Introduction

Acne or acneform (acne-like) eruptions can occasionally be caused by, or aggravated by, medications (drugs).

Acne affecting the back images

Facial acne

Facial acne

Hormones

Several hormonal medications may cause or aggravate acne.

• Oral corticosteroids, which may also cause steroid acne by increasing yeast proliferation within the hair follicle
• Contraceptive agents: medroxyprogesterone injection (Depo-Provera™), implanted (Jadelle™ or Implanon™) or intrauterine progesterone (eg Mirena™), and oral contraceptives, which reduce circulating sex hormone binding globulin (SHBG), can sometimes aggravate acne in females
• Testosterone
• Anabolic steroids such as danazol, stanozolol and nandrolone can cause severe acne including acne conglobata and acne fulminans

Athletes and body-builders sometimes abuse anabolic steroids because they result in increased muscle bulk; severe acne can arise in some of these cases.

Other medication

A variety of other medications can cause acne. Theories on why they do so include their effects on the immune system; their stimulation of insulin and insulin-like growth factor through the m-TOR pathway; and direct effects they may have on the hair follicle.

Medications known to aggravate acne include:

• Halogens (iodides, chlorides, bromides, halothane)
• Antiepileptics (carbamazepine, phenytoin, phenobarbital)
• Antituberculous drugs (ethionamide, isoniazid, rifampicin)
• Antidepressants (lithium, amoxapine)
• Ciclosporin
• B vitamins (B6, B12, cyanocobalamin)
• Epidermal growth factor receptor inhibitors
• Biologic agents, particularly TNF alpha inhibitors (rare)
• Azathioprine and ciclosporin