Acne

Acne Fulminans Induced By Anabolic Steroids

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Clinical images of the case patient. A and B, The patient at the time of his first consultation shows severe acne fulminans with inflammatory nodules, pustules, and deep hemorrhagic ulcerations in the chest area and back. C and D, The same patient 6 months after treatment with oral prednisolone and isotretinoin shows extensive scarring.


A 22-year-old male amateur bodybuilder presented to our clinic with a 3-month history of severe acne lesions on his upper trunk and face, accompanied by arthralgia of several joints. He reported the use of anabolic androgenic steroids (AAS) (testosterone enanthate, trenbolone acetate, drostanolone propionate, and methandrostenolone) for 3 months to increase his muscle mass. Shortly after he discontinued AAS intake, he developed severe inflammatory acne with painful rupturing and draining inflammatory nodules, pustules, and hemorrhagic ulcerations on his upper trunk and face (Figure, A and B). Moreover, he described an immobilizing arthralgia of his right ankle and both shoulder joints, as well as general symptoms including fatigue and a 15-kg weight loss over the 6 weeks prior to presentation.

Treatment with several antibiotics had been attempted, including erythromycin, clindamycin, doxycycline, and flucloxacillin, but his condition did not improve. Treatment with isotretinoin, 20 mg/d, was stopped after 4 weeks because of an aggravation of skin lesions. He presented to our clinic while being treated with oral doxycycline, 100 mg/d, and prednisolone, 40 mg/d, for 1 week. Enlarged lymph nodes were palpable in the groin; fever was absent.

Laboratory examination showed leukocytosis (white blood cell count, 19 400/?L) and an elevated C-reactive protein concentration of 52.3 mg/L. (To convert white blood cells to number of cells × 109/L, multiply by 0.001; to convert C-reactive protein to nanomoles per liter, multiply by 9.524.) Magnetic resonance imaging of the patient's right ankle joint revealed soft-tissue edema and articular effusion. The diagnosis of AAS-induced acne fulminans was made, characterized by sudden onset, ulceration of lesions, fever, polyarthralgia, weight loss, and failure of usual antibiotic therapy.

In our clinic, doxycycline and prednisolone treatment were discontinued. The patient was treated locally with debridements, antiseptic wound dressings, and benzoyl peroxide ointments. A new systemic therapy with isotretinoin, 60 mg/d, was started 3 days later. Arthralgia was controlled by treatment with oral diclofenac, 100 mg/d. A continuous improvement with reepithelialization of ulcerations and reduction of purulent lesions and nodules was noted. After 3 months, the isotretinoin dose was reduced, after 6 months, isotretinoin therapy was discontinued. However, the formation of extensive and partly hypertrophic scars could not be prevented (Figure, C and D).

The illegal use of AAS is increasingly common even among leisure sports athletes. Doping prevalence among college athletes in the United States reportedly is 17% to 20%; among male amateur bodybuilders it is even as high as 80%. In addition to cardiovascular, hepatocellular, and psychological adverse effects, 43% of patients who abuse AAS develop androgen-induced acne. As derivatives of the hormone testosterone, AAS lead to hypertrophy of the sebaceous glands, increased sebum production, and increased density of the Propionibacterium acnes population.

Our patient developed AAS-induced acne fulminans with the typical unresponsiveness to systemic antibiotics. After initial therapy with oral prednisolone, 0.5 mg/kg, and debridements, a clinical response was achieved with isotretinoin, 0.75 mg/kg.

In conclusion, it is important for health care providers to keep in mind that androgen-induced acne is one of the most frequent symptoms of AAS abuse. The most important measure is the immediate termination of AAS administration. Increased public education is needed to curb AAS abuse and associated health risks.


Kraus SL, Emmert S, Schon MP, Haenssle HA. The dark side of beauty: acne fulminans induced by anabolic steroids in a male bodybuilder. Arch Dermatol 2012;148(10):1210-2. JAMA Network | Archives of Dermatology | The Dark Side of Beauty: Acne Fulminans Induced by Anabolic Steroids in a Male Bodybuilder
This I was looking for,thanks
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Hello, I was referred to this site by a friend who recommended that I ask a general men’s health question here. I am 27 years old and not using any type of supplements or doing any kind of intense exercise program. However one side of my family has a history of acne and my whole life I have had moderate to severe acne on my upper body. When I was in my teens I went through two 6 month cycles of Accutane which seemed to lessen the acne but not resolve it. Since then studies have shown it not to be safe and I would prefer not to resort to it. I have also tried the topical cream treatments and I am currently on a 6 month oral antibiotic cycle. The antibiotics seem to hold the outbreak in check but not reverse or help the situation. I had a consultation with a dermatologist a couple months ago as well and they informed me they could try laser therapy or skin peels but nothing was guaranteed to work and those are costly treatments. Does anybody have any other suggestions or is anybody familiar with other remedies that I could try other than the typical perscriptions on here of topical creams, antibiotics, accutane? Thanks in advance for any help or advise.
Accutane
 
