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What Medications Can Cause Acne?

Common Medications That Cause Acne Include Corticosteroids, Anabolic-Androgenic Steroids (AAS), Lithium, Isoniazid, Halogens, and EGFR Inhibitors (EGFR-I)

Last updated: July 27, 2018

Article Summary

Based on research, common medications that often result in acne include corticosteroids, testosterone and other anabolic-androgenic steroids (AAS), lithium, isoniazid, halogens, and EGFR inhibitors (EGFR-I). Vitamin B supplements may also cause acne, but the evidence is incomplete. Finally, a few case reports suggest that rifampicin, ethosuximide, and some hormonal contraceptives that release progesterone might cause acne.

Based on the amount of research that links particular medications to acne, we can place potentially acne-causing medications into three categories.

  1. Medications that can definitely cause acne: We have a large amount of evidence linking these medications to acne
  2. Medications that may cause acne: We have a considerable but insufficient amount of evidence linking these medications to acne
  3. Medications that might cause acne: We have a small amount of evidence linking these medications to acne1

Even if someone takes a medication that falls into the first category—medications that can definitely cause acne—this does not necessarily mean that he will develop drug-induced acne. Whether he develops drug-induced acne or not depends on several other factors.

  • The dose of the medication: In other words, if a person takes a smaller dose, she may not experience acne, but may develop acne if she takes a larger dose 
  • The length of time during which acne patient takes the medication: In other words, if someone takes the medication only a few times, he may not experience acne, but may develop acne if he takes it regularly for weeks or months 
  • Whether patient already has a history of acne: In other words, if a patient has experienced acne before, she may be more likely to develop drug-induced acne2
Factors of Medication Drug-induced Acne



Regular Acne Is Different from Drug-induced Acne

Regular acne is different from drug-induced acne (acne that is caused by medication) in four respects.

Medication History. Regular acne can develop in a person who has not used any medication. In contrast, drug-induced acne only develops after he has used a medication that can cause acne.

Time of Onset. Regular acne is most common in adolescents (teens) and develops gradually, while drug-induced acne can occur at any age and often begins suddenly.1

Location of Lesions on the Body. Regular acne typically appears on the face, back, chest, and/or shoulders because the sebaceous (skin oil producing) glands located in these areas of the body tend to produce an abundance of sebum (skin oil). Some medications, like AAS and lithium, simply increase a person’s already existing tendency to develop regular acne in these areas. However, most medications that can cause acne lead to drug-induced acne, which can appear on the face and neck like regular acne but can also develop in unusual locations—such as the lower legs and the back of the arms.1

Types of Lesions. Regular acne usually produces many different types of lesions, including whiteheads, blackheads, papules, pustules, nodules, and cysts. Medications like AAS and lithium increase a person’s existing tendency to develop regular acne, so a person who takes these medications may experience all of these different types of lesions. In contrast, drug-induced acne typically produces only papules and pustules—in other words, reddened bumps on the skin that people commonly call “pimples” and “zits.” It is unusual for a person with drug-induced acne to develop comedones (whiteheads and blackheads).1 Because of these differences, drug-induced acne lesions are often called acneiform, meaning “acne-like.”

Regular Acne vs. Drug-induced Acne



Regular Acne and Drug-induced Acne Require Different Treatments

A variety of treatments are available for regular acne. These treatments typically improve it slowly over weeks or months. On the other hand, drug-induced acne does not respond well to regular acne treatments. It does, however, usually clear up gradually after the person stops using the offending medication.

In order to understand how some medications cause acne, we need to review how acne develops.

  1. The sebaceous glands begin producing more sebum 
  2. Skin pores become clogged, trapping the sebum inside
  3. The clogged pores become larger because of the trapped sebum 
  4. Oxygen levels inside the clogged pores drop
  5. The anaerobic (bacteria that does not like oxygen) acne bacteria P. acnes begins to grow in the clogged pores, feeding on the sebum
  6. The bacterial growth causes the pores to become irritated and inflamed, meaning that the area becomes red, swollen, and sometimes sore3
How Acne Develops
Normal Skin vs. Skin with Acne


Sometimes medications can cause specific subtypes of severe acne, such as:

  • Acne conglobata: This is a rare and particularly severe form of nodulocystic acne, which is a type of acne in which people develop nodules (large, inflamed, painful, firm-to-the-touch lesions) and cysts (large, fluid-filled lesions). People with acne conglobata suffer from lesions on the body and face, and inevitably develop scarring, which can be particularly severe.4
  • Acne fulminans: This type of acne is as severe as acne conglobata, but cause additional systemic (bodily, as the result of medication transferred via the blood) symptoms—such as fever and joint pains4
Acne Conglobata
Acne Fulminans


Let’s read about some common medications that have been linked with acne, beginning with the medications that can definitely cause it.


