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Drugs and Medications that may Cause or Aggravate Acne



Some medications are associated with an 'acne-like' or 'acneiform' skin reaction. Dermatologists refer to this phenomenon as an 'acneiform rash'.

Acne reactions caused by drugs, differ from 'regular' acne in several ways:

First, in traditional acne, the blackheads or whiteheads, called comedones, are the primary skin lesions and appear first. Later, these closed pores can develop into inflammatory pimples, pustules or cysts of inflammatory acne. 

In drug-induced acne, the inflammatory lesions develop first, and often there are no comedones or closed pores. Comedones develop in some patients with acneiform drug reactions as the inflammatory pimples heal.

Second, the closed pores or comedones of ordinary acne and the secondary pimples develop over time in different areas at different stages. Patients with typical acne will have a variety of closed pores, pimples and papules in varying stages of development, all at the same time.

In medication induced acne, the lesions usually occur all at once, what is called a 'monomorphous crop'. This means that all the pimples or inflammatory zits appear suddenly and are all at approximately the same stage of development.

The sudden appearance of a crop of inflammatory pimples is often the tip-off that a medication or drug may be aggravating or causing the acne rash


Some of the medications that can cause acne-like rashes include:

1. Corticosteroids.  Both systemic (oral or intravenous) and topical applied steroid skin care creams can cause or aggravate an acne rash.  In some cases, the acne doesn't flare until after the steroid is stopped.  Some patients mistakenly use topical steroids to treat acne, only to have the acne flare badly when the steroid cream is discontinued. 

2. Epidermal Growth Factor Receptor Inhibitors. 

    This is a new class of anti-cancer medications that have successfully extended the lives of some patients with solid tumors such as lung cancer.  One of the common side effects of this class of medications is the development pustules around hair follicles, similar to acne, but with no comedones or closed pores.  This rash, or folliculitis, can be severe, but is often associated with a good cancer-fighting response to the medication.

     One recent study is suggesting treating patients for the an acne rash as prevention, at the same time as the chemotherapy epidermal growth factor inhibitors are given.

3. Androgens.  Hormones play a role in most acne.  Taking male-hormones or androgens, such as testosterone, is associated with an aggravation of acne in some individuals. 

4. Seizure medication.  Both Valproate and Hydantoin, used to treat seizures have been reported to cause acne-like rashes.

5. Lithium.  Lithium has been reported to fairly commonly cause pustular acne reactions.

This list of acne-causing medications is by no means all-inclusive.  Please discuss the medications you are taking with your health care provider while embarking on acne treatment.



Reference:

Drug Induced Acneform Eruptions: Definitions and Causes

Saira Momin et al.

Cosmetic Dermatology: Vol 22 No. 1 January 2009




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