Cutaneous manifestations of misuse of androgenic anabolic steroids: A retrospective cohort study
Ida M. Heerfordt, Josefine Windfeld‐Mathiasen, Kim Dalhoff, Mette Mogensen, Jón Trærup Andersen, Henrik Horwitz
Abstract
Cutaneous manifestations of misuse of androgenic anabolic steroids: A retrospective cohort studyTo the Editor: Anabolic androgenic steroids (AAS) mimic testosterone.About 1% to 3% of the US and European populations are estimated AAS users. 1 Besides its desired effects on muscle growth, AAS may cause somatic side effects such as gynecomastia, infertility, and acne. 2,3The epidemiologic aspects of cutaneous manifestations in AAS users remain relatively unexplored.We investigated the association between AAS use and skin complications.The primary outcome was prescription of any dermatologic treatment using the subgroups presented in Table I. 4,5 The secondary outcome was a hospital-based diagnosis of any skin condition and the specific skin conditions categorized in Table I. 4,5 The data were extracted from Danish registries. 4,5he study included male AAS users identified through a nationwide anti-doping test program in Danish fitness centers from 2006 to 2018. 2 Each user was matched with 10 male Danish controls based on age and inclusion date.Relative risks with 95% CI were calculated to evaluate the association between AAS use and both prescription drug use and hospitaldiagnosed skin conditions.The study, with a 1-year follow-up, included 1189 AAS users and 11,890 controls.Both cohorts had a mean age of 27 years (standard deviation: 7).AAS users exhibited higher utilization of dermatologic treatments compared with controls (relative risk: 1.60, 95% CI: 1.43-1.79,P \.0001).Among AAS users 23% were prescribed at least one dermatologic drug, whereas it occurred in 14% of controls.The AAS cohort used more topical and systemic treatments for acne, as well as treatments for bacterial, fungal, and viral skin infections.Table I displays the results for each drug type.During the follow-up, 2.7% of AAS users had a diagnosis of one or more skin conditions, whereas the same was observed in 0.8% of controls.This yielded a relative risk of 3.20 (95% CI: 2.16-4.74,P\.0001).The increased occurrence of skin conditions in AAS users primarily resulted from a higher rate of hospitaldiagnosed skin infections.See Table I for details.