AAS Induced Acne

When someone uses anabolic-androgenic steroids, the increased androgen levels stimulate the skin’s oil glands, promote follicular (pore) plugging, and increase bacterial or fungal activity, all of which can lead to acne outbreaks.

In fact, studies report that up to about 50% of bodybuilders or users of high-dose AAS may develop acne as a result of steroid use.

Typical features may include:

• Breakouts on the face, neck, chest, or back (especially the upper back)
• Acne that may be more severe than typical acne and harder to control

• The appearance of acne may be a sign of underlying hormonal imbalance or high androgen exposure.
• If left unchecked, the acne may become more severe and lead to scarring or nodular lesions, which are harder to treat.
• Proper assessment allows us to tailor treatment, monitor for other steroid-related effects (on liver, cholesterol, hormones), and give you a plan that fits your skin and health goals.

Appearance of AAS-induced acne

• Lesion type: Often presents as inflamed red papules and pustules, sometimes with nodules or cysts in severe cases.
• Severity: Can range from mild spots to severe, painful nodular acne, which may scar if untreated.
• Rapid onset: Acne can appear suddenly after starting steroids, even in people who previously had clear skin.
• Resistant to over-the-counter treatment: Due to strong androgenic stimulation, it may not respond to standard acne creams or washes.
• Associated features: Increased oiliness of the skin (seborrhoea), follicular plugging (blackheads/whiteheads), and sometimes irritation or redness around lesions.

Typical areas affected

AAS-induced acne often appears in locations with high concentrations of sebaceous (oil) glands:

1. Face – forehead, cheeks, chin, jawline (often more severe than ordinary teenage acne).
2. Upper back and shoulders – a common site for “bodybuilder’s acne.”
3. Chest and upper arms – particularly the pectoral region.
4. Neck and sometimes lower back – less common, but possible.

Unlike regular acne, AAS-induced acne can appear suddenly in adults, affect areas not typically involved in teenage acne, and be more widespread and inflamed.

Key point

The combination of sudden onset, painful red papules or nodules, oily skin, and involvement of the chest, back, and shoulders is a strong clue that acne may be steroid-related.

Feature: Typical age of onset

• Regular acne: Teenagers or adults gradually
• AAS-induced acne: Sudden onset in adults (often after starting steroids)

Feature: Onset speed

• Regular acne: Gradual over months/years
• AAS-induced acne: Rapid, sometimes within weeks of steroid use

Feature: Common locations

• Regular acne: Face (forehead, cheeks, chin), occasionally upper back
• AAS-induced acne: Face, chest, shoulders, upper arms, upper back (“bodybuilder pattern”)

Feature: Lesion type

• Regular acne: Mostly blackheads, whiteheads, small pimples; cysts are less common
• AAS-induced acne: Inflamed red papules/pustules; sometimes painful nodules or cysts

Feature: Severity

• Regular acne: Usually mild to moderate
• AAS-induced acne: Can be moderate to severe; higher risk of scarring

Feature: Skin oiliness

• Regular acne: Normal to slightly oily
• AAS-induced acne: Often noticeably oily (seborrhoea)

Feature: Response to treatment

• Regular acne: Often responds to OTC cleansers, topical retinoids, benzoyl peroxide
• AAS-induced acne: Frequently resistant to OTC treatments; may require prescription therapy

Feature: Other associated signs

• Regular acne: Rare systemic effects
• AAS-induced acne: May accompany other steroid-related changes (rapid muscle gain, hair loss, hormonal effects, mood changes)

Acne can sometimes give clues about anabolic-androgenic steroid (AAS) use, but it is not a reliable indicator of the “quality” or exact type of steroid. Here’s a clear, patient-friendly explanation:

1. Androgenic strength matters

• Steroids with strong androgenic activity are more likely to trigger acne because they stimulate the sebaceous (oil) glands and increase pore blockage.
• Examples: Testosterone, trenbolone, and other potent androgenic compounds can produce more severe acne.
• Less androgenic steroids may cause milder acne or none at all.

2. Dosage and duration are key

• Acne severity is more strongly linked to the dose and duration of steroid use than the brand or “purity.”
• High doses or long cycles almost always increase the risk of acne, even with supposedly “clean” or high-quality steroids.

