OVERVIEW

What is drug-induced acne?

Drug-induced acne, as the name suggests, refers to acne-like rashes caused by medications, also known as drug-induced acneiform eruptions. However, since it is triggered by drugs, it differs significantly from common acne (acne vulgaris). Therefore, it is generally classified under drug eruptions rather than acne.

Many medications can cause drug-induced acne, so patients with this condition may be encountered in various medical departments. Since it is drug-related, the most fundamental treatment is discontinuing the offending medication. Typically, the acne-like rash gradually improves after stopping the drug. If discontinuation is not possible, symptomatic treatment can be applied.
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Various medications can induce drug-induced acne, including glucocorticoids, epidermal growth factor receptor inhibitors (such as cetuximab and gefitinib), phenytoin, lithium, isoniazid, iodides, bromides, androgens, adrenocorticotropic hormone, cyclosporine, psoralen, azathioprine, vitamin B₂, vitamin B₆, and vitamin B₁₂. The first two types of drugs are the most common culprits. Acne caused by glucocorticoids is termed "steroid acne," while that induced by epidermal growth factor receptor inhibitors is called "EGFR inhibitor-associated acneiform rash."

SYMPTOMS

What are the common manifestations of drug-induced acne?

Common acne presents with diverse rashes, such as comedones, papules, pustules, nodules, and cysts, whereas drug-induced acne typically exhibits a more uniform rash pattern, often appearing as inflammatory papules and pustules. Many patients also experience discomfort like itching and pain in addition to the rash.

Where does drug-induced acne usually occur?

The affected areas of drug-induced acne are similar to those of common acne, frequently appearing in sebum-rich regions like the face and scalp. In severe cases, the rash may spread to the trunk and limbs, or even become widespread across the body.

What conditions can drug-induced acne cause?

The most common complication of drug-induced acne is infection, which may be bacterial or fungal. Additionally, the rash often leaves behind post-inflammatory hyperpigmentation or telangiectasia. However, these complications are treatable and can be improved.

CAUSES

What are the causes of drug-induced acne?

The root cause of drug-induced acne is naturally the use of medications. After entering the body through oral, intravenous, or inhalation routes, drugs trigger a series of complex reactions, leading to inflammation or immune responses, which ultimately result in acne-like rashes.

Who is more prone to drug-induced acne?

• Patients taking medications such as glucocorticoids, epidermal growth factor receptor inhibitors, phenytoin, lithium, isoniazid, iodides, bromides, androgens, adrenocorticotropic hormone, cyclosporine, psoralen, azathioprine, vitamin B₂, vitamin B₆, and vitamin B₁₂ may develop drug-induced acne.

• Patients with autoimmune diseases (e.g., systemic lupus erythematosus, bullous diseases) requiring glucocorticoids or cancer patients needing epidermal growth factor receptor inhibitors are more likely to develop drug-induced acne.

• Studies have found that among those using these medications, older individuals, smokers, and those with inadequate sun protection are more susceptible to drug-induced acne.

DIAGNOSIS

What tests are needed for drug-induced acne?

An experienced dermatologist can diagnose drug-induced acne by observing the patient's clinical manifestations and reviewing their medication history. Special tests are generally not required.

However, if the doctor suspects an infection has developed alongside drug-induced acne, further testing is recommended. Bacterial culture is performed if bacterial infection is suspected, while fungal microscopy and fungal culture are conducted if a fungal infection is suspected.

How are bacterial cultures, fungal microscopy, and other tests for drug-induced acne performed?

• Bacterial culture: A sterile swab is used to collect secretions from the rash, which are then sent to the laboratory for testing. Results are typically available in about 5 days.

• Fungal testing: This includes fungal microscopy and fungal culture. Both require scraping some skin scales. Fungal microscopy results are available in about 20 minutes, while fungal culture takes longer—approximately 2–3 weeks.

These tests are painless and non-invasive.

Which conditions are easily confused with drug-induced acne?

• Pityrosporum folliculitis: This condition typically occurs on the chest and back and is caused by Malassezia (pityrosporum) infection, often accompanied by itching. A dermatologist can perform a fungal test, and the presence of Malassezia under microscopy confirms the diagnosis.

