Cutaneous manifestations of anabolic–androgenic steroid use in athletes

Abstract

Increased public awareness of the performance-enhancing benefits of anabolic-androgenic steroids (AASs) in athletes has resulted from the media coverage of the BALCO scandal and Mitchell report. The impact of this increased notoriety on the consumption of these drugs remains unclear, however. In addition, the negative connotation associated with the use of AASs may make users less forthcoming when interacting with their physicians. Cutaneous manifestations develop early in the use of AASs, placing dermatologists in a unique position to make an early diagnosis of AAS abuse in patients who engage in competitive sports. This review of the literature focuses on dermatologic presentations of AAS use.

MECHANISMS IN ENDOCRINOLOGY: Medical consequences of doping with anabolic androgenic steroids: effects on reproductive functions

“…Hirsutism and alopecia are frequent, but in most instances reversible side effects of androgen and AASs use in women (63,64,65). Assessment of body hair and hirsutism has to take ethnic dispositions into account.…”

Dermatologic Signs and Symptoms of Substance Abuse

“…AAS stimulate the sebaceous gland unit, causing it to enlarge. High doses lead to increases in sebum production, skinsurface lipids, and Propionibacterium acnes population [103,104]. This effect most commonly manifests in patients as acne vulgaris.…”

“…AAS can cause new-onset acne vulgaris or exacerbate pre-existing acne vulgaris into severe forms that are resistant to treatment, such as acne conglobata. With continued steroid use, acne vulgaris can progress to acne fulminans [104,105]. Recalcitrant acne vulgaris in athletic patients should alert physicians to include anabolic steroid use in their differential diagnosis.…”

“…Hair growth is also affected by use of AAS, resulting in androgenic alopecia of the scalp and hirsutism of the face and body. These effects are most apparent in female users of AAS but can also be seen in male abusers [104,106].…”

Skin Conditions of Baseball, Cricket, and Softball Players

“…Malassezia globosa, a saprophytic yeast that grows on warm and moist skin, is the usual causative organism [32,33]. Anabolic steroid use promotes infection by increasing sebum production, creating an ideal environment for Malassezia growth [34][35][36][37][38]. Characteristic lesions appear as well defined, hypopigmented, hyperpigmented, or pink coalescent macules and patches forming geometric patterns on the upper trunk, proximal arms, and neck in adolescents and adults and the face in children [39,40].…”