Prednisone is a corticosteroid drug that is used to treat a variety of inflammatory and autoimmune conditions. It works by reducing inflammation and suppressing the immune system. A common side effect of prednisone is that it can cause changes in facial appearance, which some people describe as making their face look “weird” or “puffy”. In this article, we’ll explore why prednisone causes facial changes, what kinds of facial changes it can cause, who is most at risk, and whether these changes are permanent or reversible once the medication is stopped.
What is prednisone and why is it prescribed?
Prednisone is a synthetic corticosteroid medication that mimics the effects of cortisol, a hormone naturally produced by the adrenal glands. It has potent anti-inflammatory and immune-suppressing properties. Prednisone is prescribed to treat a wide range of inflammatory and autoimmune conditions like:
- Rheumatoid arthritis
- Lupus
- Multiple sclerosis
- Inflammatory bowel diseases like Crohn’s disease and ulcerative colitis
- Severe allergies and asthma
- Certain types of cancer
It works by reducing inflammation, suppressing the immune system, and decreasing activity of the body’s natural corticosteroids. This helps control symptoms of inflammatory conditions. Prednisone can be taken orally in tablet form, by intravenous injection, or inhaled for asthma treatment. Doses may range from 1 mg to 100 mg per day depending on the condition being treated.
Why does prednisone cause facial changes?
Prednisone causes changes in facial appearance because it impacts fluid balance and fat distribution in the body. Some of the specific ways it can alter facial features include:
Fluid retention
Prednisone causes the kidneys to retain more sodium and water. This results in overall body fluid accumulation, including facial swelling called edema. The swelling is usually most noticeable around the cheeks and eyes.
Increased fat deposits
Corticosteroids stimulate fat cells to produce and store more fat. This can lead to fatty tissue deposits in unusual areas like the face and back of the neck. The face may take on a rounded or moon-shaped appearance.
Redistribution of fat
Prednisone causes fat to be redistributed from the arms, legs and hips to areas like the face, back of the neck and abdomen. This gives those areas a fuller look.
Thinning skin
Long-term use of steroids like prednisone can cause the skin to become thinner. This makes blood vessels in the face more visible, resulting in facial redness and a flushed appearance.
Acne
The increase in fatty acids and oils in the skin during prednisone therapy can lead to the development of acne on the face. This may be especially noticeable along the chin, cheeks or forehead.
What facial changes can occur with prednisone use?
Some of the most common facial changes seen with prednisone use include:
Round puffy face
Fluid retention and fat redistribution makes the cheeks appear rounded and puffy. The area around the eyes may also look swollen. This rounding of facial features is sometimes called “moon facies”.
Fuller facial shape
Extra fat deposits in the face give it a fuller look, almost as if the person has gained weight in just their face. The face may develop a square shape from these fat deposits.
Thick neck
Fat building up at the back of the neck makes it look thicker. This is sometimes called a “buffalo hump”.
Facial flushing
Thinner skin causes increased facial redness and flushing, especially across the cheeks. Tiny blood vessels under the skin become more visible.
Acne breakouts
Acne lesions, pimples and cysts can develop on the face, especially along the chin, jawline, cheeks and forehead. Existing acne may also flare up.
Skin discoloration
The skin of the face may develop a blotchy reddish appearance. It may also become lighter or darker in patches across the cheeks, forehead or near the mouth.
Excess facial hair growth
Some people notice increased fine hair growth on their face during steroid treatment. This is most common in women.
Skin bruising
Thin fragile steroid-treated skin bruises more easily. Bruises may appear after even minor bumps or injuries to the face.
Who is most at risk of prednisone facial changes?
Those most likely to experience cosmetic facial changes with prednisone include:
- People taking prednisone long-term
- Those on high steroid doses over 10 mg per day
- Individuals who have taken steroids multiple times
- People whose faces were rounded or full to begin with
- Those with existing acne problems
- People with naturally thin skin
- Older individuals
- Females, who tend to retain more facial fat
The longer someone takes prednisone and the higher the dose, the more likely facial changes become. People who need repeated courses of steroids have more opportunity for fat redistribution and other cosmetic effects to build up over time. Starting out with a rounder face or thin skin also appears to predispose some people to developing a “moon face”.
Are prednisone facial changes permanent?
For most people, facial changes from prednisone are reversible. After stopping the medication, it may take anywhere from weeks to many months for fluid retention, fat deposits, and acne to normalize and facial puffiness to resolve. Skin bruising and thinning improve within a few weeks.
However, with very long-term use of high-dose steroids, some changes like fat redistribution can become permanent. The likelihood of irreversible facial changes depends on factors like:
- Length of prednisone treatment
- Cumulative steroid dose
- Time since stopping prednisone
- The individual’s tendency to retain fluid and fat
- Genetics
- Age
- Severity of facial changes while on steroids
Older individuals and people whose faces were significantly impacted by steroids have a higher chance of permanent changes.
After stopping prednisone, it’s a good idea to be patient and give the body several months to gradually readjust fluid balance, fat distribution, and hormone production. If significant facial puffiness persists beyond 6 months post-treatment, cosmetic surgery may be an option to remove excess fat.
Tips to minimize prednisone facial changes
While facial changes from steroids may be unavoidable, the following tips can help reduce their severity:
- Use the lowest effective prednisone dose possible
- Take prednisone every other day instead of daily if permitted
- Avoid excess sodium in the diet to minimize fluid retention
- Stay hydrated by drinking plenty of water
- Follow a healthy low-fat, high-protein diet
- Get regular exercise to encourage fluid loss through sweating
- Sleep with head elevated to minimize facial edema
- Avoid excessive sun exposure to thin vulnerable skin
- Use gentle skin care and moisturizers
- Treat acne with over-the-counter washes and creams
Let your doctor know if prednisone is causing difficult or embarrassing facial changes. They may be able to switch your prescription to a non-steroid medication or lower your dose. Don’t abruptly stop taking prednisone without medical supervision.
Conclusion
Prednisone and other corticosteroids commonly cause cosmetic changes in facial appearance like puffiness, rounding, acne, redness and thinning skin. This occurs because steroids influence fluid balance, fat deposits, skin integrity and hormone regulation in the body. Facial changes tend to be most noticeable in people who use prednisone long-term or at high doses. While facial changes are reversible for most people after stopping prednisone, some effects like fat redistribution can become permanent after prolonged use. Work with your doctor to minimize steroid doses and try dietary, lifestyle and skin care measures to reduce the risk and severity of prednisone’s effects on your face. Be patient after discontinuing steroids, as it can take months for facial edema, fat patterns and skin appearance to normalize again.