Medications That Can Definitely Cause Acne

Corticosteroids

What They Are. Corticosteroids, not to be confused with anabolic steroids—which people take for bodybuilding—are medications that suppress the immune system. The immune system is the body’s natural defense mechanism against infection and disease. Corticosteroids can be taken by mouth, inhaled, injected into a vein, or used as a topical cream or ointment on the face and other areas of the body. Using corticosteroids in high doses can result in so-called “steroid acne.” A person who has a previous history of acne is more likely to develop steroid acne, the severity of which depends on how long and at what dose the person uses the corticosteroids.2 The first symptoms of steroid acne are usually inflammatory papules and pustules.4 Months later, these lesions gradually disappear, and so-called “secondary” comedones (whiteheads and blackheads) appear in their place. These are not the kind of comedones that develop in regular acne. Rather, these secondary comedones develop because of repeated damage to the hair follicles (pores) from the previous papules and pustules.5

Corticosteroids - Can Definitely Cause Acne


In people who have asthma and inhale steroids using a mask, steroid acne may appear on the part of the face that the mask covers.1

How They Cause Acne. We do not know exactly how corticosteroids cause acne. Research suggests that they may increase the amount of sebum in skin pores, the same place where acne develops. This may be problematic because P. acnes, which lives in skin pores, obtains its energy from sebum. When the amount of sebum in pores increases, the number of P. acnes also increases—which can lead to inflammation. This is when pimples form.4

Drug-induced Acne Caused by Corticosteroids


Treatment of Steroid Acne. Steroid acne usually disappears gradually after patients stop using corticosteroids. However, sometimes they need to continue using them—for example, if they have asthma. In that case, their doctor may prescribe an acne treatment for ongoing use.2

Anabolic-androgenic Steroids - Can Definitely Cause Acne


Anabolic-androgenic Steroids

What They Are. Androgenic steroids are male sex hormones that are artificially synthesized in a laboratory. The structures of a number of AAS are similar to that of testosterone,7 a male sex hormone that is also found in females in small amounts. The anabolicportion of “anabolic-androgenic steroids” means that these steroids can be used to “bulk up”—that is to say, to increase muscle mass. Thus, AAS are the type of steroids that bodybuilders and athletes employ when looking to enhance their performance. Doctors may prescribe AAS to treat muscle atrophy (wasting), and small doses can also treat hereditary angioedema (swelling of the deeper layers of the skin that runs in families). When it comes to the substance itself, doctors sometimes prescribe testosterone—an anabolic-androgenic steroid—to extremely tall boys to prevent further growth in height, but research shows that about 1–2% of these boys develop acne fulminans.2

Acta Dermato-Venereologica

For example, a study that was published in 1992 in the journal Acta Dermato-Venereologica examined 176 Norwegian teen boys who received testosterone injections to stop growth in height. The researchers compared these boys to 23 boys who were untreated, and they found that those who received testosterone experienced a clear increase in acne one to eight weeks after the treatment. The acne lesions developed on the face and trunk (torso) and were severe in some of the boys—for example, there were four cases of acne fulminans.5

Drug-induced Acne Cause by Anabolic-androgenic Steroids


A main place that women produce testosterone is the ovaries, so doctors also occasionally prescribe testosterone treatment to women whose ovaries have been surgically removed. However, this therapy is controversial in women. Some studies report that testosterone replacement therapy causes acne in up to 38% of women, but other studies report numbers as low as 5%.2

How They Cause Acne. Scientists and doctors now understand the role of testosterone and other androgens in the development of acne. These male sex hormones increase the production of sebum. This is a key step in the development of acne. In addition, like corticosteroids, high doses of AAS can cause an increase in the amount of sebum in the skin. When this occurs, the number of P. acnes also increases, potentially leading to the inflammation seen in acne pimples. In this way, high doses can cause acne in both males and females or make pre-existing acne worse, particularly in females. If a person who already has acne takes high doses of AAS, the sebaceous glands in his/her skin may increase in size dramatically and begin producing more sebum. He or she may also experience alopecia (hair loss) as a side effect of the medications. In addition, they can cause acne fulminans or acne conglobata.2

Treatment for Acne Caused by AAS. Once you stop using AAS, the acne may gradually disappear. However, in 30–60% of women who develop acne due to them, the acne does not clear up after ceasing use. In such cases, or for people who need to continue using AAS, doctors may prescribe the topical acne treatment of retinoids.2

Lithium - Can Definitely Cause Acne


Lithium

What It Is. Lithium is a mood stabilizer that doctors prescribe for various psychiatric conditions, such as depression, bipolar disorder, and schizophrenia. Lithium can make existing acne worse or cause acne in people who have never had acne and sometimes causes acne conglobata. Males are somewhat more likely than females to develop acne due to lithium.2

How It Causes Acne. In some people, even small doses of lithium can cause acne—but typically, people develop acne when large amounts of lithium build up in the body. When lithium accumulates in the skin, it can damage skin cells. Damaged skin cells can clog skin pores, increasing the likelihood of acne to develop. Scientists also speculate that lithium may trigger inflammation in the skin.2,5

Drug-induced Acne Cause by Lithium
Treatment of Acne Caused by Lithium.

