madman
Super Moderator
A 22-year-old man presented with a 4-month history of an acute onset of a severe pustular eruption on his chest and back. He had been commenced on minocycline 100 mg daily by his general practitioner (GP). Two weeks prior to attending the dermatology department, this had been increased to 100 mg twice daily. The patient reported that he had been improving on this treatment. He had had a similar episode 1 year previously, which had taken 6 months to settle. There had been no other skin problems prior to this and he had not had acne as a teenager.
On examination, we found a muscular man, with numerous scars on his back and chest that in some places were hypertrophic. There were comedones and active pustular and nodular lesions on the back and chest and a crusted area overlying the sternum (Fig. 1). His face was clear.
A diagnosis of anabolic-androgenic steroid (AAS)- induced acne was made and he was advised to continue with the minocycline 100 mg twice daily for a further 3 months and to use Vioform HC hydrocortisone ointment to the crusted area for 2 weeks. He made good progress, and after 6 months of minocycline therapy had very few active lesions. He declined the option of oral isotretinoin.
The use of self-administered AAS by recreational bodybuilders is well recognized in the UK. A feature of their use is polypharmacy with large doses of both human and veterinary preparations.1,2 ‘Sus’ and ‘Deca’ are terms commonly used for Sustanon, a preparation of four testosterone esters and nandrolone decanoate.
The side-effects of AAS that may cause an individual to seek the advice of a dermatologist include acne, male pattern hair loss, hirsutism, and drug eruptions. O’Sullivan et al. found in one study that 43% of participants admitted to problems with acne while taking AAS.3 This is one of the most frequent adverse effects of these drugs but for many users is an acceptable one. AAS increase skin surface lipids and the density of Propionibacteria acnes, leading to an increased likelihood of acne.4
The management of AAS-induced acne can be difficult, as patients are often unwilling to admit using AAS. Indeed, some individuals may not be aware that the agents they are using contain AAS. It is important to elicit a history of AAS use in such individuals and advise them to stop these drugs. Knowledge of the colloquial names of these drugs may help to obtain an accurate history of use. Standard treatment determined by the severity of the acne should then be instituted.5
On examination, we found a muscular man, with numerous scars on his back and chest that in some places were hypertrophic. There were comedones and active pustular and nodular lesions on the back and chest and a crusted area overlying the sternum (Fig. 1). His face was clear.
A diagnosis of anabolic-androgenic steroid (AAS)- induced acne was made and he was advised to continue with the minocycline 100 mg twice daily for a further 3 months and to use Vioform HC hydrocortisone ointment to the crusted area for 2 weeks. He made good progress, and after 6 months of minocycline therapy had very few active lesions. He declined the option of oral isotretinoin.
The use of self-administered AAS by recreational bodybuilders is well recognized in the UK. A feature of their use is polypharmacy with large doses of both human and veterinary preparations.1,2 ‘Sus’ and ‘Deca’ are terms commonly used for Sustanon, a preparation of four testosterone esters and nandrolone decanoate.
The side-effects of AAS that may cause an individual to seek the advice of a dermatologist include acne, male pattern hair loss, hirsutism, and drug eruptions. O’Sullivan et al. found in one study that 43% of participants admitted to problems with acne while taking AAS.3 This is one of the most frequent adverse effects of these drugs but for many users is an acceptable one. AAS increase skin surface lipids and the density of Propionibacteria acnes, leading to an increased likelihood of acne.4
The management of AAS-induced acne can be difficult, as patients are often unwilling to admit using AAS. Indeed, some individuals may not be aware that the agents they are using contain AAS. It is important to elicit a history of AAS use in such individuals and advise them to stop these drugs. Knowledge of the colloquial names of these drugs may help to obtain an accurate history of use. Standard treatment determined by the severity of the acne should then be instituted.5