Acne on Steroids: Why It Happens
STEROID ACNE: WHY ANABOLIC STEROIDS CAUSE BREAKOUTS AND WHAT TREATS THEM
Steroid acne is acne driven by anabolic steroids. Androgens push the skin to make more oil, and oil is the fuel for acne. About half of steroid users in German gyms had it (PMID 17274777).
This guide covers why it happens, how common it is, the severe forms, acne on TRT, and the treatments dermatology guidelines recommend. More side effects are on the PED side effects hub.
Steroid acne in three numbers
Three study figures show how much more often acne hits steroid users than men on TRT.
German gym users
Acne in steroid users (PMID 17274777).
Saudi gym users
Self reported acne (PMID 34356984).
Men on TRT
Range 0.6 to 9.1% in 10 studies (PMID 41182303).
Study figures come from PubMed papers. Which compounds users find worst for skin is practice, not studied; where we describe it, we say so.
What this steroid acne guide covers
Why anabolic steroids cause acne, and how often it happens.
Severe forms such as acne conglobata and acne fulminans, and acne on TRT.
Steroid acne treatment options from the American Academy of Dermatology guideline.
Not covered
Corticosteroid acne. Acne from prednisone or cortisone creams is a different problem.
A prescription. Isotretinoin and antibiotics need a doctor.
Why do steroids cause acne?
Androgens drive the sebaceous glands to make sebum, the skin oil. Androgen driven sebum is required for acne to develop (PMID 38146664).
More sebum feeds the acne bacteria C. acnes and switches on inflammation and blocked pores (PMID 38146664).
Anabolic steroids are androgens. At the high doses users take, the push on the oil glands is much stronger than normal (PMID 24423981).
How common is steroid acne?
About half. A German review reports acne in about 50% of steroid users, especially men aged 18 to 26 (PMID 17274777).
One in three. In Saudi gym users who took steroids, 32.7% reported acne (PMID 34356984).
In medical records. In 545 Danish men who tested positive for steroids, acne affected more than 10%. That was significantly more than in 5,450 controls (PMID 30460728).
What steroid acne looks like
Steroid acne usually shows on the face, chest, shoulders and back. Back acne on steroids is a common complaint.
Described forms include acne papulopustulosa, acne conglobata and acne fulminans (PMID 32941710).
| Form | What it looks like | How serious |
|---|---|---|
| Papulopustular | Red bumps and pus spots on face, chest, back | Mild to moderate |
| Acne conglobata | Deep connected nodules and cysts, scars | Severe |
| Acne fulminans | Sudden painful ulcerating spots, fever, joint pain | Emergency level |
Muscle building supplements contaminated with steroids can cause it too. Whey protein is also linked to acne on the trunk (PMID 32941710).
Severe steroid acne: conglobata and fulminans
Both acne conglobata and acne fulminans can be induced by steroid abuse (PMID 17274777).
Acne fulminans is the most severe form of acne. It brings sudden painful ulcerating spots, high fever and joint pain (PMID 27699859).
Starting or stopping testosterone, and anabolic steroid intake, are among its suggested triggers (PMID 27699859).
Treatment combines oral corticosteroids with low dose isotretinoin, sometimes with weeks in hospital. Lesions usually leave scars (PMID 27699859).
Dermatologists are urged to see acne fulminans as a possible sign of steroid abuse (PMID 37632935).
Does testosterone cause acne? TRT acne
Yes, but far less often than steroid cycles. A review of 10 TRT studies found acne in 0.6% to 9.1% of men (PMID 41182303).
Oral forms had the lowest rates. Injections were generally linked to more acne than gels or oral forms (PMID 41182303).
Which steroids cause the worst acne?
No trial has compared acne between compounds. What follows is what users commonly report.
Users often report more acne on strongly androgenic compounds and higher doses. Trenbolone, oral steroids and DHT based compounds come up most in user reports.
The dose matters in every case. Higher androgen exposure means more oil (PMID 38146664).
Steroid acne treatment: what the guideline says
The 2024 American Academy of Dermatology guideline covers acne in general. Steroid acne responds to the same tools (PMID 38300170).
| Treatment | Recommendation | Note |
|---|---|---|
| Benzoyl peroxide | Strong | Wash or gel, over the counter |
| Topical retinoid, such as adapalene | Strong | Some over the counter |
| Topical antibiotic | Strong | Combine with benzoyl peroxide |
| Oral doxycycline | Strong | Prescription, limit length |
| Oral isotretinoin | Strong for severe or scarring acne | Prescription, monitored |
| Salicylic acid, azelaic acid | Conditional | Milder options |
The guideline also advises combining topical treatments and limiting oral antibiotics (PMID 38300170).
Isotretinoin for steroid acne
Oral isotretinoin is strongly recommended for severe acne, scarring acne, or acne that fails standard treatment (PMID 38300170).
It is one of the few treatments that lowers sebum production (PMID 38146664).
Isotretinoin needs a prescription and blood test monitoring. Combining it with steroid cycles adds load on the liver and lipids; that combination is not studied.
When to see a doctor
Fever with painful spots
Possible acne fulminans, which can need hospital care (PMID 27699859).
Deep lumps or cysts
Acne conglobata scars; it needs prescription treatment (PMID 17274777).
Scarring
Isotretinoin is recommended for scarring acne (PMID 38300170).
No change on topical treatment
Escalation options exist, such as oral treatment (PMID 38300170).
Verdict: 5 facts about steroid acne
1. It is very common. About 50% of users in one review (PMID 17274777).
2. It is driven by oil. Androgens push sebum production (PMID 38146664).
3. TRT causes far less. 0.6 to 9.1% of men (PMID 41182303).
4. Severe forms exist. Conglobata and fulminans can follow steroid use (PMID 17274777).
5. Standard treatment works. Benzoyl peroxide, retinoids and isotretinoin (PMID 38300170).
Steroid acne: frequently asked questions
What is steroid acne?
Acne caused by anabolic steroids. Androgens raise sebum production, which drives acne (PMID 38146664).
How common is acne on steroids?
Very common: about 50% of users in a German review and 32.7% in Saudi gym users (PMID 17274777, 34356984).
Does testosterone cause acne?
It can. On TRT, acne affected 0.6% to 9.1% of men across 10 studies, more with injections (PMID 41182303).
How do you get rid of steroid acne?
Benzoyl peroxide and topical retinoids are strongly recommended; isotretinoin for severe or scarring acne (PMID 38300170). Lowering the dose helps.
Does steroid acne go away after a cycle?
Often it improves as androgen levels fall, since androgens drive sebum (PMID 38146664). Scars from severe forms stay (PMID 27699859).
What is acne fulminans?
The most severe acne: sudden painful ulcerating spots with fever and joint pain. Steroid use is a suggested trigger (PMID 27699859).
Can you take isotretinoin on steroids?
That combination is not studied. Isotretinoin needs a prescription and monitoring (PMID 38300170).
Can protein powder cause acne like steroids?
Whey is linked to trunk acne, and some supplements are contaminated with steroids (PMID 32941710).
Sources and further reading
Every study figure on this page comes from one of the 10 papers below, checked against PubMed on 4 November 2026. Practice notes are marked as practice. Reference links are dofollow to support open science.
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Final Educational Note
This article is educational and is not medical advice. MuscleScience does not prescribe, sell or supply steroids and does not give cycle protocols. Non medical steroid use is illegal in many countries.
Fever with painful skin lesions needs urgent medical care. More guides sit on the PED side effects hub. Read more on the about page and in the full disclaimer.
