Corticosteroids, and especially prednisone, are often prescribed to treat many inflammatory conditions, including inflammatory bowel disease (IBD). Some people who take steroid medications can develop a type of acne commonly known as “steroid acne.”
Far from being a trivial adverse effect of a medication, acne breakouts can have a significant negative effect on the quality of life.
People with IBD often feel that acne is a secondary condition not worth complaining about and may not bring it up with their healthcare providers. However, feeling good about yourself and your appearance can help you cope with the IBD and keep IBD flares under control.
Prednisone Side Effects
Prednisone is an inexpensive and effective medication prescribed by many physicians to keep Crohn’s disease or ulcerative colitis under control. Ideally, it should only be used for a short amount of time but is sometimes used for longer periods if IBD symptoms aren’t improving.
Prednisone is associated with many side effects, some of which are serious or intolerable. They include:
- Nausea and vomiting
- Blurred vision and eye pain
- Rapid weight gain
- Shortness of breath
- Muscle weakness
- Slow wound healing
- Rapid or irregular heart rate
- Chest pain
- Increased urination
- Changes in personality or behavior
- Bloody or tarry stools
- Coughing up blood
The current goal of IBD treatment is to control inflammation without the use of steroids or, at very least, to use them for as short a period of time as possible.
Types of Steroid Acne
Acne is often thought of as a problem for adolescents, but steroid acne can happen to anyone taking steroids regardless of age.
That said, it tends to be more common in teens and adults. Steroid acne can appear on the face, chest, or back and is commonly associated with two forms: Acne vulgaris and Malassezia folliculitis.
- Acne vulgaris is the main type of acne and the one most often occurs with high-dose prednisone therapy (usually within two weeks of starting treatment). It often appears as uniform lesions and is prevalent in people with a tendency towards acne in the first place.
- Malassezia folliculitis is caused by a fungus in and around hair follicles. It’s estimated that anywhere from 75% to 98% of people have this type of fungus on their skin. While its presence is normal, overgrowth is not. This itchy acne is most common on the chest and trunk.
Steroid acne will begin to recede once prednisone is discontinued. During prednisone treatment, acne remedies can be used to help control outbreaks.
The type of treatment that is used will depend on the type of acne present as well as several other factors such as other medications that are being taken and the severity of the acne.
Accutane (isotretinoin) is usually not recommended for treating acne in people with IBD as it may trigger diarrhea and rectal bleeding. Instead, topical cleansers and anti-acne agents such as benzoyl peroxide are recommended as the first step in treating acne.
For moderate to severe steroid acne, common prescription treatments include oral antibiotics such as:
Fungal acne is best treated with:
- Topical antifungals
- Oral antifungals like itraconazole
- Shampoos containing ketoconazole
Once prednisone is started, it cannot be abruptly stopped due to the risk of withdrawal symptoms. Depending on how long you’ve taken prednisone and in what dose, the tapering-off process can take weeks and even months.
A Word From Get Meds Info
Remember that even though acne, especially on the face, can be difficult to live with, the acne will clear up when you taper down off the steroids.
In the meantime, receiving treatment for acne may help to clear up the skin until the prednisone is stopped.