Steroid Folliculitis
Steroid folliculitis (also called corticosteroid-induced acne) belongs to the group of acneiform eruptions. It is marked by a sudden outbreak of inflamed papules and pustules centered on hair follicles, and it develops as a result of systemic corticosteroid treatment or prolonged use of topical corticosteroid products.
Ordinary acne is driven by androgen-stimulated sebum production and its interaction with Cutibacterium acnes. Steroid folliculitis works differently: corticosteroids disrupt keratinization at the follicular opening and trigger acute or subacute inflammation around the upper part of the pilosebaceous unit. In some cases, long-term steroid use also weakens local immunity, allowing secondary overgrowth of Malassezia yeast or bacteria on the skin.
At Haute-Derma, we assess steroid folliculitis by carefully examining the pattern of the skin lesions, taking a detailed history of all corticosteroid-containing medications, and building an individualized management plan to restore the skin barrier.
Clinical Features and Differential Diagnosis
Steroid folliculitis is diagnosed clinically from distinctive morphologic features that set it apart from ordinary acne (acne vulgaris):
- Monomorphism: The lesions are small red papules or pustules of uniform size, all at the same stage of development across the affected skin.
- No comedones: There are no closed comedones (whiteheads) or open comedones (blackheads). This is the single most important feature distinguishing it from ordinary acne.
- Distribution: Mainly the chest, back, shoulders, neck and forearms. The face can also be involved when topical corticosteroids have been applied there.
- Acute onset: Pustules typically erupt quickly after starting systemic corticosteroids or after a period of applying steroid-containing products.
- Associated symptoms: Patients may notice mild itching, burning or stinging in the affected skin.
Types of Corticosteroid Exposure That Cause the Condition
| Type of Exposure | Clinical Features and Pathogenesis |
|---|---|
| Systemic corticosteroids | Appears after high-dose or prolonged oral or injected corticosteroids. Uniform pustules cluster densely on the chest, back and shoulders. |
| Topical corticosteroids | Develops after long-term use of steroid creams or ointments over large areas. Inflamed papules appear directly where the product was applied. |
| Secondary microbial infection | Steroid-induced suppression of local immunity allows Malassezia yeast or bacteria to multiply, causing a superimposed folliculitis. |
