24. Acne and Other Drugs, including Marijuana

Doctor Jacob here, and we're talking today about acne and other drugs, including Marijuana.

Let's start with Marijuana, because that's becoming more and more popular these days as it's becoming more and more legal. So Marijuana and acne - yes, it's very true, Marijuana can worsen or even cause acne. The mechanisms behind that are not yet clear; the science has yet to be worked out. But we somehow can think about Marijuana potentially impacting different levels of hormones and influencing them. We don't quite know yet, but somehow Marijuana affects the oil glands.

If you're struggling with acne and you're using Marijuana for medical reasons or for otherwise, best to put aside Marijuana.

Let's talk about a myriad of prescription drugs that can cause problems with acne. First is Prednisone, for long-term use of it at least. Prednisone, if you fast forward to the episode about quick fixes, you may hear of this as prom pills, pills that you can take to actually clear up your acne, and it works great for five or seven days to clear up the acne, but if you take it for a very long time, it actually can cause acne flare-ups, the so-called 'steroid acne'.

The same is true of topical steroids applied to the skin, for example hydrocortisone applied to the skin on a long-term basis can cause acne flare-ups. That's very true especially for higher potency, prescription-strength version of topical hydrocortisone. So oral corticosteroids like prednisone, which is for many inflammatory conditions, as well as topical corticosteroids like hydrocortisone can cause acne when used for the long term.

Now let's talk about a drug commonly used for psychiatric conditions such as bipolar disorder, also called manic depression, and schizoaffective disorder, mood disorders - that drug is lithium. Now, lithium as a salt is very useful for mood stabilization in many psychiatric conditions, but unfortunately it comes with a side effect of pretty bad acne, and it's not rare that this happens. Unfortunately, many psychiatrists who are prescribing this drug do not inform their patients about this, and I think that's one of the worst things because patients can often become depressed because they have bad acne, and if you're using it to treat a mood disorder and you're not addressing that, then I think the psychiatrist is not doing a great job. There are often other drugs, which if the acne occurs, the patient can see the psychiatrist and have the drug switched to an equally effective potentially but less acnegenic drug.

There are certain cancer drugs which can cause acne, but those are kind of necessary. In fact when it arises, usually that's the least of a patient's worries. There is a drug called the potassium iodide and surprise, if you've been listening to these episodes, you would know all about iodide worsening acne, but there is actually a drug called Super Saturated Solution of Potassium Iodide (SSKI) and it's useful for treating various inflammatory or autoimmune conditions, and it of course, no surprise, triggers acne.

For patients who have neurologic conditions such as seizures there is a drug called phenytoin, also called Dilantin, and that can lead to acne breakouts as well.

Something to keep in mind, not most of you listening will be taking any of these, but some people out there will be, so I want to give people a good idea that their prescription medications can cause acne. This is not an exhaustive list, but these are some of the bigger, more common ones.

Let's also talk about acne being caused by topical medications designed to treat acne. Now, you may think "Oh my gosh, how could that be?!" Well, a lot of the medications that are designed to treat acne are then formulated by chemists who, for better or for worse, put comedogenic things into the vehicles. A lot of these are done to make the vehicles more creamy, or to make them more apparently moisturizing, but they can actually defeat the purpose. For example, the biggest one that comes up over and over again is tretinoin cream. tretinoin, as you'll learn from later episodes, is a form of Vitamin A known as all-trans retinoic acid, and it's a topical medicine that was a great breakthrough for acne. However, when it came to be formulated into a cream, the chemists who formulated the vehicle packaged it with isopropyl myristate, and that's an extremely comedogenic ingredient. Why they did that? To make it a little more creamy, or help the tretinoin to penetrate the skin. It's really a tragedy, because patients who are sensitive to it, which is everyone with acne who is actually using this cream, can actually be worsened by the isopropyl myristate which is in the tretinoin cream which is supposedly treating acne. But you can take a deep breath and relax, because the tretinoin gel is safe, as are the tretinoin microsphere preparations. They don't contain the isopropyl myristate as a comedogenic ingredient. So you may ask yourself why the chemists formulated the preparation of tretinoin cream with isopropyl myristate. Well, it helps make it a little more creamy and sometimes tretinoin actually dries out the skin, so maybe they thought they were balancing out a little bit of the dryness with the isopropyl myristate, but it turns out that it's not a good idea for acne patients.

But unfortunately, the problems don't stop with tretinoin. There are numerous over-the-counter acne washes which contain comedogenic ingredients, like the detergent sodium lauryl sulfate and sodium laureth sulfate, so unfortunately when consumers are purchasing over-the-counter products they really have to be able to take that list of comedogenic ingredients with them and check out all their anti-acne products. That is, if the manufacturer bothers to list their ingredients at all, which not all manufacturers do.

So don't give up hope, I'm going to preselect some over-the-counter acne products and you can find those on our website. Much more coming soon about anti-acne over-the-counter therapy in the future episodes.

I'm Doctor Jacob, we'll see you next time.