High doses of corticosteroids in connection with immunosuppressive therapy precipitate a distinctive eruption, steroid acne. A sudden outcropping of densely aggregated, uniform, follicular, reddish papules is succeeded in wave-like progression by numerous whiteheads (closed comedones) that eventually transform into blackheads (open comedones). Crowds of persistent, mixed comedones characterize the mature disease.
Topical application of a 0.05% solution of tretinoin, once to twice daily, was found to be an effective treatment for obliterating the dense aggregates of comedones in 12 patients with steroid acne. Complete clearing can be obtained in most instances within two to three months, despite continued therapy with high doses of steroids.
Mills OH, Leyden JJ, Kligman AM. Tretinoin Treatment of Steroid Acne. Arch Dermatol. 1973;108(3):381-384. doi:10.1001/archderm.1973.01620240035008