3. Individual susceptibility

• Some people are genetically more prone to acne, so even low-dose steroids may cause significant breakouts.
• Conversely, others may tolerate relatively strong steroids without noticeable acne.

4. Other influencing factors

• Skin care habits, diet, stress, and underlying hormonal balance can all affect acne severity.
• Injectable vs. oral steroids can influence side effects like liver strain or cholesterol changes, but acne risk is primarily determined by androgenic stimulation.

Key takeaway

Acne does not reliably indicate the quality, purity, or specific type of AAS. Severe acne is generally a sign of high androgenic activity, high dose, prolonged use, or individual sensitivity, rather than an indication that a steroid is “fake” or low-quality.

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Yes — in many cases, AAS-induced acne can be managed while continuing steroid use, but it depends on severity, your health, and careful medical supervision. Here’s a patient-friendly breakdown:

1. Topical treatments

• First-line approach for mild-to-moderate acne.
• Options include benzoyl peroxide, topical retinoids (like adapalene), or combination therapies.
• These reduce inflammation, unclog pores, and prevent new lesions.
• Gentle, non-comedogenic cleansers and moisturisers help maintain skin health.

2. Oral medications

• Antibiotics (e.g., tetracyclines) may be prescribed for moderate acne to reduce bacterial growth and inflammation.
• Oral isotretinoin is considered in severe or resistant cases, but must be closely monitored due to potential side effects (liver, cholesterol, and mood).
• These can be used without necessarily stopping steroid use, but your doctor will carefully weigh benefits versus risks.

3. Adjunctive measures

• Skincare habits: Avoid picking, squeezing, or using harsh scrubs.
• Lifestyle factors: Diet, hydration, and stress management can influence acne severity.
• Monitoring: Regular check-ups to track acne improvement and detect any complications early.

4. Limitations

• While acne can often be improved without stopping steroids, some patients may still experience flare-ups if the AAS dose is high or the steroid is very androgenic.
• Stopping or reducing steroid use is the most reliable way to fully resolve acne, but it’s not always necessary for improvement if medical treatment is optimised.

Key takeaway

Effective treatment is possible without stopping AAS, especially for mild to moderate acne, but it requires personalised medical supervision. At Harley Street MD, we can help you balance skin management with hormone therapy, reducing acne risk while monitoring your overall health.

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Managing AAS-Related Acne Without Stopping Steroids

If you’re using anabolic-androgenic steroids (AAS) and develop acne, there are ways to manage it safely without immediately discontinuing your cycle. At Harley Street MD, we take a doctor-led, evidence-based approach to help you maintain skin health while monitoring overall wellbeing.

Step 1: Medical Assessment

• Schedule a consultation to review your steroid use, health history, and skin condition.
• Blood tests may be performed to check hormones, liver function, and cholesterol.
• Assess acne severity and risk of complications like scarring.

Step 2: Topical Treatment

• Start with medicated creams and gels such as:
  • Benzoyl peroxide – reduces bacteria and inflammation.
  • Topical retinoids (e.g., adapalene) – unclogs pores and prevents new lesions.
• Use gentle, non-comedogenic cleansers twice daily.
• Avoid picking or squeezing spots to reduce scarring risk.

Step 3: Oral Medications (if needed)

• Antibiotics (tetracycline family) for moderate acne.
• Oral isotretinoin for severe or resistant cases, under close supervision.
• These medications can often be used without stopping steroids, but require careful monitoring for side effects.

Step 4: Skin & Lifestyle Support

• Keep skin clean and moisturised with oil-free products.
• Maintain a balanced diet and stay hydrated.
• Manage stress and avoid excessive sun exposure or harsh scrubs.

Step 5: Ongoing Monitoring

• Follow-up appointments to track improvement and adjust treatment.
• Monitor for side effects from acne treatments or steroids themselves (liver, cholesterol, hormones).
• Early intervention prevents scarring and long-term skin damage.

Step 6: Evaluate Steroid Dose if Acne Persists

• If acne is severe or not responding, review your steroid regimen with a medical professional.
• Sometimes reducing dose or switching to a less androgenic compound helps control acne while maintaining goals.

Key Takeaways

• Mild-to-moderate steroid acne can often be managed without stopping AAS.
• Severe or resistant acne may require prescription medications or a steroid review.
• Medical supervision is essential for safe and effective management.