When it comes to acne due to lithium, a potential roadblock presents itself with the medication called isotretinoin (Accutane®), which is approved to treat severe cases of acne. This roadblock is that about one percent of people who take isotretinoin may experience depression as a side effect, which would defeat the purpose of taking lithium in the first place.1 Therefore, if you develop acne as a result of taking lithium, your doctor may hesitate to prescribe isotretinoin to you.

Tetracyclines, a class of oral antibiotics that can treat acne, are also not an option for treating acne caused by lithium, because the combination of tetracyclines and lithium can be toxic to the body. As a result, your psychiatrist may recommend replacing lithium with another mood stabilizer which does not cause acne—or if you continue to take lithium, your dermatologist may suggest a different acne therapy.1

Isoniazid - Can Definitely Cause Acne


Isoniazid

What It Is. Isoniazid is one of the main medications for the treatment of tuberculosis (a bacterial disease that affects the lungs). According to two large studies, approximately 1.4–2.5% of people who take isoniazid develop acne—usually after taking the drug over a long period of time2—and taking it with other tuberculosis drugs may increase your chances.

One study of 2600 people found that among people who took isoniazid in combination with aminosalicylic acid, another tuberculosis medication, 16% developed acne.4

How It Causes Acne. We do not yet know how isoniazid causes acne. Research suggests that in some people, isoniazid tends to build up in the body, and these people may be more likely to develop acne due to it.4

Drug-induced Acne Caused by Isoniazid


Treatment of Acne Caused by Isoniazid. In most cases, once someone stops taking isoniazid, her acne will gradually disappear.2

Halogens - Can Definitely Cause Acne


Halogens

What They Are. Halogens are medications that contain the following chemicals: iodides, bromides, and/or chlorides. They are part of:

  • Many asthma medications, such as potassium iodide (Quadrinal®) and (Theophylline Ki)
  • Some expectorants (cough medicines), such as potassium iodide
  • Some vitamin supplements, such as supplements that contain kelp and many multivitamins2

Bromides, specifically, are found in:

  • Some sedatives, such as potassium bromide
  • Some cold remedies, such as the oral medication dextromethorphan hydrobromide (Bromfed DM®) and the nasal spray compound ipratropium bromide2
  • Some medications for treating ulcers, such as mepenzolate bromide
  • Some medications for treating the muscle disease myasthenia gravis, such as pyridostigmine bromide and prostigmin bromide

Halogens often cause acne. Iodides and bromides are especially likely to cause acne or worsen existing acne, but iodides tend to cause more severe acne than bromides do.2 Acne due to halogens usually consists of comedo-like lesions and yellow cysts on the face.1

Drug-induced Acne Caused by Halogens


How They Cause Acne. We currently do not know how halogens cause acne.

Treatment of Acne Caused by Halogens. Once a person stops using medications containing halogens, his acne should gradually disappear.

EGFR Inhibitors - Can Definitely Cause Acne


EGFR inhibitors

What They Are. Epidermal growth factor receptor (EGFR) inhibitors are a class of drugs for treating cancer, and they include cetuximab and erlotinib. As many as 85% of patients who take these drugs develop acne. More than 50% of people start to see acne after just one week of taking EGFR-I. Unlike regular acne, acne caused by EGFR-I can also appear on the lower legs and the back of the arms, and the breakouts typically do not include comedones.2,3

Drug-induced Acne Caused by EGFR Inhibitors


How They Cause Acne. EGFR-I block the normal life cycle of skin cells, leading to clogging of skin pores. In addition, they speed up inflammation of the skin pores—so if acne has already started to form, these drugs will speed up the process.2

Treatment of Acne Caused by EGFR-I. Acne caused by EGFR-I, just like regular acne, can be treated with a variety of therapies. Treatment, however, is nonspecific. The lesions are known to respond to the regimens used in the standard treatment of acne, including commonly used anti-acne medications8.


