Does Tamoxifen Cause Acne?

Medically reviewed by Dr. Doug Blayney on December 18, 2023

Introduction

We often hear the diagnosis of breast cancer and lose sight of the fact that there are several types of breast cancer. In the US, and much of the Western world, the most common form of breast cancer is called hormone-positive or estrogen receptor positive breast cancer. Hormone-positive breast cancer is a type of breast cancer that relies on hormones like estrogen and progesterone to signal the cancer cells to grow. Doctors can treat hormone positive cancer with hormone therapies that help block the action of these hormones and slow down or stop the cancer from growing. Tamoxifen is one of these types of “hormone blocking” medicines for breast cancer that can lower the chance of it coming back and spreading. It is taken as a pill every day and works by protecting the cancer cells from the estrogen signaling growth signal. Tamoxifen engages and clogs up the estrogen receptor in the cancer cell. Paradoxically, Tamoxifen can stimulate growth in other cells of the body with estrogen receptors. For example, cells of the uterine lining can grow when their receptors are engaged with tamoxifen. 

Like many medicines, tamoxifen has side effects. The side effects often occur in parts of the body which have cells with estrogen receptors.  One of the beneficial side effects of tamoxifen is stimulation of cells which help form bone; tamoxifen can help prevent osteoporosis or bone loss. One of the known but uncommon side effects of tamoxifen is endometrial (uterine) cancer, which is likely caused by tamoxifen signaling the uterine lining cells to grow.  While acne is not a listed side effect of tamoxifen, some of tamoxifen’s other side-effects from blocking hormones might increase your likelihood of dealing with acne.

What is Tamoxifen?

There are several subtypes of breast cancer, but the main ones are divided into three common categories (note that there can be overlap between the first two categories):

Hormone Receptor-Positive Breast Cancer: This type of breast cancer is sensitive to hormones like estrogen and progesterone. It includes subtypes like estrogen receptor-positive (ER+), progesterone receptor-positive (PR+), or both (ER/PR+).

HER2-Positive Breast Cancer: In this subtype, the cancer cells have too much of a protein called HER2, which also acts as a growth signal in the cancer cells. 

Triple-Negative Breast Cancer: This type does not have hormone receptors (ER/PR) or excess HER2 protein.

Tamoxifen is a drug used by some people who have been diagnosed with Hormone Receptor-Positive Breast Cancer. If we think of each cancer cell like a little car, hormones such as estrogen and progesterone signal those cells to accelerate their growth and make it possible for them to spread. To stop those cells from getting the signal, doctors try to stop (or block) any estrogen or progesterone from being present in the body, or from reaching the gas pedal. The theory is that if we take away the growth signal, we lower the risk of the cancer cells growing and spreading. That is why Tamoxifen is called a hormone-blocking medicine.

Tamoxifen can be used by women both before and after menopause. For those at a higher risk of developing breast cancer, some doctors might recommend taking tamoxifen as a preventive measure to reduce the chances of developing cancer Additionally, for women who have already been treated for breast cancer, tamoxifen can be used to help prevent the cancer from coming back. The duration for taking tamoxifen varies and is typically decided by the doctor based on individual circumstances. A 2021 article in the ASCO Post summarizes current thinking about taking Tamoxifen for 5 years versus 10 years. The benefit of taking Tamoxifen for longer than the standard 5 years is based on the stage of cancer at diagnosis and various risk factors for recurrence, and can be tailored to an individual’s circumstances by a doctor. It's important to follow the doctor's advice and take the medication as prescribed to maximize its effectiveness in managing and preventing breast cancer.

Tamoxifen Side Effects

Some of the side effects of taking Tamoxifen might include:

• Menopause-like symptoms, including hot flashes, night sweats and vaginal dryness
• Weight gain (more common) or fluid retention (edema)
• Changes in menstrual periods for some women
• Tiredness or fatigue
• Changes in mood, like feeling sad or irritable
• Changes in how the uterus (womb) feels
• Hair thinning or hair loss
• Changes in the skin, like rashes or itching

Rarely, Tamoxifen may cause serious issues such as:

• Blood clots, deep vein thrombosis (DVT) and strokes.
• Cataracts or other eye problems.
• Endometrial (uterine) cancer.

These side effects can vary from person to person.  Many of these side effects are similar to other times in life when the body detects changes in the level of estrogen – pregnancy and after delivery, puberty, and menopause.  With this understanding, it's important to talk to a doctor about any concerns or discomfort when taking Tamoxifen. If you need a reminder to write down your symptoms, check out our Manta Planner which provides an easy way to remember side effects you are experiencing between doctor’s appointments.

