Drug-induced acne: when a medicine causes or worsens spots

Acne develops when hair follicles become blocked with excess oil and dead skin cells and bacteria grow in them, causing inflammation and pus. That is how the NHS describes it, and the British Association of Dermatologists adds that the oil-producing glands are particularly sensitive in acne, even when hormone levels are normal.

In drug-induced acne, a medicine or similar substance is the trigger or the factor that makes existing acne worse. The NHS lists taking certain medicines among the causes of acne. The British Association of Dermatologists is more specific, naming high-dose steroids, certain hormonal contraceptives and anabolic steroids, and saying that occasionally other types of medication can make acne worse.

The term is used by doctors for the pattern more than as a separate disease. The spots usually look like ordinary acne: blackheads, whiteheads, red bumps and pus-filled spots, mostly on the face, chest and back. The clue is the timing, with spots appearing or worsening after a medicine has been started or its dose increased.

The sources used for this page name a short list. They do not give a complete catalogue of drugs, so the pharmacist or the patient information leaflet that comes with a particular medicine is the best place to check whether acne is listed as a side effect.

The NHS says acne can range from mild, with a few spots, to severe, with deep, painful lumps under the skin, and that it usually affects the face, chest and back. Skin may feel hot or painful to touch, and acne can leave scars, such as shallow holes in the skin.

The British Association of Dermatologists describes the lesion types as blackheads and whiteheads (comedones), pus-filled spots (pustules), and occasionally larger, deeper nodules or cysts. Scars can be raised and lumpy or indented, and discolouration may be red, darker or lighter than the usual skin colour.

Acne can affect mental health. The NHS says it can cause anxiety, depression and low self-esteem, and the British Association of Dermatologists notes that severe acne has been associated with suicidal behaviour and encourages people to speak with their healthcare professional about support if needed.

Do not stop a prescribed medicine on your own because of spots. Steroids, hormonal contraceptives and many other medicines are prescribed for good reasons, and stopping some of them suddenly can cause harm. The British Association of Dermatologists simply advises discussing sudden-onset or sudden worsening acne with your healthcare professional. A GP or pharmacist can check the timing against what you take and decide whether a change, a lower dose or an acne treatment alongside it is sensible.

If the substance is not prescribed, such as anabolic steroids bought for bodybuilding, the British Association of Dermatologists identifies these as a trigger of acne. It is worth being open with a GP or pharmacist about such products, because they have other effects on the body that the sources used for this page do not cover.

Bring a list of everything you take, including over-the-counter products, supplements and skin or hair products. The NHS also suggests non-comedogenic skincare and make-up, washing the skin twice a day with a gentle cleanser, and not picking or squeezing spots because this can cause scars.

Treatment follows the same steps as for other acne. The NHS says a pharmacist can recommend treatments to put on the skin, such as salicylic acid or benzoyl peroxide, and the British Association of Dermatologists lists benzoyl peroxide, azelaic acid and nicotinamide as treatments available over the counter. It says most take 2 to 4 months to produce their full effect, and that if you have had no success with over-the-counter products you should visit a healthcare professional.

The NHS says a GP may offer prescription treatments, or refer to a dermatologist, if you have tried treating acne yourself and it is not getting better, if you have lots of spots or deep, painful or scarring spots, or if it is affecting your mental health. The treatments it lists include topical retinoids such as tretinoin and adapalene, topical antibiotics such as clindamycin and erythromycin, antibiotic tablets such as doxycycline and lymecycline, the combined pill, and isotretinoin.

The British Association of Dermatologists says oral antibiotics need to be taken for at least 12 weeks, are usually given for 3 to 6 months and should not normally continue beyond 6 months because of concerns about antibiotic resistance. It says isotretinoin can be prescribed only under the supervision of a dermatology healthcare professional, can harm an unborn child, and requires a pregnancy prevention programme for people who can get pregnant.

The British Association of Dermatologists says there is no cure for acne as such, but treatments can be very effective, preventing new spots and reducing scarring. When a medicine is the main trigger, a GP or pharmacist may be able to adjust it or treat the acne alongside it. The sources used here do not say how quickly acne settles after a trigger is removed, so a GP is the best guide for your own situation.

Scarring is the main long-term concern, which is why early treatment is encouraged. If scars have formed, the NHS notes acne can leave shallow holes in the skin (ice-pick or boxcar scars), and treatments for scars are a separate topic from treating the spots themselves.

Acne linked to medicines is usually dealt with by a pharmacist and GP, with referral to NHS dermatology if it is severe, scarring or not responding. Isotretinoin is prescribed under dermatology supervision. Some people see a private dermatologist; if you do, give them the full medicine list and let your GP know about any new treatment, since several acne treatments interact with other medicines or are unsuitable in pregnancy.