At Harley Street MD, we provide a confidential, tailored service combining dermatology and hormone expertise to help you manage acne while supporting overall health.

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At Harley Street Medical Doctors we recognise that acne arising in the context of anabolic-androgenic steroid (AAS) use may require a tailored treatment approach.
Below is a brief overview of the medications and over-the-counter (OTC) skin treatments commonly used, always under medical supervision.

Common OTC / topical treatments

These are a good first-line approach, especially for mild-to-moderate acne:

• Benzoyl peroxide: An antiseptic gel or wash that kills acne-causing bacteria and helps reduce inflammation. OTC forms are widely available.
• Salicylic acid: A beta-hydroxy acid that helps exfoliate pores and prevent plug formation (blackheads/whiteheads). OTC topical washes or leave-on treatments.
• Topical retinoids: Some are available OTC (in certain jurisdictions) such as low-strength Adapalene 0.1%. They help normalise skin-cell turnover and prevent pore blockage.
• Non-comedogenic skincare and gentle cleansing: Though not a “medication”, using oil-free moisturisers and gentle cleansers supports treatment and helps reduce worsening.

Prescription medications

For more extensive, inflamed, nodular or body-wide acne (which is often what we see with steroid-related cases) the following are commonly used:

• Topical prescription retinoids (e.g., Tretinoin): There is evidence that even in steroid-induced acne, tretinoin applied topically cleared dense comedonal eruptions despite ongoing steroid exposure.
• Oral antibiotics: Typically from the tetracycline class such as Doxycycline or Minocycline, used when there is significant inflammation, pustules or risk of scarring.
• Hormonal or anti-androgen treatments: In some hormonally-mediated cases of acne, especially in women, agents such as Spironolactone may be considered.
• Isotretinoin: For severe, scarring, nodular acne (including steroid-triggered), a full course of isotretinoin may be required under specialist supervision.

Points to keep in mind

• Even OTC treatments take several weeks before improvement is evident — typically 6–8 weeks (and sometimes more) before you see meaningful change.
• Because steroid-related acne may be more aggressive (due to higher androgenic stimulation), you may need stronger or combined treatments than standard “teenage” acne.
• Always use treatments as advised, gradually building up to full use, especially with retinoids (which can irritate skin initially).
• Because the underlying cause (excess androgenic stimulation) may still be present, good skincare and medical monitoring are especially important in steroid-related cases.
• Avoid relying solely on OTC treatments if you notice nodules, cysts, scarring or rapid worsening — early specialist review is key.

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Yes — while AAS-induced acne cannot always be completely prevented, there are strategies that can significantly reduce its severity and risk. Here’s a patient-friendly guide:

1. Understand the risk factors

• Acne risk is higher with potent androgenic steroids, higher doses, and longer cycles.
• Individual sensitivity varies — some people are more prone genetically.

2. Maintain good skincare habits

• Wash your face and body twice daily with a gentle, non-comedogenic cleanser.
• Use oil-free moisturisers to avoid clogging pores.
• Avoid picking, squeezing, or scrubbing the skin aggressively.
• Shower promptly after heavy sweating, especially after workouts.

3. Topical preventative treatments

• Benzoyl peroxide washes or gels can help reduce bacterial growth and inflammation.
• Topical retinoids (like adapalene) prevent pore blockage and help skin renew itself.
• These can be started before acne appears if you know you are beginning steroid use.

4. Monitor hormone and health status

• Regular check-ups can help identify early signs of hormonal or metabolic imbalance that may contribute to acne.
• Your doctor may monitor testosterone, liver function, and cholesterol during steroid use, which indirectly helps skin health.

5. Lifestyle factors

• Maintain a balanced diet rich in whole foods and low in highly processed, high-glycaemic foods that can aggravate acne.
• Manage stress and ensure adequate sleep, as hormonal stress can worsen acne.
• Avoid excessive sun exposure or harsh chemicals that can irritate skin.

6. Early intervention

• Treat small pimples or early signs of acne immediately with OTC treatments or topical prescription therapy to prevent progression.
• Consult a clinician promptly if acne is painful, widespread, or nodular — early intervention reduces risk of scarring.