Medications That May Cause Acne

Vitamin B Compounds

What They Are. Vitamin B compounds are vitamins that are present in some foods and can also be taken as supplements. Vitamins B6 and B12 may cause acne, and almost all known cases of acne that are thought to be due to vitamin B compounds have occurred in women.2 Vitamin B12 may cause acne or exacerbate existing acne only at high doses, such as 5–10 milligrams per week. When it comes to vitamin B6, we do not know what doses may cause acne.2 On average, acne may appear about two weeks after a person begins using vitamin B compounds.1

Vitamin B Compounds - May Cause Acne


How They May Cause Acne. We do not know how vitamin B compounds may cause acne. Some scientists have suggested that these vitamins may irritate the skin pores, causing inflammation.2

Drug-induced Acne Caused by Vitamin B Compounds


Treatment of Acne Caused by Vitamin B Compounds. Acne that may be caused by vitamin B compounds usually disappears gradually once someone stops taking the supplements.2


Medications That Might Cause Acne

Several common medications might cause acne, based on a small number of case reports. Because there is little research evidence linking these medications to acne, we do not know how they potentially cause acne or how the acne should be treated.

Hormonal Contraceptives that Release Progesterone - Might Cause Acne


Hormonal Contraceptives That Release Progesterone

Oral contraceptives (birth control pills) containing female hormones normally help to clear up acne in females. These pills typically contain both estrogen and progesterone, the two main female sex hormones. However, some birth control devices that only contain progesterone might occasionally cause acne in some females. These include:

Intrauterine Devices (IUDs) That Release the Female Sex Hormone Progesterone. Some women develop acne one to three months after starting to use an IUD that releases hormones. In these cases, the acne might appear on the jaw and back and consists of papules.4,5

Implants, Such as Implanon®, Which Releases Progesterone Up to 26.8% of women using Implanon® might develop acne, although not all studies agree on these numbers.5

Drug-induced Acne Caused by Hormonal Contraceptives that Release Progesterone
Rifampicin - Might Cause Acne


Rifampicin

Rifampicin is a drug for treating tuberculosis, and doctors usually prescribe it in combination with isoniazid. Only one report, published in 1974, links rifampicin to acne:

journal-1.jpg

The report describes a number of African patients who received rifampicin with another drug to treat tuberculosis, and developed acne on the face, shoulders, and back after five weeks. The authors found that the acne resolved after the patients stopped taking rifampicin, even though they continued to take the other medication.5

Drug-induced Acne Caused by Rifampicin
Ethosuximide - Might Cause Acne


Ethosuximide

Ethosuximide is a medication for treating epilepsy (seizure disorder). Only one case report, published in the European Journal of Dermatology in 2017, links the drug to acne:

European Journal of Dermatology

The report describes a 20-year-old Italian girl who had never had acne, but who developed acne after treatment with ethosuximide. The girl experienced papules and pustules on the chest, back, forehead, and neck that were intensely itchy.6

To treat the acne, the girl’s doctors reduced her ethosuximide dose and also prescribed an antihistamine (antiallergy) medication for the itching and a topical antibiotic. This treatment was effective, and the acne gradually disappeared.6

Drug-induced Acne Caused by Ethosuximide


The table below summarizes all the common medications we have looked at and their link with acne.

Summary of All Common Medications and Their Link to Acne



The Bottom Line

Research shows that common medications, such as corticosteroids, anabolic-androgenic steroids (AAS), lithium, isoniazid, halogens, and EGFR inhibitors (EGFR-I), definitely can cause acne. Though the evidence is scanty, the same may be true of vitamin B supplements. Lastly, some case reports suggest that rifampicin, ethosuximide, and other hormonal contraceptives which release progesterone potentially bring about acne.

The Experts at Acne.org

Our team of medical doctors, biology & chemistry PhDs, and acne experts work hand-in-hand with Dan (Acne.org founder) to provide the most complete information on all things acne. If you find any errors in this article, kindly use this Feedback Form and let us know.

References:

  1. Kazandjieva, J. & Tsankov, N. Drug-induced acne. Clin Dermatol 35, 156–162 (2017).
  2. Zouboulis, C. Pathogenesis and Treatment of Acne and Rosacea. (Springer Berlin Heidelberg, 2014).
  3. Cutaneous drug eruptions. 157–165 (Springer, 2015).
  4. Zeichner, J. Acneiform eruptions in dermatology. (Springer Science+Business Media, 2014).
  5. Du-Thanh, A., Kluger, N., Bensalleh, H. & Guillot, B. Drug-Induced Acneiform Eruption. Am J Clin Dermatol 12, 233–245 (2011).
  6. Ricci, F., Paradisi, A. & Masini, F. Acneiform eruption induced by ethosuximide. EJD 24, 97–98 (2017).
  7. Anabolic steroid,  .
  8. DeWitt, C., Siroy, A. & Stone, S. Acneiform eruptions associated with epidermal growth factor receptor–targeted chemotherapy. J Am Acad Dermatol 56, 500–505 (2007).

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