Kang D, Shi B, Erfe MC, Craft N, Li H. Vitamin B12 modulates the transcriptome of the skin microbiota in acne pathogenesis. Science Translational Medicine. 2015;7(293):293ra103-293ra103. http://stm.sciencemag.org/content/7/293/293ra103

Various diseases have been linked to the human microbiota, but the underlying molecular mechanisms of the microbiota in disease pathogenesis are often poorly understood.

Using acne as a disease model, we aimed to understand the molecular response of the skin microbiota to host metabolite signaling in disease pathogenesis. Metatranscriptomic analysis revealed that the transcriptional profiles of the skin microbiota separated acne patients from healthy individuals.

The vitamin B12 biosynthesis pathway in the skin bacterium Propionibacterium acnes was significantly down-regulated in acne patients. We hypothesized that host vitamin B12 modulates the activities of the skin microbiota and contributes to acne pathogenesis. To test this hypothesis, we analyzed the skin microbiota in healthy subjects supplemented with vitamin B12.

We found that the supplementation repressed the expression of vitamin B12 biosynthesis genes in P. acnes and altered the transcriptome of the skin microbiota. One of the 10 subjects studied developed acne 1 week after vitamin B12 supplementation.

To further understand the molecular mechanism, we revealed that vitamin B12 supplementation in P. acnes cultures promoted the production of porphyrins, which have been shown to induce inflammation in acne.

Our findings suggest a new bacterial pathogenesis pathway in acne and provide one molecular explanation for the long-standing clinical observation that vitamin B12 supplementation leads to acne development in a subset of individuals.

Our study discovered that vitamin B12, an essential nutrient in humans, modulates the transcriptional activities of skin bacteria, and provided evidence that metabolite-mediated interactions between the host and the skin microbiota play essential roles in disease development.
 
the only 1 real working active substance against acne is
Isotretinoin.
It has really strong and mentally occurig side effects.
Especially in the U.S. there are reviews about suicide do to this medicine.
 
the only 1 real working active substance against acne is
Isotretinoin.
It has really strong and mentally occurig side effects.
Especially in the U.S. there are reviews about suicide do to this medicine.

It still comes back after a few years, especially with juice. Plus, if you carry staph in your nose it's never going away without Bactroban on hand.
 
yes often it comes back, but for month or mostly years its gone as first.
the psychical side effects of a really strong acne are hard.
most people hide with strong acne.
 
Melnik BC. Linking diet to acne metabolomics, inflammation, and comedogenesis: an update. Clin Cosmet Investig Dermatol. 2015;8:371-88. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4507494/

Acne vulgaris, an epidemic inflammatory skin disease of adolescence, is closely related to Western diet.

Three major food classes that promote acne are:
1) hyperglycemic carbohydrates,
2) milk and dairy products,
3) saturated fats including trans-fats and deficient omega-3 polyunsaturated fatty acids (PUFAs).

Diet-induced insulin/insulin-like growth factor (IGF-1)-signaling is superimposed on elevated IGF-1 levels during puberty, thereby unmasking the impact of aberrant nutrigenomics on sebaceous gland homeostasis.

Western diet provides abundant branched-chain amino acids (BCAAs), glutamine, and palmitic acid. Insulin and IGF-1 suppress the activity of the metabolic transcription factor forkhead box O1 (FoxO1). Insulin, IGF-1, BCAAs, glutamine, and palmitate activate the nutrient-sensitive kinase mechanistic target of rapamycin complex 1 (mTORC1), the key regulator of anabolism and lipogenesis.

FoxO1 is a negative coregulator of androgen receptor, peroxisome proliferator-activated receptor-gamma (PPARgamma), liver X receptor-alpha, and sterol response element binding protein-1c (SREBP-1c), crucial transcription factors of sebaceous lipogenesis. mTORC1 stimulates the expression of PPARgamma and SREBP-1c, promoting sebum production. SREBP-1c upregulates stearoyl-CoA- and Delta6-desaturase, enhancing the proportion of monounsaturated fatty acids in sebum triglycerides.