Key takeaway

While you cannot guarantee prevention, careful skincare, early use of topical agents, monitoring health, and early treatment can significantly reduce the severity and long-term impact of AAS-induced acne.

Acne caused by anabolic-androgenic steroid (AAS) use can sometimes lead to permanent skin changes if not addressed early. Understanding the risks and taking preventive steps is essential for protecting your skin.

Why AAS acne can scar

• Inflamed lesions: Steroid-related acne often produces red papules, pustules, nodules, or cysts that affect deeper layers of the skin.
• Sudden flare-ups: Rapid onset on the face, chest, back, and shoulders increases the likelihood of lasting damage.
• Picking or squeezing: Manipulating spots can worsen inflammation and increase scarring risk.

Types of scarring

1. Atrophic (pitted) scars: Small depressions or “holes” in the skin.
2. Hypertrophic or keloid scars: Raised, thickened areas (more common in certain skin types).
3. Post-inflammatory hyperpigmentation: Dark spots or patches that persist after acne heals.

Factors that increase risk

• Severe or nodular acne
• Delayed or inadequate treatment
• Ongoing steroid use while acne is untreated
• Picking or squeezing lesions

How to reduce the risk

• Early treatment: Begin topical or prescription therapy as soon as acne appears.
• Hands-off approach: Avoid picking, popping, or scratching lesions.
• Professional care: Dermatological treatments (chemical peels, laser therapy, microneedling) can help manage scarring if it occurs.
• Regular monitoring: Follow-up appointments allow clinicians to adjust treatment and prevent acne from worsening.

Yes, the presence of AAS-induced acne can sometimes indicate other underlying or concurrent health issues, especially because acne in this context is a sign of high androgenic activity. Here’s a patient-friendly explanation:

1. Hormonal imbalance

• Acne develops because anabolic-androgenic steroids increase androgen levels in the body.
• High androgen levels can suppress your natural testosterone production (hypogonadism), affecting fertility, libido, and mood.
• Imbalances may also alter estrogen, progesterone, or other hormone levels, which can contribute to skin changes.

2. Liver stress

• Many oral AAS are processed through the liver.
• Severe or persistent acne can coincide with liver strain or elevated liver enzymes, especially if combined with other medications or supplements.

3. Cardiovascular risk

• AAS use can increase cholesterol imbalance (higher LDL, lower HDL) and blood pressure.
• Acne itself isn’t a direct cause, but its presence can indicate high androgen exposure, which may correlate with increased cardiovascular risk.

4. Kidney or metabolic effects

• High doses of steroids can affect kidney function, fluid balance, and glucose metabolism.
• Acne can be a visible sign of systemic steroid activity that may also impact these organs.

5. Psychological effects

• Rapid-onset acne may coincide with mood swings, irritability, anxiety, or depression, which are sometimes seen with AAS use.

Key takeaway

While acne itself is primarily a skin reaction to high androgen levels, its presence can be a red flag for other AAS-related health issues, including hormonal imbalance, liver strain, cardiovascular changes, and psychological effects.

At Harley Street MD, we recommend a full medical review whenever AAS-induced acne develops. This includes:

• Blood tests for hormones, liver function, kidney function, and cholesterol.
• Assessment of mental health and lifestyle factors.
• Individualised advice to manage acne safely while monitoring overall health.

Topical Benzoyl Peroxide
How it works:
Kills acne-causing bacteria and reduces inflammation

Potential side effects:
Skin dryness, redness, peeling, bleaching of clothes or towels

Notes for AAS users:
Often first-line for mild-to-moderate acne; can be combined with other topical treatments

Topical Retinoids (Adapalene, Tretinoin)
How it works:
Unclogs pores and normalises skin cell turnover

Potential side effects:
Redness, burning, dryness, sun sensitivity

Notes for AAS users:
Apply at night, start slowly; sunscreen is essential

Salicylic Acid
How it works:
Exfoliates pores and reduces blackheads and whiteheads

Potential side effects:
Mild skin irritation, dryness

Notes for AAS users:
Good for preventive use and mild acne

Oral Antibiotics (Doxycycline, Minocycline)
How it works:
Reduces inflammation and acne-causing bacteria

Potential side effects:
Gastrointestinal upset, sun sensitivity, rare liver changes or rashes, risk of antibiotic resistance