• Acne vulgaris: This usually occurs during adolescence, primarily on the face, with diverse rash forms such as comedones, papules, or nodules. There is typically no history of medication use.

TREATMENT

Which department should I visit for drug-induced acne?

You can first go to the dermatology department for a diagnosis. You may also need to visit the department that prescribed the medication to assess whether the drug causing the acne-like rash can be discontinued.

How is drug-induced acne treated?

The most crucial step is identifying the medication causing the acne. If the drug can be replaced with an alternative, stopping its use will naturally allow the rash to gradually improve without risk of recurrence. If the medication cannot be discontinued, symptomatic treatment for the acne-like rash is necessary.

What are the symptomatic treatments for drug-induced acne?

• Treatment should be individualized based on the severity of the rash.

• Mild cases may only require topical medications, such as clindamycin, erythromycin, or low-potency corticosteroids. Moderate cases may need oral tetracycline antibiotics like doxycycline or minocycline in addition to topical treatments. Severe cases might require medications like isotretinoin.

• For patients with itching, antihistamines like loratadine can be used. Those with pain may benefit from pain relievers like pregabalin.

• Regardless of severity, patients should seek treatment under the guidance of a professional doctor at a reputable hospital, with regular follow-ups. Avoid unverified "miracle cures" or exaggerated claims from unlicensed practitioners.

Can drug-induced acne be completely cured?

Yes, drug-induced acne is treatable. Discontinuing the causative medication allows the rash to gradually improve. If the drug cannot be stopped, proper treatment can still effectively control the rash.

What if drug-induced acne leaves scars?

Drug-induced acne may leave post-inflammatory hyperpigmentation or telangiectasia, both of which are treatable. Hyperpigmentation can be addressed with topical agents like hydroquinone or asiaticoside, while laser therapy may be considered for telangiectasia.

DIET & LIFESTYLE

What should patients with drug-induced acne pay attention to in their diet and daily life?

• Reduce the intake of spicy, irritating, and greasy foods. Since the root cause of drug-induced acne is medication, there is no need for excessive dietary restrictions. Just maintain a balanced diet.

• Drug-induced acne mainly affects the patient's appearance, which may further impact their quality of life and even lead to anxiety or low self-esteem. Therefore, emotional adjustment is very important for patients.

• It is worth mentioning that more than 80% of cancer patients treated with EGFR inhibitors develop drug-induced acne. However, studies have also confirmed that patients who develop rashes have a significantly lower risk of death and disease progression compared to those who do not. Simply put, developing drug-induced acne is actually a good sign!

PREVENTION

Can drug-induced acne be prevented? How to prevent it?

The most fundamental prevention method is to avoid using medications that may cause drug-induced acne, but this is often very difficult. For example, patients with systemic lupus erythematosus require long-term treatment with glucocorticoids, and lung cancer patients need prolonged use of molecular targeted drugs. In such cases, the use of medications that may cause drug-induced acne is essential and irreplaceable. In these situations, proper skin care can help prevent the condition or reduce its severity. Measures include:

• Strengthening sun protection: Use sunscreen or wear masks and hats for physical sun protection.

• Avoiding excessive cleansing: Refrain from using deep-cleansing products repeatedly and avoid washing with hot water.

• Moderate skin moisturizing: Apply moisturizing creams from reputable brands.

How can patients with drug-induced acne prevent severe complications?

Once drug-induced acne occurs, prompt medical attention and active treatment are necessary. Most cases of drug-induced acne are mild and can be significantly improved with proper treatment. Many patients who develop severe complications have undergone irregular or entirely incorrect treatments, leading to prolonged conditions.

How can patients with drug-induced acne prevent acne scarring?

When drug-induced acne appears, timely medical consultation and proper medication adjustment and treatment are crucial for alleviating rashes and reducing the incidence of pigmentation and capillary dilation. Additionally, patients should avoid squeezing or picking at the acne, as this not only increases the risk of scarring but also raises the likelihood of infection.