Diet-mediated aberrations in sebum quantity (hyperseborrhea) and composition (dysseborrhea) promote Propionibacterium acnes overgrowth and biofilm formation with overexpression of the virulence factor triglyceride lipase increasing follicular levels of free palmitate and oleate.

Free palmitate functions as a "danger signal," stimulating toll-like receptor-2-mediated inflammasome activation with interleukin-1beta release, Th17 differentiation, and interleukin-17-mediated keratinocyte proliferation. Oleate stimulates P. acnes adhesion, keratinocyte proliferation, and comedogenesis via interleukin-1alpha release.

Thus, diet-induced metabolomic alterations promote the visible sebofollicular inflammasomopathy acne vulgaris. Nutrition therapy of acne has to increase FoxO1 and to attenuate mTORC1/SREBP-1c signaling.

Patients should balance total calorie uptake and restrict refined carbohydrates, milk, dairy protein supplements, saturated fats, and trans-fats. A paleolithic-like diet enriched in vegetables and fish is recommended.

Plant-derived mTORC1 inhibitors and omega-3-PUFAs are promising dietary supplements supporting nutrition therapy of acne vulgaris.
 
Is my bacne gonna go away?

Guys, I was about 7 weeks into 700 mg per week test e and humming along nicely, great feeling, gains, libido and very little acne. Decided to give mast e a try for final 5 weeks and on first inj by following day was a little bumpy on shoulders, 2nd inj 3 days later and full on bacne and on chest almost overnight so immediately ended that experiment, finished my 12 weeks test cycle over a week ago and transitioned to TRT cruise of 200 per week but back is still a mess!! Thoughts on prognosis would be appreciated!! Little old for this lol..
 
Bump..pretty sure it's dht related, any ideas how long it's likely to linger and is my TRT dose gonna prevent recovery?
 
Bump..pretty sure it's dht related, any ideas how long it's likely to linger and is my TRT dose gonna prevent recovery?

Sorry I just seen this. I believe there is a direct correlation between dht and acne. Acne is greatly increased with androgens. There was an article I posted a few days explaining it. So what did you find out?
 
Thanks guys! Meso is awesome. My initial research didn't bring up a lot but after some digging I was able to find a wealth of info on here that let me know what I dealing with, why and how to treat if needed. Acne popped up almost immediately after first and second inject of mast e so I stopped right away and fingers crossed but I've had some improvement lately, so hopefully it will continue to get better even with my TRT doseage. This shit is like nothing I've ever experienced. Accutane is out there too if you look a little. Probably go with good ole Pharmacist if I end up having to.
 
Acne-AAS.gif

Severe Acne Conglobata Induced By Anabolic-Androgenic Steroids
http://thelancet.com/cms/attachment/2000996625/2003695825/fx1_lrg.jpg

The patient at the time of his ideal body image; the 21-year-old bodybuilder had a history of anabolic-androgenic steroid abuse (A). Severe acne conglobata (B); lesions include papules, pustules, abscesses, and deep ulcerations. Patient after 6 weeks of antiseptic-antibiotic therapy (C).


Gerber PA, Kukova G, Meller S, Neumann NJ, Homey B. The dire consequences of doping. The Lancet. 2015;372(9639):656. http://thelancet.com/journals/lancet/article/PIIS0140-6736(08)61278-7/fulltext

Various cases in professional sports have brought the matter of doping—the use of performance-enhancing drugs—to the attention of the broad public.

Here, we present a case of doping in a 21-year-old amateur bodybuilder. The man presented to our clinic feeling generally unwell.

He was subfebrile and had massive, deep ulcerations, abscesses, and pustules located on his chest and upper back (figure).

Persistent questioning revealed a history of continuous abuse of anabolic-androgenic steroids (testosterone enantate 250 mg plus metandienona 30 mg twice weekly), which was consistent with the diagnosis of a severe acne conglobata that was anabolic-androgenic steroid induced.

Additional investigations showed a substantial impairment in sperm concentration and reduced testicular volume.

Skin lesions showed rapid improvement after discontinuation of anabolic-androgenic steroid abuse and with antiseptic and antibiotic therapy. However, the extensive scarring is likely to remain with the young man for the rest of his life.
 
I've hear researchstop has some good stuff. But just get it from the same place you get pharm grade serms

This option seems much cheaper than getting the generics which are also out there pharm grade. Anyone have actual experience with this? Seems kinda too good to be true
 
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