Why did prednisone clear up my acne?
December 3, 2018 5:32 PM   Subscribe

And given that I can't take prednisone long term, can knowing that it worked where other things haven't steer me towards finding an effective treatment?

I have mild to moderate adult acne. (I'm male and 40.) Over the years I've tried just about everything except accutane -- topical creams, antibiotics, supplements, every kind of diet (gluten-free, low glycemic...) -- and though some things have worked partially, nothing has cleared it up completely. Until now. Recently I had to take prednisone for unrelated reasons over a period of a couple of months, and my skin was perfectly clear -- not a single pimple for that entire time, and a month or two afterwards. Then the regular breakouts returned. I know it was the prednisone because I had a little left over and took it for two days when I broke out: hey presto, perfectly clear again.

Don't worry MeFi, I'm not thinking of taking prednisone regularly for acne: I know it's like shooting a fly with a machine gun, and anyway I'm almost out and can't get more. What I want to know is this: does knowing this shed any useful light on what's causing my acne and how I can treat it? Why was prednisone so effective? Does that say anything specific about the underlying causes of my breakouts (e.g. some kind of immune system malfunction)? Can I mimic the effect of prednisone with something less dangerous, or otherwise use this knowledge as a clue towards finding other effective treatments?
posted by zeri to Health & Fitness (11 answers total) 1 user marked this as a favorite
I'm guessing it might be because your acne is caused by a food or environmental reaction. Prednisone slows your immune response to these types of things. Have you done an allergy panel? That would be my next step. If that's not possible, try an elimination diet and switch to hypoallergenic detergent and soap.

Also, check your vitamin D levels after your done with your prednisone course. It can really tank your levels. Luckily my doctor had just read a research paper on vitamin levels and prednisone and had me tested right away as soon as I said I was feeling extra lethargic afterwards. I had to take horse pills of D for ages after a 10 day course.
posted by ananci at 5:51 PM on December 3, 2018

Prednisone helps suppress inflammation, and inflammation plays a role in acne.
posted by needs more cowbell at 6:21 PM on December 3, 2018 [10 favorites]

Inflammation. It means your acne is inflammation based. There *are* low-inflammation diets, though look for a doctor approved one if you decide to try it, because some of those diets are not doctor approved so much as they're goop approved if you know what I mean. Good luck! My acne also disappeared the one time I was on oral steroids, but mine is much more hormone based, so the diet did nothing for me. Hope it, or something like it, works for you!
posted by Homo neanderthalensis at 6:25 PM on December 3, 2018

I know someone who had an inflammatory type of acne. He saw a doctor about it and now has a regular prescription of a topical steroidal cream (same type of drug as prednisone, not so strong, and since it's a cream, less gets into the bloodstream etc). Definitely share your observation of the prednisone effect with your gp or dermatologist. The steroid cream prescription was described by the gp to my friend as a very low risk thing to at least try, and he says it has worked really well. He only applies it on an as needed basis.
posted by Tandem Affinity at 8:03 PM on December 3, 2018 [2 favorites]

I'm not a doctor or phramacist or whatever. But, in all your tests did you every try cortizone cream? It's a corticosteroid just like Prednisone. It's cheap and easy to try. Also, have you seen a dermatologist with this information?
posted by chasles at 4:43 AM on December 4, 2018 [1 favorite]

Anecdotally, in my opinion, in my personal experience, dairy increases acne inflammation. My dad told me this all my life and I scoffed, "acne not caused by diet, duh, dad" until I was 30 and realized that my face cleared when I stopped drinking milk. When I stopped buying milk for our house, my 16 year-old's faced cleared almost magically. I find that I can still have some small breakouts and blackheads but little redness (inflamation) as long as I'm off most of the dairy. I know some people can be upset by suggesting that someone remove dairy from their diet so want to emphasize that this is just my experience. I know you said that you tried different diets but you didn't list dairy. It might be worth a try if you drink a lot of milk or other dairy (whey protein for example) to stop for a couple weeks and see if it helps. I also think the suggestions for a derm would be helpful as other creams such as dapsone are very common and anti-inflammatory.
posted by RoadScholar at 5:17 AM on December 4, 2018 [1 favorite]

Nthing that this means your acne is inflammation or allergy or hormone related.

In your shoes I'd try to get an allergy panel, a blood panel, and get into a dermatologist if possible. In the meantime, there's lots of ways to keep allergens and irritants away from your face.

Wash bedding in hot water at least once a week. Use hypoallergenic mattress covers and pillowcases (underneath the regular ones). Use extremely gentle cleansers like micellar water and a clean washcloth or hand towel for your face every day. Consider getting a HEPA air filter - I like the Coway Mighty for being silent and effective, but there's lots of good brands. Don't get an ionizing filter, that makes things worse. You can also buy filters for your central air unit, if you have one, that will filter out a lot of allergens.

People can have sensitivities to different things that don't rise to the level of allergies or a medical problem, but still cause a bodily reaction. Maybe try keeping a food diet, where you write down what you ate and how your skin is, as a way to track this? You might want to try an elimination diet, although those are a huge pain and need to go on for a while to really be definitive.

FWIW, I'm much healthier on a high-dairy diet but have trouble with some starches and vegetables. Everybody's different, so don't feel weird if you turn out to not tolerate a common ingredient well.
posted by Ahniya at 8:59 AM on December 4, 2018

Can I mimic the effect of prednisone with something less dangerous?

Sugar is an inflammatory. For everyone. Dermatologist Dr. Whitney Bowe particularly expands on this in her book "The Beauty of Dirty Skin." She says to have clear skin, avoid added sugar.

Vegetable oils with high amounts of polyunsaturated fatty acids are also inflammatories. Canola, corn, cottonseed, soy, safflower, sunflower, rice bran, grapeseed. More here by Dr. Cate Shanahan of "Deep Nutrition."

You can take these things out of your diet without an allergy test. It'll make a difference in your skin.
posted by tooloudinhere at 9:43 AM on December 4, 2018

Spices are anti inflammatory. You could try getting heavily into curry and chili.
posted by Jane the Brown at 10:30 AM on December 4, 2018

There's a (prescription in Canada) topical "accutane" called Biacna with tretinoin and clindamycin. As a spot treatment, it's good at causing cellular turnover of keratinocytes - it's fairly reliable for getting my (40yo XY chromosome) cystic acne to express and then go away and it'll stop "regular" acne cold.

Its a little bit pricey and the shelf life isn't great. I usually pair it with a benzoyl peroxide (to decrease the risks of resistance development against the clindamycin).

As a male, and as a topical, there is next to no issues with teratogenicity.

It can cause redness, irritation, and peeling - use sparingly especially at first. Do not use it for sensitive areas (ie., peri-groinal regions).
posted by porpoise at 4:09 PM on December 4, 2018

Are you sure you have acne and not rosacea? They can look a lot alike, but rosacea is an inflammatory condition that's treated somewhat differently than acne.
posted by The Elusive Architeuthis at 8:37 PM on December 5, 2018

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