From the Research
For acneiform rash while taking testosterone, the most effective treatment approach is to start with topical retinoids, such as adapalene 0.1% gel, which has been shown to reduce acne lesion counts by 63% compared to baseline, as demonstrated in a randomized trial of 207 patients 1. This treatment strategy prioritizes minimizing morbidity, mortality, and improving quality of life. The following steps can be taken:
- Apply topical retinoids, such as adapalene 0.1% gel, nightly to affected areas
- Use benzoyl peroxide (2.5-10%) once or twice daily, as it has been found to be efficacious and well-tolerated in combination with other topical agents 2
- Utilize over-the-counter salicylic acid cleansers to help manage acne
- If there is no sufficient improvement after 4-6 weeks, consult a healthcare provider about prescription options like topical clindamycin 1% or oral antibiotics such as doxycycline 100mg twice daily for 6-12 weeks
- For severe cases, oral isotretinoin might be considered, as it is approved by the US Food and Drug Administration for treating severe recalcitrant nodular acne 1 It is essential to maintain a gentle skincare routine with non-comedogenic products, avoid picking at lesions, change pillowcases frequently, and shower after sweating to prevent further irritation and infection. Regular follow-up with a healthcare provider is crucial to monitor both testosterone therapy and skin condition, ensuring the best possible outcome in terms of morbidity, mortality, and quality of life. The acne breakouts occur due to testosterone increasing sebum production in skin glands, creating an environment where acne-causing bacteria thrive, highlighting the importance of addressing the root cause of the issue 3. Some key points to consider:
- Topical treatments are the first line of defense against acneiform rash
- Combination therapy may be necessary for more severe cases
- Oral antibiotics and isotretinoin should be considered for persistent or severe acne
- Gentle skincare and regular follow-up are vital for effective management.