From the Guidelines
Anticonvulsant medications can lead to acne as a side effect, with valproic acid being the most commonly associated, and patients should be aware of this potential side effect and consult their neurologist if they develop acne while taking these medications. The exact mechanisms by which anticonvulsants cause acne are not fully understood, but it is thought that they may alter hormone levels, particularly by increasing androgen activity or decreasing estrogen levels, which stimulates sebum production 1. Additionally, some anticonvulsants may affect the immune system and inflammatory responses, potentially triggering or worsening acne.
Some of the anticonvulsants that can cause acne include:
- Valproic acid (Depakote)
- Phenytoin (Dilantin)
- Carbamazepine (Tegretol)
- Phenobarbital
These medications can cause acne by:
- Altering hormone levels
- Affecting the immune system and inflammatory responses
- Increasing androgen activity or decreasing estrogen levels, which stimulates sebum production
If a patient develops acne while taking anticonvulsants, they should consult their neurologist before discontinuing any medication, as they may adjust the treatment plan by:
- Reducing the dose
- Switching to an alternative medication
- Adding treatments specifically for the acne, such as topical retinoids, benzoyl peroxide, or antibiotics 1.
It is essential to note that the onset of acne usually occurs within the first few months of starting the medication, and the severity can vary from mild to severe. Therefore, patients should be closely monitored for any signs of acne and report them to their neurologist promptly.
From the FDA Drug Label
Although serious skin reactions may occur without warning, patients should be alert for the signs and symptoms of skin rash and blisters, fever, or other signs hypersensitivity such as itching, and should seek medical advice from their physician immediately when observing any indicative signs or symptoms Anticonvulsant Hypersensitivity Syndrome (AHS) is a rare drug induced, multiorgan syndrome which is potentially fatal and occurs in some patients taking anticonvulsant medication. It is characterized by fever, rash, lymphadenopathy, and other multiorgan pathologies, often hepatic. Although up to 1 in 5 patients on Dilantin may develop cutaneous eruptions, only a small proportion will progress to AHS
The anti-convulsant medication phenytoin can lead to acne-like symptoms such as skin rash, which may be a sign of a more serious condition like Anticonvulsant Hypersensitivity Syndrome (AHS) or Stevens-Johnson Syndrome (SJS). Key points to consider:
- Skin reactions can occur without warning
- Patients should be alert for signs and symptoms of skin rash and hypersensitivity
- AHS is a rare but potentially fatal condition that can occur in patients taking anticonvulsant medication, including phenytoin 2
From the Research
Anti-Convulsant Medication and Acne
- Anti-convulsant medications can lead to acne as a side effect, as reported in several studies 3, 4.
- Phenytoin, an anti-convulsant medication, has been associated with acne, hirsutism, and gingival hyperplasia 3.
- Valproate, another anti-convulsant medication, has been linked to hair loss, hirsutism, and acne 3, 4.
- A systematic review of cosmetic adverse effects of antiseizure medications found that phenytoin and valproate are the most notorious medications in terms of cosmetic side effects, including acne 3.
- A study on cosmetic side effects of antiepileptic drugs in adults with epilepsy found that acne was a common side effect, particularly with valproic acid and pregabalin 4.
Mechanism of Acne Development
- The exact mechanism of how anti-convulsant medications lead to acne is not fully understood, but it is thought to be related to the medication's effect on hormone levels and oil production in the skin.
- Some anti-convulsant medications, such as valproate, can increase the levels of androgens, such as testosterone, which can contribute to the development of acne 4.
Prevalence of Acne in Anti-Convulsant Medication Users
- The prevalence of acne in users of anti-convulsant medications varies depending on the medication and the population being studied.
- A study on cosmetic side effects of antiepileptic drugs in adults with epilepsy found that acne occurred in 5.8% of patients taking antiepileptic drugs, with valproic acid and pregabalin being the most common offenders 4.