Notes for AAS users:
Usually prescribed for moderate acne; shortest effective course recommended

Oral Isotretinoin
How it works:
Reduces oil production, prevents clogged pores, highly effective

Potential side effects:
Dry skin, lips, and eyes; nosebleeds; joint aches; liver or cholesterol changes; rare mood effects

Notes for AAS users:
Reserved for severe or resistant acne; requires regular blood tests and close supervision

Hormonal / Anti-Androgen Therapy (e.g. Spironolactone)
How it works:
Reduces androgen-driven acne

Potential side effects:
Altered potassium levels, blood pressure changes, menstrual changes in women

Notes for AAS users:
Rarely used in men; mainly for hormonally driven acne and requires monitoring

Mild to Moderate Acne (Topical / OTC Treatments)

• Treatments
• Benzoyl peroxide
• Salicylic acid
• Topical retinoids (adapalene / tretinoin)

• Expected results
• Reduction in inflammation and new lesions within 4–6 weeks
• Significant improvement in skin texture and fewer breakouts within 8–12 weeks

• Notes
• Acne may initially appear to worsen (“purging”) in the first 1–2 weeks with retinoids
• Consistency is key — skipping applications can delay improvement

Moderate to Severe Acne (Oral Antibiotics ± Topical Therapy)

• Treatments
• Oral tetracyclines (doxycycline, minocycline), often combined with topical agents

• Expected results
• Noticeable reduction in redness and pus-filled lesions within 4–6 weeks
• Full effect usually seen by 8–12 weeks

• Notes
• Short-term flare-ups may still occur; continued adherence is essential
• Courses are usually limited to a few months to reduce antibiotic resistance

Severe or Resistant Acne (Oral Isotretinoin)

• Treatments
• Oral isotretinoin under close medical supervision

• Expected results
• Early improvement in inflammation often seen in 2–4 weeks
• Significant clearing of nodular or cystic acne usually occurs within 3–6 months of a full course

• Notes
• Maintenance skincare may still be necessary after treatment
• Regular blood tests and monitoring are required for safety

General Considerations for AAS Users

• If steroid use continues, acne may persist or recur, requiring ongoing or combination therapy
• Scarring risk decreases with early intervention and consistent treatment
• Continued use of gentle skincare, non-comedogenic moisturisers, and sunscreen remains important even after improvement

Key Takeaways

• Mild acne: improvement typically in 4–12 weeks
• Moderate acne: visible reduction in 4–6 weeks, full effect by 8–12 weeks
• Severe or resistant acne: initial improvement in 2–4 weeks, significant clearing in 3–6 months
• Early, consistent treatment and medical supervision are essential to prevent scarring

Is there any downtime for AAS-induced acne treatment?

• Most treatments involve minimal downtime, allowing normal work, exercise, and social activity
• Temporary dryness, redness, or sensitivity are the most common effects
• Gradual introduction of topical treatments and good sun protection help minimise irritation
• Medical supervision is important when combining acne treatment with ongoing steroid use

Expected Downtime by Treatment Type

• Topical treatments (benzoyl peroxide, salicylic acid, adapalene / tretinoin)
• Minimal to none
• Possible redness, dryness, or peeling — start slowly

• Oral antibiotics (doxycycline, minocycline)
• Minimal to none
• Possible sun sensitivity or mild gastrointestinal upset

• Oral isotretinoin
• Minimal to none
• Dry lips/skin, nosebleeds, joint aches
• Requires regular blood tests and monitoring

• Hormonal / anti-androgen therapy (spironolactone)
• Minimal to none
• Rare fatigue or dizziness
• Requires blood pressure and potassium monitoring

Proper preparation before starting treatment can improve results, minimise side effects, and protect your skin.

