Peer Reviewed

Photo Essay

A Collection of Cutaneous Manifestations of Anabolic-Androgenic Steroid Use

Nadine H. Ruth, MD

Volume 56 - Issue 11 - November 2016

AUTHOR:
Nadine H. Ruth, MD

CITATION:
Ruth NH. A collection of cutaneous manifestations of anabolic-androgenic steroid use. Consultant. 2016;56(11):1021-1022.

DISCLAIMER:
The views expressed in this article are those of the author and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government.

Acknowledgement:
The author thanks Michael J. Scott Jr, MD, and Michael J. Scott III, DO, MD, of the Seattle Dermatology Center in Seattle, Washington, for their contributions to this article.

 

The use of anabolic-androgenic steroids by amateur and professional athletes—and by those who want to look like athletes—has reached epidemic proportions.1,2 Cutaneous manifestations are often the initial visual indication of the use and abuse of anabolic-androgenic steroids.

These steroids produce muscular hypertrophy and are being used by athletes of all ages and of both sexes for the purpose of bulking their musculature and enhancing their performance in sports or other physical endeavors. They also may desire to have a bulked musculature and enhanced performance level seen and appreciated by others. Ironically, however, they do not desire to have the unintended adverse cutaneous manifestations of steroid use seen by others.


Figure 1. Acne and gynecomastia in a male bodybuilder.
 

Anabolic steroids are available in oral or injectable form and increase protein synthesis in skeletal muscle, resulting in an increase in muscle mass. These steroids are taken in cycles, not continuously. Individuals generally take the oral or injectable steroids for 4 to 12 weeks and then stop for another few months before starting another cycle. These steroids are readily available for purchase in most bodybuilding gyms.1,2


Figure 2. Alopecia in female athlete.
 

Individuals taking anabolic steroids often feel euphoric and stronger and often have increased aggressiveness. This aggression may lead to violent and hostile antisocial behaviors. When anabolic steroid users are not taking these drugs, they may experience psychotic symptoms, major depression, and rarely suicidal ideation as an adverse effect.1,2


Figure 3. Tinea versicolor in a male athlete.
 

The cutaneous manifestations of the use of anabolic steroids include the sudden onset of the following:

  • Cystic acne and comedones (Figure 1)
  • Alopecia (Figure 2)
  • Sebaceous cysts
  • Rosacea
  • Oily skin and hair
  • Seborrhea
  • Bacterial infections such as furunculosis, folliculitis, and pyodermas
  • Superficial mycotic infections such as tinea corporis, tinea cruris, and tinea versicolor (Figure 3)
  • Gynecomastia (Figure 1)
  • Male pattern baldness of the scalp
  • Increased facial hair and body hair
  • Striae (Figure 4)
  • Linear keloids (Figure 5)
  • Yellow discoloration of the skin and conjunctivas


Figure 4. Striae in a high-school athlete.
 

Human growth hormone in the synthetic form is similarly utilized and may produce the following cutaneous signs:

  • Hyperpigmentation
  • Cutis verticis gyrata
  • Coarse, thick skin

Once these cutaneous manifestations occur, physicians should take the opportunity to educate these persons and, in the case of adolescents, their families as well, about the potential health risks and dangers inherent in the use of anabolic-androgenic steroids.

Nadine H. Ruth, MD, is a lieutenant commander in the US Navy Medical Corps (Fleet Marine Force/Flight Surgeon) and a third-year postgraduate dermatology resident at Naval Medical Center San Diego, California.

REFERENCES:

  1. Scott MJ. Cutaneous side-effects of anabolic-androgenic steroid use. Clin Sports Med. 1989;1:5-16.
  2. Scott MJ Jr, Scott MJ III. Dermatologists and anabolic-androgenic drug abuse. Cutis. 1989;44(1):30-35.