What role do oral steroids play in treating acne?

Corticosteroids, such as oral prednisone, are the gold standard for anti-inflammatory medications. Strong topical corticosteroids are limited by the potential for delayed side effects, including thinning of the skin, stretch marks, new blood vessel formation in the skin (commonly called broken blood vessels), papulopustular flares of acne, and skin addiction to the steroid so that when the drug is stopped there is a rebound flare of the acne.

When topical or oral steroids are used in high enough doses over long periods of time, adverse effects exist that go beyond the skin, such as the risk of developing cataracts and suppression of the body’s own production of cortisols under periods of stress, which can be very serious; however, a short course (5 days to 2 weeks, depending on the part of the body) may be useful as part of the initial strategy in treating severe inflammatory acne.

One of the main benefits of this approach is to kick start the improvement and get quick control of the situation. Oral steroids may be preferable in very severe inflammatory acne because a short course will immediately reduce the number of inflammatory lesions. As with topical steroids, this can have a significant positive psychologic effect. In addition, the reduction in the severe cystic lesions reduces the pain and/or itching associated with them. When oral steroids are used, they are most commonly given along with oral antibiotics or isotretinoin. If oral steroids are recommended, your doctor will review with you the potential side effects. It is important to understand that this class of steroids, called glucocorticoids, is very different from the anabolic steroids sometimes used by athletes and body builders.