What is the association between anabolic steroids (Androgenic Anabolic Steroids) and acne (acne vulgaris)?

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From the Guidelines

Anabolic steroids are strongly associated with the development of acne, particularly due to their impact on hormone levels and subsequent increase in sebum production. The use of anabolic steroids leads to an increase in testosterone and other androgen levels, which in turn stimulates oil glands in the skin to produce more sebum, creating an environment conducive to the development of acne-causing bacteria and inflammation 1. This association is well-documented, with the severity of steroid-induced acne often correlating with the dosage and duration of steroid use, and can lead to cystic lesions and scarring if not properly managed.

Pathogenesis and Risk Factors

The pathogenesis of acne is multifactorial, involving follicular hyperkeratinization, microbial colonization with Cutibacterium acnes, sebum production, and complex inflammatory mechanisms, among other factors 2. The introduction of anabolic steroids into this delicate balance further exacerbates the condition by increasing androgen levels, which are known to play a significant role in the development of acne. Risk factors for acne development, such as family history, oily skin type, and increasing age during adolescence, can be compounded by the use of anabolic steroids, leading to a higher likelihood of severe acne outbreaks.

Clinical Presentation and Treatment

The acne associated with anabolic steroid use typically appears on the face, back, shoulders, and chest, areas with the highest concentration of oil glands. Treatment options for steroid-induced acne include topical retinoids, benzoyl peroxide, antibiotics, and in severe cases, oral medications like isotretinoin. However, the most effective approach to managing acne caused by anabolic steroids is discontinuation of the steroids, after which the acne typically improves gradually as hormone levels normalize 1. This approach not only addresses the symptoms but also targets the underlying cause, reducing the risk of long-term sequelae such as scarring and persistent psychological impacts associated with acne.

Quality of Life and Morbidity Considerations

Given the significant impact of acne on emotional functioning, social functioning, relationships, and overall quality of life, as well as its association with increased risks of stigmatization, bullying, depression, anxiety, poor self-esteem, and suicidal ideation 2, it is crucial to prioritize the management of acne in the context of anabolic steroid use. The potential benefits of anabolic steroids must be carefully weighed against the risks, particularly the risk of developing acne and its subsequent effects on mental and physical health. In clinical practice, the recommendation to avoid anabolic steroids or to discontinue their use in patients with acne is based on the potential to significantly improve quality of life and reduce morbidity associated with acne.

From the Research

Association between Anabolic Steroids and Acne

  • The abuse of anabolic-androgenic steroids (AAS) has been linked to the development of acne, particularly in young men aged 18-26 years 3.
  • Acne occurs in approximately 50% of AAS abusers and can be an important clinical indicator of AAS abuse 3.
  • The use of anabolic steroids is associated with a variety of somatic adverse drug reactions, including acne, gynaecomastia, infertility, and testicular dysfunction 4.
  • Both acne conglobata and acne fulminans can be induced by AAS abuse, highlighting the potential severity of acne associated with anabolic steroid use 3.

Acne Pathogenesis and Treatment

  • Acne vulgaris is a chronic and recurring disease involving multiple etiological factors, including follicular hyperkeratinization, increased sebum production, Propionibacterium acnes proliferation, and inflammation 5, 6, 7.
  • Treatment options for acne include topical retinoids, benzoyl peroxide, azelaic acid, and combinations of topical agents, as well as systemic agents such as oral antibiotics and hormonal therapies 5, 6, 7.
  • Retinoids, derived from vitamin A, are a key component of acne treatment, addressing the key pathogenic pathways of acne and available in both topical and systemic formulations 7.

Clinical Implications

  • Dermatologists should recognize bodybuilding acne as a potential indicator of AAS abuse and address the underlying issue, warning patients about other potential hazards associated with anabolic steroid use 3.
  • The management of acne vulgaris requires a comprehensive approach, considering the severity and extent of the disease, as well as the potential impact on quality of life and mental health 6.

References

Guideline

guidelines of care for the management of acne vulgaris.

Journal of the American Academy of Dermatology, 2024

Guideline

guidelines of care for the management of acne vulgaris.

Journal of the American Academy of Dermatology, 2024

Research

Abuse of anabolic-androgenic steroids and bodybuilding acne: an underestimated health problem.

Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG, 2007

Research

[Not Available].

Ugeskrift for laeger, 2022

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.