1. Schedule a Medical Review

• Have a consultation with a qualified clinician to assess acne severity, skin type, and overall health
• Discuss steroid use, medical history, allergies, and any medications or supplements you are taking
• Blood tests may be recommended to check hormones, liver function, kidney function, and cholesterol

2. Stop or Adjust Certain Skin Products

• Avoid harsh scrubs, strong chemical peels, or abrasive treatments that may irritate the skin
• Discontinue other acne treatments (e.g. multiple topical retinoids or benzoyl peroxide combinations) if instructed, to prevent over-irritation

3. Prepare Your Skin

• Start a gentle cleansing routine: wash face and affected areas twice daily with a mild, non-comedogenic cleanser
• Use oil-free moisturisers to maintain the skin barrier

4. Sun Protection

• Many acne treatments (retinoids, benzoyl peroxide, antibiotics) increase sun sensitivity
• Apply broad-spectrum SPF 30+ daily and avoid excessive sun exposure

5. Lifestyle and Hygiene

• Shower after sweating (exercise or hot weather) to remove sweat and oil that can worsen acne
• Avoid touching, picking, or squeezing acne lesions to reduce scarring risk
• Maintain a balanced diet, good hydration, and adequate sleep to support skin health

6. Set Realistic Expectations

• Acne treatments often take 4–12 weeks to show improvement, depending on severity
• Initial irritation or “purging” may occur, especially with retinoids

Key Takeaways

• Medical consultation first ensures safe, tailored treatment
• Gentle skincare before starting medication is crucial
• Sun protection and hygiene support healing and reduce irritation
• Patience is essential — acne treatment takes time

After-Care Instructions

Following treatment for anabolic-steroid–related acne, proper after-care helps maintain results, protect the skin barrier, and prevent flare-ups.

1. Follow Your Treatment Plan Consistently

• Use prescribed topical or oral medications exactly as instructed
• Do not stop treatment early, even if improvement is seen
• If a dose is missed, take or apply it when remembered (unless close to the next dose)

2. Manage Skin Sensitivity

• Mild dryness, redness, or flaking is common in the first 1–2 weeks
• Use a gentle, fragrance-free moisturiser daily
• Avoid over-washing — twice daily is sufficient
• Reduce frequency and contact your clinician if irritation becomes uncomfortable

3. Avoid Picking or Squeezing Acne

• Picking increases the risk of:
– scarring
– post-inflammatory pigmentation
– infection

4. Sun Protection is Essential

• Apply SPF 30+ daily, even on cloudy days
• Reapply if sweating or outdoors for long periods
• Avoid tanning beds and deliberate sun exposure

5. Support Your Skin with the Right Products

• Use non-comedogenic skincare and cosmetics
• Avoid:
– harsh scrubs
– alcohol-based toners
– strong exfoliants unless prescribed
– fragranced or heavy oils
• If shaving causes irritation, use an electric razor or shave with the grain

6. Shower and Cleanse After Sweating

• Sweat and bacteria can trigger flare-ups
• Shower promptly after training or heavy sweating
• Use clean towels and avoid sharing personal care items

7. Medication-Specific After-Care

• Topical retinoids: use at night; avoid mixing actives unless advised
• Antibiotics: complete the full course
• Benzoyl peroxide: rinse thoroughly; may bleach fabrics
• Oral treatments (e.g. isotretinoin): follow blood-test and monitoring schedules strictly

8. Review Hormone Use and Triggers

• Do not restart anabolic steroids, SARMs, or prohormones without medical guidance
• Acne may temporarily worsen after stopping steroids as hormones stabilise
• Support with PCT or hormone evaluation may be required

9. Maintain Healthy Lifestyle Habits

• Prioritise sleep
• Stay well hydrated
• Maintain a balanced, whole-food diet
• Manage stress where possible

10. Understand the Healing Timeline

• Improvement is gradual (typically 4–12 weeks)
• Temporary purging may occur
• Scarring or pigmentation fades over months; further treatments may be discussed once acne is controlled

11. Attend All Follow-Up Appointments

• Regular reviews allow treatment adjustment and monitoring
• Blood tests may be required for oral or hormone-related treatments
• Contact the clinic urgently if you experience:
– severe redness or peeling
– spreading rash
– allergic reactions
– persistent nodules or cysts
– mood changes (if on isotretinoin)

Quick Reference

• Medication use: Follow instructions exactly; continue even if improving
• Skin sensitivity: Expect mild dryness; moisturise daily
• Sun protection: SPF 30+ daily; avoid tanning
• Lifestyle: Shower after sweating; avoid picking or harsh products
• Hormonal triggers: Avoid restarting steroids without guidance
• Follow-up: Attend reviews and monitoring appointments

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