Understanding Acne and Its Relation to Anabolic Steroids

Acne, a common skin issue that many of us encounter, particularly during our adolescent years, can often persist into adulthood. Research suggests that around 64% of individuals still experience acne in their 20s, and approximately 43% continue to deal with it into their 30s. While acne's clinical presentation is evident, its complex underlying causes are still under investigation by researchers worldwide.

In this article, we will delve into the intricacies of acne, its pathogenesis (the process of development), and its potential connections to anabolic steroids. If you're seeking information on effective treatments, feel free to skip ahead to the final section.

Acne is believed to result from a combination of factors, including increased sebum production, abnormal keratinization, the release of inflammatory mediators into the skin, and bacterial colonization of hair follicles by Cutibacterium acnes (C. acnes). While elevated sebum production alone may not directly cause acne, it does create a favorable environment for C. acnes and alters the composition of fatty acids in sebum, potentially disturbing the barrier function of follicular walls, ultimately leading to inflammation.

Abnormal keratinization occurs when skin cells fail to shed properly, instead accumulating in hair follicles, resulting in blockages. This process can lead to the development of comedones, including microcomedones, which are early-stage acne lesions.

Androgens, a group of hormones, are known to play a role in both sebum production and keratinization. Research has shown that androgen-insensitive individuals do not produce demonstrable levels of sebum and are less likely to develop acne. Studies involving testosterone administration have also demonstrated increased sebum production.

High-dosage anabolic steroid use has been associated with an increased risk of acne. For example, the HAARLEM trial followed 100 anabolic steroid users during their cycles, and the incidence of acne rose from 13% at the beginning to 29% at the end of their cycles. Self-reported acne was even higher, with 52% experiencing it at the end of their cycles.

While acne is a common side effect of anabolic steroid usage, effective treatments are available. In this article, we'll explore some of these treatment modalities, which, while not specifically evaluated for AAS-induced acne, are likely to be effective in this context as well.

Over-the-counter oral supplements such as zinc, vitamin D, and omega-3 fatty acids have shown promise in improving acne. Zinc supplementation has been effective in several clinical trials, and vitamin D supplementation has led to a decrease in inflammatory lesions. Omega-3 fatty acids, when administered daily, have also been found to reduce acne severity.

Topical treatments like benzoyl peroxide and retinoids are available over the counter in some countries and can help combat acne. Benzoyl peroxide is particularly effective against C. acnes and may improve follicular keratinization. Topical retinoids, such as adapalene and tazarotene, primarily target keratinization and have been found to be effective. It's essential to start with lower dosages and gradually increase use to avoid skin irritation.

Isotretinoin, available only by prescription, is a highly effective acne treatment that addresses all four factors involved in acne pathogenesis. It is associated with some side effects, including dry skin and lips, but is considered the gold standard for acne treatment.

In conclusion, acne is a common side effect of high-dosage anabolic steroid use, but there are effective treatments available. Over-the-counter supplements and topical treatments can provide relief, and in severe cases, prescription medications like isotretinoin may be necessary.