What Is Acne Medicamentosa?
Acne is a common skin issue characterized by inflamed, red lesions on the face, shoulders, neck, and other regions. The condition typically occurs when the tiny pilosebaceous follicles become clogged with dirt, dead skin cells, and oil. Acne medicamentosa is sometimes caused as a result of drug or medication side effects. Some medications that cause the condition include hormones like testosterone and corticosteroids, dehydroepiandrosterone (DHEA), medicines containing halogens (iodine and bromine), anti-epileptics (anti-seizure), anti-depressants, etc.
Who Gets Acne Medicamentosa?
Acne medicamentosa can be caused or aggravated by medications or drugs. Any individual can be at risk for acne medicamentosa. It can affect anyone, both males and females of any age group, racial and ethnic background.
What Are the Causes of Acne Medicamentosa?
Acne medicamentosa is an adverse reaction of the body to certain medications taken for various medical conditions. The offending medication potentially drives an abnormal cell-mediated immune response in the body. As a result, certain medications or drugs can trigger acne. The common causes include:
Hormones
Several hormonal medications can cause or aggravate acne, such as:
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Contraceptive agents can sometimes aggravate acne in females. These agents include Medroxyprogesterone injection, intrauterine Progesterone, and oral contraceptives.
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Testosterone.
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Oral corticosteroids can also cause steroid acne by growing yeast proliferation within the hair follicle.
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Anabolic steroids like Danazol, Stanozolol, and Nandrolone can result in severe acne. In addition, these performance-enhancing steroids can also lead to acne conglobata (an uncommon severe form of nodulocystic acne) and acne fulminans (a rare and very severe form of acne marked by painful inflammatory nodules). Athletes and bodybuilders sometimes abuse anabolic steroids to increase muscle bulk.
Other Medications
A variety of other medications can cause or aggravate acne, such as:
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Cyclosporins.
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Halogens (chlorides, iodides, bromides, halothane).
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Anti-epileptics (Phenytoin, Carbamazepine, Phenobarbital).
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Anti-depressants (Lithium and Amoxapine).
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Anti-tuberculosis drugs (Isoniazid, Ethionamide, and Rifampicin).
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Epidermal growth factor receptor inhibitors
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Vitamin B (B6, B12, cyanocobalamin).
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Biologic agents, especially (tumor necrosis factor) TNF alpha inhibitors (rare).
What Are the Symptoms of Acne Medicamentosa?
Acne medicamentosa may have a slow onset. In some cases, the signs and symptoms do not immediately appear following the beginning or usage of the drug. Instead, it can take a few weeks, months, or even years for eruptions to develop. Generally, the face, neck, chest, back, and shoulders are the usual locations of acne skin lesions. The common signs and symptoms include:
The skin lesions are classified as inflammatory and non-inflammatory:
- Inflammatory lesions include cysts, nodules, papules, and pustules.
- Non-inflammatory lesions consist of whiteheads (closed comedones) and blackheads (open comedones).
- Nodules and skin cysts deep within the skin may lead to permanent skin scarring.
- Individuals with active acne may suffer from a more severe condition.
- Signs and symptoms associated with underlying medical conditions may also be observed.
How Is Acne Medicamentosa Diagnosed?
Acne medicamentosa is typically diagnosed through a physical examination by the healthcare provider. The healthcare provider can also ask certain questions about the individual’s age, family medical history, current medications, other medical conditions, infections, and current skincare products. In addition, the provider may order a culture test if secondary infections develop. Invasive techniques, such as skin biopsy, are usually not required. However, many other medical conditions can have similar signs and symptoms. Therefore, the healthcare provider may recommend additional tests to rule out other clinical conditions to reach a definitive diagnosis.
How Is Acne Medicamentosa Treated?
The treatment for acne medicamentosa is considered case-by-case and may be based on the medication causing the signs and symptoms. Discontinuing or stopping the medication responsible for the side effects is the best way to eliminate this condition. The healthcare provider may also prescribe the following treatment options:
Medications:
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Antibiotic topical applications, antiseptic, anti-inflammatory gels, creams, and lotions.
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Benzoyl peroxide is the commonly prescribed ointment for mild acne, and topical retinoids help control hair follicles. In addition, topical retinoids help cure acne by removing the dead skin cells from the affected area.
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Antibiotics are used for more moderate acne cases.
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A newly released topical medication that plugs oil gland androgen receptors may be helpful.
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Isotretinoin is prescribed for severe acne. However, this drug is not recommended for pregnant women.
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Other therapies, such as chemical peeling, hydro facials, and microdermabrasion, phototherapy, can be helpful for the treatment of acne medicamentosa.
At-Home Care:
A few simple practices can provide a faster recovery from acne medicamentosa eruptions:
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During the period of acne, it is often advised to bring about certain dietary changes, including avoiding certain food items like sugar-rich foods and dairy products as it worsens or aggravates the condition.
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Maintain hydration by drinking plenty of fluids.
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Take care of cleanliness and hygiene (particularly face and hands).
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Avoiding the urge to pop or squeeze the blisters. This can trigger more acne to form or lead to infection or scarring.
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Wash the face daily with a gentle facial cleanser and water.
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Switch to non-comedogenic or water-based makeup products and remove makeup before bed.
What Are the Possible Complications of Acne Medicamentosa?
Some of the potential complications of acne medicamentosa include:
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Increased psychological stress negatively influences the quality of life.
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Permanent scarring and pitting of the skin. If the face and neck are necks involved, cosmetic surgery may be needed to remove such scars and marks.
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The condition can recur with more severe signs and symptoms due to further use of the causative drug.
How Can Acne Medicamentosa Be Prevented?
There is no sure way of preventing acne medicamentosa. However, some strategies can help prevent worsening symptoms and reduce the risk of scarring. These include:
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Discontinuing the medication causing the condition as soon as possible is essential. The provider may prescribe alternative drugs to treat the current underlying condition.
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Eliminating the use of the offending medication can help in preventing relapses or recurrence of acne medicamentosa.
What Is the Outlook of Acne Medicamentosa?
The outlook typically depends upon the severity of symptoms. Individuals with mild symptoms have a better prognosis than those with severe symptoms. The symptoms improve after discontinuing the drug-causing acne and through proper medical and home-based treatment. However, severe acne may result in permanent facial marks, pigmented scars, and deep pits. This may complicate the prognosis.
Conclusion
Acne medicamentosa is a skin condition caused or exacerbated by certain medications administered for other underlying medical conditions. Depending on the severity of the symptoms, acne medicamentosa may be treated mainly by discontinuing the offending drug and using suitable creams or gels, oral acne medications, and other treatments. The condition may not be preventable in some cases, but some strategies can help prevent worsening symptoms and reduce the risk of scarring.
