Hydroxyzine (Vistaril) Does Not Cause Acne
Hydroxyzine is not a known cause of acne and does not require discontinuation for this reason. The medication is an antihistamine used for pruritus, anxiety, and allergic conditions, and acne is not listed among its dermatologic adverse effects in major guidelines or clinical literature.
Evidence Against Hydroxyzine as an Acne Trigger
No documented association exists between hydroxyzine and acne development in comprehensive acne management guidelines from the American Academy of Dermatology 1
Drug-induced acne has specific characteristics including sudden onset, monomorphous inflammatory papules or papulopustules, and location beyond typical seborrheic zones—none of which are reported with hydroxyzine 2
Known acne-inducing medications include corticosteroids, anabolic steroids, testosterone, halogens, isoniazid, lithium, and certain anticancer agents, but antihistamines like hydroxyzine are notably absent from this list 2
Documented Dermatologic Reactions to Hydroxyzine
While hydroxyzine does not cause acne, it can rarely cause other skin reactions:
Cutaneous drug eruptions (morbilliform rash, palmar erythema, desquamation) have been reported with hydroxyzine, particularly in patients with cross-reactivity to other piperazine derivatives like cetirizine 3, 4
These reactions present as generalized rashes with pruritus, not as acneiform eruptions with comedones or papulopustules 3
Clinical Approach If Acne Develops While Taking Hydroxyzine
Evaluate other potential causes including concurrent medications (corticosteroids, lithium, anabolic steroids), hormonal factors, or standard acne vulgaris unrelated to hydroxyzine 1, 2
Continue hydroxyzine if needed for its primary indication (pruritus, anxiety) while treating acne with standard therapies: topical retinoids, benzoyl peroxide, or topical antibiotics for mild-to-moderate cases 1
Consider systemic antibiotics (doxycycline, minocycline) for moderate acne or isotretinoin for severe, treatment-resistant cases—these can be safely combined with hydroxyzine 1
Important Safety Considerations for Hydroxyzine
The primary concerns with hydroxyzine are unrelated to acne:
Significant sedation occurs in 80% of patients, with impaired reaction times and increased fall risk, particularly in elderly patients 5, 6
Anticholinergic effects can cause cognitive impairment, urinary retention, and constipation, especially when combined with other anticholinergic medications 6
Dose adjustments are mandatory in renal impairment (reduce by 50% if creatinine clearance 10-20 mL/min; avoid if <10 mL/min) and severe hepatic disease (avoid completely) 5, 6
Contraindicated in early pregnancy and should be avoided in elderly patients due to fall risk and cognitive effects 5, 6