Moon Face - Causes, Treatment, and Prevention

Introduction:

Moon facies, more commonly called moon face, is not a disease but occurs due to other medical conditions. The face becomes full, puffed up, and rounded due to fat accumulation on the sides of the face. It occurs mainly in people who take steroid therapy for long periods. Though it does not cause any severe complications, the moon face can be disturbing to the person, thereby affecting their self-esteem. However, the condition is easily treatable when the underlying cause is identified and resolved.

What Are the Causes of Moon Face?

Multiple factors, conditions, and medications can lead to the development of a moon face. The below listed is the relationship between the moon face and various factors.

• Steroids and Moon Face: Prednisone is a steroid medication that is prescribed to help relieve pain and inflammation. The most common cause of moon face is the long-term use of Prednisone. Long-term use of the drug affects the levels of hormones released by the adrenal gland, thereby causing side effects. The patient experiences puffing up and fullness of the face due to fat accumulation on the sides of the skull, to such an extent that ears cannot be seen from the front.

The drug Prednisone is prescribed under the following conditions:

• Organ transplant.

• Asthma, narrowing of airways causing cough, wheezing, and difficulty breathing.

• Arthritis, in which there is swelling and inflammation of the joints.

• Lupus erythematosus is an autoimmune condition that causes skin rashes, joint erosions, and kidney failure.

• Anemia, or deficiency of red blood cells (RBCs).

• Addison's disease is a deficiency of hormones released by the adrenal glands.

• Chronic inflammatory conditions.

The side effects that occur due to long-term use of Prednisone include:

1. Weight gain.

2. Mood changes.

3. Moon face.

Apart from Prednisone, other drugs from the corticosteroid group can also cause moon face. The drugs include:

• Cortisone.

• Methylprednisolone.

• Dexamethasone.

Certain conditions that affect the adrenal and thyroid glands can also cause moon face as a side-effect. For example, hypercortisolism or hyperadrenocorticism is a condition in which excess cortisol is released by the adrenal glands, which are a pair of triangular glands.

The conditions related to moon facies include:

• Increased ACTH (adrenocorticotropic hormone) released by the pituitary gland causes an increase in cortisol released by the adrenal glands.

• Benign or malignant (harmful) tumors of the adrenal gland.

• Tumors of the lungs, pancreas, or thymus gland can also trigger the release of large amounts of ACTH.

• Chronic use of Prednisone for the treatment of autoimmune conditions.

Doctors advise blood and urine tests to determine if the moon face is caused due to elevated cortisol levels. In addition, an MRI (magnetic resonance imaging) or a CT (computed tomography) scan is suggested to know the exact cause of the moon face.

• Cushing’s Syndrome and Moon Face: Cushing's syndrome is a condition in which the body produces too much of the hormone cortisol. The causes of Cushing's syndrome include receiving high levels of medicines like Prednisone, stress, tumors, or overproduction of pituitary hormones. Cushing's syndrome can cause fat accumulation on the trunk, abdomen, and neck, making the arms and legs look thin. If moon face and other characteristics worsen with time, then the cause of moon face due to Cushing's syndrome is confirmed. Treatment depends on identifying the cause and treating it.

• Hypothyroidism and Moon Face: Hypothyroidism is one condition that can cause a moon face. Hypothyroidism occurs when the thyroid gland does not produce enough thyroid hormones due to autoimmune disorders, irradiation of the neck, or removal of the thyroid gland.

• Diabetes and Moon Face: People with diabetes have high blood sugar. These blood sugars get converted into fats and are stored by the body. This can cause weight gain with time, leading to a moon face. People with sudden weight gain must consult a doctor, as it is not a healthy sign and could be due to an underlying condition.

• Weight Gain and Moon Face: Weight gain and obesity can make a face look puffier and rounder. A sudden loss of weight is not possible nor advisable. A gradual weight loss under the guidance of a doctor or a dietitian can make a face normal over time.

What Are the Risk Factors for Developing Moon Face?

The most common risk factor for developing moon face is the chronic use of Prednisone. The condition is more common in women compared to men and in older individuals compared to the younger age group. Also, conditions such as hypothyroidism and Cushing's syndrome affect females more than males, which is also a coinciding factor for developing a moon face.

Can Moon Face Be Prevented?

It is not possible to prevent moon faces. Stopping certain medicines to reduce the severity of moon face can cause severe symptoms to return. A change of drugs, if needed, has to be suggested only by doctors. However, there are a few ways that can help in reducing the puffiness, that include:

• Managing the body weight.

• Drinking enough water.

• Reducing the intake of sodium.

• Opting for a healthy diet.

• Enquiring the doctor about treatments that are less likely to cause moon face.

How Is Moon Face Managed?

Moon face is not a disease; it is only a condition occurring due to another condition. There is no treatment for moon faces; however, identifying the underlying cause and managing it accordingly can help moon faces decrease in severity or disappear gradually. Doctors may advise a change of steroid medication or reducing its dose if moon face is due to the intake of Prednisone. In contrast, conditions like Cushing's syndrome or hypothyroidism are treated accordingly, which helps in reducing the symptoms caused by those conditions. Moon face is one of the symptoms, also tends to disappear with proper treatment.

What Are the Tips for Living With a Moon Face?

Some people with moon faces can be low on confidence, affecting their self-esteem and social interaction. A few tips that can help in boosting the morale of such persons include:

1. Emphasizing Body Neutrality: Body neutrality focuses on making a person feel neutral towards their body rather than pressuring them to look a certain way.

2. Encouraging Body Appreciation: Body appreciation means conscious thinking about the impressive things a body can do rather than focusing on how it looks. Also, if the weight gain is due to treatment, the mind must focus on the treatment's positive outcome.

3. Reducing Water Retention: Reducing the intake of salt and processed foods can help decrease water retention in the body and improve the moon face.

Conclusion:

Moon face is a condition that causes a rounder, puffy-looking face due to fat accumulation on the sides of the skull. As it is not a disease, managing the underlying cause helps. Though it cannot disappear in a day or two, lifestyle changes like weight management and less salt intake can help ease the condition. In addition, joining support groups with people facing similar issues can help boost the lost self-confidence.