Prednisolone and acne

[Lili18]

Hi guys,

I have a question. I’ve been getting severe acne ever since I started with medication for Lupus. My rheumy said that it’s caused by prednisolone. Of course, i failed to ask him whether it will clear up once I taper to 5 mg. I’ve seen a dermatologist, who prescribed some antibiotics locally and suggested some hormonal tests, which I am yet to do. My question is: what is your experience? Will it clear up with the maintenance dose? Or should I continue with what the dermatologist is saying? I don’t want to go to the doctors or do more tests unless i really have to. It looks horrible, i feel so self conscious, i cant even cover it up anymore.

[citygirl1234]

Hi Lili18,

I can really relate to your experience as I have gone through a similar experience myself.

Prednisolone is known to cause acne as a side effect (usually refered to as 'steroidal acne') but this will usually clear up after you stop taking the steroids (this is what my dermatologist told me). The problem here is that you need to take the steroids to control your lupus (which is the frustrating bit). I take prednisolone for vasculitis and have the same problem (I also had moderate to severe acne before I was diagnosed with vasculitis) and had a long discussion with my rheumatologist about it. She was very understanding but said that unfortunately, I need the steroids to control my autoimmune condition but that they would try and keep my steroid dose as low as possible to try and minimise the side effects (i.e. reduce the impact on my face). I have had short course high dose prednisolone before which has taken at least a month for my face to clear up afterwards so I was very reluctant to agree to long term prednisolone but begrudgingly have at a low dose (7.5 mg). At the moment I can just about manage to control the acne that I do get from the low dose prednisolone using topical retinoids and a combined contraceptive pill however I have a prescription for antibiotics on standby if my acne becomes cystic again.

As you probably already know, there is no quick 'cure' for acne and a lot of it is about finding the treatment that works for you but it is quite a long process as it takes 6-8 weeks for any treatment to work. This is because it takes 6-8 weeks for your skin to go through a full "cycle". With a lot of treatments your skin will also start to look worse before it gets better, which hopefully your dermatologist has already told you. For me, it takes about 3 months for the antibiotics to be most effective but it is very gradual and you might not see much difference day to day. One thing that my dermatologist recommended to me is to take a weekly selfie (I know the last thing you probably want to do is to take photos of yourself but it helps you to see whether actually a treatment is working for you or not) and then you can see how your skin is changing as your treatment progresses. It may be helpful to share these pictures with your dermatologist too, but you don't need to share them with anyone else and you should not be wearing any make up in these pictures.

With regards to covering it up, it can be very difficult sometimes but through trial and error I have found some make up that will cover mine (as best as I can anyway). The key thing with any make up or skin products that you apply is that they are non comedogenic (i.e. they won't block your pores). I personally like to use Bare Minerals as I found that the creams and gel treatments made my skin very dry and would react badly to other brands but it's very much about finding what works for you. There are lots of "acne make up tutorials" on YouTube but there are also a lot of people talking about their "acne miracle cure" which you need to wade through and take with a pinch of salt. That specific brand of moisturiser / foundation may have worked for them but it might not work for you and your dermatologist should be best placed to advise you on what will or won't work for you. That being said, if you do want to know more about the skin Dr Anjjali Mahto (consultant dermatologist) has written a very good book which has some helpful tips about skincare routines, choosing make up and skincare products and treatments for acne and some other skin diseases. (Link here: amazon.co.uk/Skincare-Bible...

The key thing here is that you have a dermatologist who understands how much of an impact the acne is having on you and that you can't just stop taking the steroids because of your lupus. My first dermatologist did not understand this and just told me to stop taking them (which was contrary to my rheumatologist's opinion), so if you don't feel like your dermatologist "gets" it, please try and see a different dermatologist who does.

If this is starting to affect your mental health, please also talk to your GP who can refer you for some support. I know it can be hard to talk to someone but if your acne is stopping you from doing things e.g. going out, seeing friends, there is nothing wrong with asking for some help. (I too felt like I just wanted to put a paper bag over my head every time I left the house.) Lots of people really struggle with the impact of acne on their mental health, and that is why it is so important that you see a dermatologist.

Bottom line: it's good that you are discussing this with your rheumatologist and are seeing a dermatologist. I would hope or expect your acne to get better when you lower your dose of prednisolone but not to go completely. You may have to take prednisolone for a while so it is still worth working with your dermatologist to try and get on top of the acne. It will take some time and it will be a painful process, but with treatment your acne should improve. With your rheumatologist's help you may be able to stop prednisolone altogether but you need to work with your doctor to do this and resist the urge to just stop the pred as it may not be safe for you to do this.

I really hope this helps you.