Tamoxifen and Acne

While Tamoxifen is not a listed side effect of Tamoxifen, we hear anecdotally from our community that many of us do see an increased incidence of acne while taking tamoxifen. While I took tamoxifen, I didn’t develop acne on my face, but definitely saw an increase of the dreaded “back-ne” or acne on my back. Acne is a common skin condition that normally happens during puberty that happens when hair follicles get clogged with oil and dead skin cells, leading to pimples and blackheads. It often shows up on the face, back, and chest, and can be influenced by hormones and genetics. Since the purpose of tamoxifen is to block estrogen, it makes sense that your skin will be impacted. Hormones can affect your skin by increasing oil production, which may lead to acne. Changes in hormones can influence the skin's condition and contribute to breakouts (like me, you might remember this from puberty!).

Skin Changes

So can tamoxifen cause skin changes? Yes, both directly and indirectly via the menopausal symptoms that Tamoxifen can induce. A literature review on tamoxifen-associated skin reactions in breast cancer found, “From 17 clinical studies identified, over ten distinct types of adverse reactions of the skin were itemized. The character of these cutaneous events ranged from the relatively common hot flashes to the rare, but potentially life-threatening, Stevens-Johnson syndrome. Overall, tamoxifen is generally a well-tolerated hormone therapy with decades of supporting safety data.”

Some other skin-related side effects of Tamoxifen may include:

• Hot Flashes: Tamoxifen may cause hot flashes, which are sudden feelings of warmth, redness of the face, and sweating, often experienced in the upper body.
• Skin Rash: Some individuals may develop a rash as a side effect of tamoxifen, which can manifest as redness, itching, or irritation on the skin.
• Dry Skin: Tamoxifen use may result in dryness of the skin, making it important for individuals to stay well-hydrated and use moisturizers as needed.
• Vaginal Dryness: Tamoxifen can lead to hormonal changes that may cause vaginal dryness, which can impact the skin in the genital area.
• Itchy Skin: Itching or pruritus is another skin-related side effect that some people may experience while taking tamoxifen.
• Increased Sweating: Tamoxifen use may contribute to increased sweating, which can affect the skin and may be linked to other side effects like hot flashes.
• Hyperpigmentation: In some cases, tamoxifen has been associated with changes in skin pigmentation, leading to darkening or discoloration of certain areas.
• Photosensitivity: Tamoxifen use may increase sensitivity to sunlight, making the skin more prone to sunburn. It's essential for individuals to use sunscreen and protective clothing when outdoors.
• Nail Changes: Some people on tamoxifen may experience changes in their nails, such as brittleness or discoloration.
• Swelling: Edema or swelling is a potential side effect of tamoxifen, and it may affect the skin, causing puffiness or tightness.

Make sure you discuss any side effects you are experiencing with your doctor to ensure you have tools to manage them.

Hormonal Changes

Since Tamoxifen is a medicine tasked with blocking hormones, it is no surprise that this hormonal change will impact many parts of your body. Let’s first think about what the hormones estrogen and progesterone are meant to do for our body if we are healthy and unconcerned about cancer (wouldn’t that be nice?!).

What is estrogen?

Estrogen is a hormone that plays important roles in our bodies, especially in girls and women, though estrogen is present in men as well. Its main purpose is to help control and regulate things like the menstrual cycle and the development of female characteristics, such as breast growth, hair patterns, and voice pitch. Estrogen also helps keep bones strong and healthy. It's like a natural messenger that tells the body what to do, and it's important for normal growth and functioning, particularly during puberty and in women's reproductive years. Here are some of the main roles of estrogen:

1. Regulating the Menstrual Cycle: Estrogen helps control the menstrual cycle in women, including the release of eggs from the ovaries.
2. Promoting Breast Development: During puberty, estrogen is responsible for the growth and development of breast tissue.
3. Maintaining Bone Health: Estrogen plays a role in keeping bones strong and healthy. It helps prevent bone loss and reduces the risk of osteoporosis.
4. Supporting Pregnancy: Estrogen levels rise during pregnancy and help maintain the uterine lining, necessary for a successful pregnancy.
5. Affecting Mood and Memory: Estrogen can influence mood and memory, and changes in estrogen levels are linked to mood swings and cognitive changes.
6. Skin Health: It contributes to skin health by maintaining skin thickness and promoting collagen production.
7. Vaginal Health: Estrogen helps maintain the health of the vaginal lining and can affect lubrication and elasticity.
8. Metabolism and Cholesterol: Estrogen has an impact on metabolism and can help control cholesterol levels in the blood.

What is progesterone?

