Bupropion and Acne
Bupropion is not documented to cause acne as an adverse effect in FDA labeling, clinical trials, or authoritative guidelines. The extensive FDA adverse event profiles for bupropion list numerous dermatologic reactions including rash (1-5%), pruritus (2-4%), sweating (2-6%), urticaria, and serious reactions like maculopapular rash, angioedema, exfoliative dermatitis, and DRESS syndrome, but acne is notably absent from these comprehensive listings 1.
Documented Dermatologic Adverse Effects
The most common skin-related side effects of bupropion include:
- Rash occurs in 1-5% of patients in controlled trials, with higher rates (up to 5%) at the 400 mg/day dose 1
- Pruritus affects 2-4% of patients 1
- Sweating occurs in 2-6% of patients, with dose-dependent increases 1
- Urticaria is reported in 0-2% of patients 1
Serious Dermatologic Reactions
More concerning cutaneous reactions documented in postmarketing surveillance include:
- Angioedema and serum sickness-like reactions were the most frequently reported serious cutaneous adverse reactions in French pharmacovigilance data, comprising 31.2% of all serious adverse reactions, with younger patients and women at higher risk, and a dose-dependent effect observed 2
- Maculopapular rash, exfoliative dermatitis, acute generalized exanthematous pustulosis, and DRESS syndrome are rare but serious reactions identified in postmarketing experience 1
- Drug-induced subacute cutaneous lupus erythematosus has been reported as a rare reaction to bupropion 3
- Exacerbation of psoriasis, including potentially life-threatening erythrodermic psoriasis, has been documented, though this remains an under-recognized side effect particularly in the United States 4
Clinical Context and Monitoring
If a patient develops acne while taking bupropion, alternative explanations should be investigated rather than attributing it to the medication, as this is not an established adverse effect. The American Academy of Dermatology guidelines for acne management mention bupropion only in the context of drug interactions with amoxicillin (where bupropion and other agents lower seizure threshold), not as a causative agent for acne 5.
Important Monitoring Considerations
- Most serious cutaneous adverse reactions to bupropion occur within a median of 12-14 days after drug initiation, suggesting closer monitoring during the first 2 weeks of treatment 2
- Younger patients appear to be at higher risk for cutaneous serious adverse reactions generally, and younger women specifically for angioedema 2
- A dose-dependent effect has been observed for angioedema, suggesting that exceeding recommended doses increases dermatologic risk 2
Clinical Pearl
Bupropion has potential anti-inflammatory effects that are being investigated for dermatologic conditions, though evidence is currently limited to pilot studies and case reports 6. This theoretical anti-inflammatory property would argue against acne causation rather than support it.