If your skin has started breaking out since you began taking steroids, you are in good company. Many other Sam visitors tell us the same thing: spots on the chest, back or shoulders, sometimes for the first time in years. Dealing with breakouts on top of everything else your body is going through can feel unfair. There is plenty you can do, and the first step is figuring out what is actually going on.
Why steroids can cause breakouts
Steroids can make your skin produce more oil, which can block pores. They also change how your skin reacts to the bacteria that normally live on it, so bumps can become more inflamed. Doctors call this steroid acne.
It often looks a little different from the acne many of us remember from our teens. The spots tend to be small red bumps that look similar, and they often appear more on the chest, back, and upper arms than the face.
Is it acne, or something that looks like it?
This is the most useful question to ask, because the answer changes what helps.
Steroids can also let a yeast that lives harmlessly on everyone's skin grow more than usual. This causes a condition called Malassezia folliculitis, sometimes known as fungal acne. It looks very similar to steroid acne, with small matching bumps on the chest, back, and shoulders.
A few clues can point toward yeast:
- The bumps itch. In one large review, about 7 in 10 people with this condition said their spots were itchy.
- Regular acne products have made little difference.
- The spots appeared after starting steroids or a course of antibiotics.
Your doctor or dermatologist can advise on whether these are yeast-related bumps that may need antifungal treatment. Acne washes alone often won't clear them, so if you have been faithfully using spot treatments with little change, you haven't done anything wrong.
If ordinary acne products haven't helped, it is worth asking whether yeast could be involved.
Gentle steps you can start today
Steroids can also make skin thinner and more fragile, so whatever is behind your breakouts, kindness goes a long way.
1. Wash gently
Use a mild, fragrance-free cleanser and lukewarm water. Avoid scrubs and rough washcloths.
2. Moisturize every day
Moisturizers containing ceramides help repair the skin's protective barrier. In one study, they eased dryness and redness in people using acne treatments.
3. Try an over-the-counter acne wash
Benzoyl peroxide and salicylic acid are both easy to find. Benzoyl peroxide has more research behind it, though very few studies compare the two directly, so the best choice is often the one your skin is happiest with. Start slowly, and keep benzoyl peroxide away from colored towels and pillowcases, as it can bleach fabric.
4. Keep your hands off
Picking or squeezing can lead to scarring and infection, especially when your skin heals more slowly.
When to see a dermatologist
Ask for a referral if your breakouts are painful, itchy, spreading, leaving marks, or getting you down. A dermatologist can tell acne and yeast apart, sometimes with a quick skin scraping. They may suggest prescription creams called retinoids, antifungal medicines or antibiotic tablets. Retinoids can be drying, so if your skin is already thin, your dermatologist may start you on them gradually.
Bring a list of everything you take, including your steroid dose and any creams you use on your face. Steroid creams applied to the face can cause breakouts of their own Topical steroid withdrawal.
Please don't lower or stop your steroids to clear your skin. Talk to the doctor who prescribes them first, as stopping suddenly can be dangerous.
How long it takes
Acne treatments need time. Most studies measure results after 10 to 12 weeks, so give a new routine about three months before deciding it isn't working. Yeast-related bumps often improve more quickly once you start the right treatment.
It also helps to know that steroid acne usually settles as your steroid dose comes down. In the meantime, each gentle step keeps your skin more comfortable and better protected.