Steroid Side Effects: Fight Acne with Shampoo?
by Anthony Roberts

One of the most notorious side effects experienced with the use of Anabolic/Androgenic Steroids is the development of Acne. This is, for the more hardcore users, not too big of a deal. Granted, if you are three hundred pounds ripped, are balding with a permanent red face from high blood pressure, and develop a bunch of zits suddenly, that last part is probably the least of your concerns. Large oil filled zits just aren’t a pressing concern to the next Mr. Olympia. However, for most of us, and especially first time steroid users or females, zits are usually something we want to avoid. Acne is the most media-popularized side effect of Anabolic Steroid use, and (next to weight gain) the most outwardly recognizable.

Females especially, want to avoid this for aesthetic reasons, and it’s actually through interaction with one of the female moderators on a bodybuilding message board that I was most recently reminded of this point. She had been experiencing pretty bad acne from Anavar use, but she couldn’t find a suitable answer for how to get rid of it. The most typical answer to the question was “use Retin-A,” which was spouted by nearly everyone she spoke to. It is unfortunate that Retin-A, for many reasons, is a very poor choice for her purposes (one reason being it doesn’t address the cause of the acne appropriately, and it is also a prescription medication). In this particular case, I told her to take some Nizoral (Ketoconazole) Shampoo and rub it on her back and face as a body wash. Huh? What? Shampoo on your face and back? Shampoo is for your hair! Yeah, well that’s what everyone thought. Until now. Okay, I know: shampoo on your face is weird. But, I wouldn’t be writing for Mind and Muscle if I wasn’t three things:

a.) Weird (in the public’s eye)

b.) Creative

c.) Weird

Now, let’s talk about DHT and how it causes acne. We will then discuss why using Nizoral shampoo would be good for getting rid of acne. Development of AAS-related acne and the extent to which it is experienced can be due to a number of varying factors, with the steroids and dosages used being primary factors. It has been established that the receptors of the sebaceous glands have a particularly high affinity to Dihydrotestosterone (1)(2)(3). Anecdotally, it would also seem that DHT-derivations (Winstrol, etc…) cause more acne than others (Testosterone or 19-Nor derived steroids). Thus, we can also safely assume that steroids, which are affected by the 5-alpha-reductase enzyme and turned into DHT in the body, will also be highly probable to cause acne. Increased sebaceous gland activity causes oily skin, and this, in combination with bacteria and dead skin caused by normal wear and tear, then causes pores to become clogged more quickly than the body can deal with them (or than you can exfoliate or unclog them). This causes visible acne and generally terrible looking skin.

So DHT is a primary culprit in all those nasty zits, right? Well, stay with me here, because the next part may get slightly complicated. Nizoral shampoo (the chemical in it is Ketoconazole) is actually a topical anti-androgen. Remember, the catalyst for acne is initially DHT (an androgen) and the sebaceous activity it causes. When used topically, in shampoo form, this particular compound’s effects are limited to the skin/scalp and are not systemic (affecting the whole body) unless you take it orally (drink the shampoo). Ketoconazole’s pharmacokinetics have been studied with oral ingestion (they make a pill, you don’t drink the shampoo of course), and it has been determined that even orally, it is effective against acne, because oral ketoconazole has three delivery routes to the skin (4):

1. Passive uptake by keratinocytes in the basal layer

2. Excretion through the sweat glands

3. (The important one) A massive excretion through the sebaceous glands

In that same study, sebum levels compared with the plasma levels are very high, even with oral ingestion (4), which prompted researchers to simply create a shampoo from the base chemical (Ketoconazole) to prevent androgenic alopecia (balding) caused by DHT. Unfortunately, oral ingestion of an anti-androgen will cause an anti-anabolic effect as well. However, there is almost no effective plasma level to cause an anti-androgenic effect in your body when you topically apply it (4). So this should keep anyone from needlessly worrying about the possibility of an anti-anabolic effect to be had from topically applying Nizoral (even though it’s technically an anti-androgen).

Lets back up a bit and let me give you a little background on how I stumbled on all of this roughly 8 years ago.

I figured out that Nizoral would prevent acne when I had some acne on my forehead during my first cycle. I had been using Nizoral to prevent hair loss, and I always got some shampoo on the top of my forehead when I washed my hair. I soon noticed that the area the shampoo came into contact with was free of acne. So, long story short, I started using it as a topical acne treatment and my steroid-induced acne cleared right up. I tried it on my back acne, and it went away. My girlfriend at the time had some acne, and it cleared that up too. A few years ago, I actually looked for validation on my theory, and found it. The study I first found (4) examined the pill form, but the shampoo is the same active ingredient, and won't have a noticeable systemic effect, but rather will have a localized one wherever you apply it.

Interestingly, about the same year that I had discovered the use of a topical anti-androgen for use in preventing DHT-caused acne (steroid related in my case) scientists completed a study basically saying the same thing. Although I had discovered this use for topical anti-androgens in my shower, and they discovered it in a lab, it’s basically the same idea.

The study I found from that year examining a topical anti-androgen and its effects on the sebaceous glands was very interesting. When a topical anti-androgen was used on rodents, the scientists noted that sebaceous glandular and ductal regression was quite profound. This strongly suggests that a topical anti-androgen could effectively counteract endogenous androgens resulting in a suppression of growth of the sebaceous glands while leaving serum concentrations of both testosterone and dihydrotestosterone intact and not reduced (5). This means, for all intents and purposes, that Nizoral’s anti-androgenic effect on your skin will prevent acne, without it having a systemic effect on your body. In simplest terms, it will leave 100% of the muscle building effects imparted by the steroids you are taking totally unaffected.

Shampoo. It’s not just for hair anymore.

References

1. Am J Clin Dermatol. 2002;3(8):571-8.
2. Clin Dermatol. 2004 Sep-Oct;22(5):419-28.
3. Pol Merkuriusz Lek. 2004 May;16(95):490-2.
4. Int J Tissue React. 1988;10(2):111-3
5. Skin Pharmacol. 1997;10(5-6):288-97.