gradually increase in severity, and older lesions heal with scarring ahich are intermingled with newer spots.

The treatment for steroid acne, like that for ordinary acne (acne vulgaris), involves the use of various topical skin preparations and oral antibiotics.

Steroid-induced fungal acne (malassezia folliculitis) is treated with topical antifungals, such as ketoconazole shampoo, or an oral antifungal, such as itraconazole.

Oral antibiotics

Oral antibiotics of the tetracycline group are prescribed for severe and some moderate cases of steroid acne, and for any case showing scarring. These include doxycycline, minocycline, and tetracycline. These antibiotics kill the bacteria that aggravate acne and may also have some anti-inflammatory properties. It can take four to eight weeks of regular antibiotic use before you see the effects of skin clearing. The full response can take three to six months. People of color are more susceptible to scarring from acne outbreaks and may be advised to take oral antibiotics, even for a mild case. Because of the increased risk of antibiotic resistance and slow onset of action, specialists now discourage the use of topical antibiotics for acne.

Benzoyl peroxide

Benzoyl peroxide is a very effective antiseptic that helps to kill the acne bacteria and reduce inflammation. It’s recommended for use together with oral antibiotics, and also in mild cases that don’t require antibiotics. Benzoyl peroxide is available in many over-the-counter acne treatments. It’s sometimes combined with salicylic acid.

When using any topical preparation on your face, it’s important to apply it to your whole face, and not just to the spots you see. This is because acne develops from microscopically small sites on your face that you can’t see. Don’t scrub your face aggressively when cleaning or applying medication, as this can actually aggravate an acne outbreak.

Phototherapy

There’s some evidence for the effectiveness of phototherapy with blue and blue-red light to treat acne.

Mild cases

For a mild case, your doctor may try to avoid use of oral antibiotics, and instead prescribe a type of skin preparation known as a topical retinoid. These include:

• tretinoin (Retin-A, Atralin, Avita)
• adalpene (Differin)
• tazarotene (Tazorac, Avage)

Topical retinoids are creams, lotions, and gels derived from vitamin A. They work by helping production of healthy skin cells and reducing inflammation. They shouldn’t be used during pregnancy or breastfeeding.

Prevention

Steroid acne is the direct result of the use or misuse of steroids. To prevent steroid acne, people using anabolic steroids for performance enhancement should stop using them. Stopping anabolic steroid use can prevent future acne outbreaks and other, much more serious, health conditions.

However, people taking prescription corticosteroids should not stop taking their medication without first talking to their physician. In certain situations, taking steroids plays a vital role in keeping a person healthy, and stopping the treatment without discussing it with their physician may be very dangerous. People who should not stop taking steroids can try preventive measures and treatments that improve acne. For example, they should avoid using skin products containing oils that may clog pores. They should only use noncomedogenic products on acne prone areas. A person should also be gentle on their skin and not rub or pick at their acne lesions.

For some people, the routine use of topical retinoids alongside other dermatologist-recommended treatments can greatly reduce the appearance of steroid acne. However, it is important to remember that because steroids are the primary cause of this type of acne, it may not be possible to resolve it. These treatments may, however, improve the symptoms.

30.08.2022