[Lili18 in reply to citygirl1234]

Hi citygirl,

I cannot thank you enough for your reply, you are very kind in taking the time to explain everything to me in such a clear way. You have helped me a lot to understand . I wanted to thank you yesterday but I teared up right after I read your reply. I wish my doctors were half as patient and kind as you are. Would have made everything much easier.

It’s a horrible disease isn’t it? With the unknowing and worrying, having to take these steroids that help one thing but can do a lot of damage to other things. I should be grateful that my Lupus is with “minimal activity”, but I cant help being scared and wanting to “fix” what I can, this time, my horrible acne. My six year-old the other day asked me why my face is so dirty. I didn’t even know what to say anymore. He’s right. It does look dirty, with layers of sunscreen and makeup to make myself halfway presentable. Not to mention the weight gain. Im using Avene mineral sunscreen and then foundation on top, trying to cover the malar rash and the acne. And then two hours later, washing it all off to put it on again. Am probably doing even more damage to the acne this way.

Sorry for the rambling, thanks for the book you mentioned. I will look into it

Xxx

[citygirl1234 in reply to Lili18]

You're very welcome, it can be really hard going through this and I'm glad you posted as you won't be the only person to feel this way. I'm sorry no one took the time to explain this to you before.

I really wish doctors made patients more aware of the side effects of steroids and how they can be mitigated before they prescribed them, even if it was just in a leaflet if they don't have time to talk them through with every patient. Yes, steroids are very effective but the side effects can be really horrid sometimes and if you know what the side effects are, you can try and do your best to minimise them or at least come to terms with what's ahead. To some people the side effects like weight gain, acne, "moonface" and mood swings (to name just a few) can seem trivial compared to having active autoimmune disease but actually the side effects can really change the way you feel about yourself.

I also have fairly mild / early stage disease too and it can feel like you shouldn't be complaining sometimes as other people have much more active disease, but actually it's really important that you do speak up and tell your doctor / nurse what is bothering you. After all, if you don't tell them, they can't try and help. That said, some doctors and nurses are more helpful and understanding than others so sometimes you need to be persistent or ask to speak to someone else if you feel that you are not being listened to.

I'm sure your son means well and is just trying to understand but if you weren't expecting it that question would be quite painful. Maybe explaining to him will help? E.g. Mummy has lupus which gives her a rash and she takes some medicine for it which makes her feel better but gives her spots, so she puts makeup on so people can't see them. Lots of people wear make up to hide things and it's ok but we should be careful when we ask questions about it as they might find us rude. One of my friends has a little boy who is also in the "question everything" stage and he once asked a lady around Halloween time "Why do you have such a big nose? Are you a witch?". Luckily the lady took it very well and laughed it off! (He now knows not to do this after his very embarrassed Mum explained)

Do you leave any time between putting the suncream on and the foundation? I find if I don't leave 5-10 minutes between suncream and foundation, the foundation goes a bit cakey and looks really bad (and orange) later (even if it looked fine at first). I also found liquid foundation was a lot worse for that so I switched to powder foundation but you might find differently. What sort of soap or make up remover are you using to wash it off? That could potentially be irritating your skin (but so would not reapplying the sun protection so it's another catch 22 situation). I would ask your dermatologist's opinion next time you see him or her. There may be a particular type that he or she recommends for you, and sometimes dermatologists can give you free samples to try. Treat your dermatologist appointments in a similar way to your rheumatology ones - make sure you go prepared, with a list of questions and that you leave knowing what the next steps are, and that should help you feel more in control of the situation.

xxx

[Hidden]

I started on a high dose and ended up with acne on my neck, back, stomach and arms. It wasn't painful just annoying that it was there. As I got them reduced to 10mg daily I've found they've all disappeared and still away since they've been upped to 20mg daily. Not everyone is the same but it was a side effect I was willing to accept to get better. They will die down and disappear so I personally wouldn't worry too much. Hope this helps a little.

[Lili18 in reply to Hidden]

Hi Kitman,

Thanks for your reply. You did help. You are right, every person is different. I’m glad your acne has disappeared. You have the right attitude about this disease. I will try to think the same as you and not pay so much attention to it.

Xxx

[Hidden in reply to Lili18]

Glad it helped. I try to stay as positive as I possibly can at all times. I do have the odd moment but the way i look at it is I beat the bugger the 1st time around and I'm going to beat it again this time around. Good luck.

[Sue6]

Hi Lili18 I had the same and it does clear up. I used a steriod cream not sure which one. I'll come back to u on that. But it just your body reacting to Prednisolone. It does settle down and clear up. The Prednisolone is the best thing for you. It saved my life and I'm now drug free and my lupus is under control. Keep positive knowing it worth it. x