Progesterone is another important hormone in our bodies, and its main purpose is to help prepare a woman's body for a possible pregnancy. It's like a helpful caretaker for the uterus. If a woman's egg gets fertilized by a sperm, progesterone helps make the uterus (womb) ready to support the growing baby. If there's no pregnancy, progesterone levels drop, leading to the start of the menstrual period. So, progesterone helps control the menstrual cycle and is a key player in pregnancy, making sure everything is ready for a baby if one is on the way. Here are some of the main roles of progesterone:

1. Preparing the Uterus: One of its primary roles is to prepare the lining of the uterus (womb) for a possible pregnancy. If an egg is fertilized by sperm, progesterone helps make the uterus a suitable place for the fertilized egg to implant and grow.
2. Regulating the Menstrual Cycle: Progesterone helps control the menstrual cycle by maintaining the uterine lining. If there is no pregnancy, a drop in progesterone levels triggers the start of the menstrual period.
3. Supporting Pregnancy: During pregnancy, progesterone levels remain high, maintaining the uterine lining and reducing the chances of miscarriage. It also helps relax the uterine muscles to prevent contractions.
4. Affecting Mood and Sleep: Progesterone can influence mood, making some women feel more relaxed or even drowsy. This hormone can also affect sleep patterns.
5. Breast Health: It plays a role in maintaining healthy breast tissue.
6. Cervical Mucus: Progesterone can affect cervical mucus, making it thicker and less receptive to sperm during non-fertile periods of the menstrual cycle.

So if we are blocking estrogen and/or progesterone, how will that impact our body?

When someone has hormone positive breast cancer, the goal is to remove as much estrogen and/or progesterone from the cancer cell growth signaling as possible by using Tamoxifen to block the action of these hormones at the cancer cell. Paradoxically, tamoxifen acts in some cells, such as the uterus, bone cells and fat cells like normal estrogen. This is a good thing for reducing the amount of growth signal getting to cancer cells to help them grow, but tamoxifen, acting like estrogen on the other cells superchargers the estrogen effect on the other cells. This can lead to undesirable side effects like weight gain, mood swings and depression, but also may stimulate bone growth. These menopausal side effects can also lead to Menopausal Acne. Several factors that might trigger or aggravate adult acne also play a role in menopausal acne, such as cosmetics, dietary factors, obesity, smoking, ultraviolet radiation, drugs, sleep deprivation and stress.

Increased levels of androgen

Androgen is a type of hormone, primarily produced in the testes in males and the ovaries in females, although smaller amounts are also produced in the adrenal glands. In males, androgens, such as testosterone, play a crucial role in the development of male reproductive tissues and secondary sexual characteristics, while in females, they contribute to overall hormonal balance and are converted into estrogen. A 2013 study showed that use of tamoxifen can increase levels of androgen may be the reason for oilier skin while taking tamoxifen. Androgen levels impact the skin in several ways. Higher levels of androgens can increase the production of sebum, an oily substance that can clog pores, leading to acne. Additionally, androgens influence the skin's sensitivity to inflammation, affecting conditions like acne and rosacea. Changes in androgen levels can also contribute to the aging process, influencing factors such as skin thickness and elasticity. In females, hormonal fluctuations during the menstrual cycle and menopause can influence androgen levels, impacting skin health and contributing to conditions like hormonal acne.

Stress

Stress not only takes a toll mentally, but can impact many parts of your physical health as well. This includes your skin! If you’ve been impacted by cancer, chances are you’re experiencing some stress in your life! Here are some of the ways that stress can impact your body (including your skin!):

1. Skin Issues: Stress can contribute to various skin problems, including acne, eczema, psoriasis, and hives. It may exacerbate existing skin conditions or trigger flare-ups.
2. Hair Problems: Stress can lead to hair loss, thinning, or changes in hair texture. Conditions like alopecia areata, where hair falls out in patches, can also be stress-related.
3. Muscle Tension: Stress often causes muscle tension, leading to headaches, neck pain, and backaches. Chronic stress may contribute to conditions like tension headaches and migraines.
4. Digestive Troubles: Stress can impact digestion, leading to issues such as indigestion, heartburn, irritable bowel syndrome (IBS), and other gastrointestinal problems.
5. Weakened Immune System: Prolonged stress can suppress the immune system, making individuals more susceptible to illnesses and infections.
6. Cardiovascular Effects: Chronic stress is associated with an increased risk of cardiovascular problems, including high blood pressure, heart disease, and stroke.
7. Sleep Disturbances: Stress can disrupt sleep patterns, leading to difficulties falling asleep or staying asleep. Poor sleep, in turn, affects overall health and well-being.
8. Weight Changes: Stress may contribute to weight gain or loss. Some people may overeat as a way to cope with stress, while others may experience a loss of appetite.
9. Cognitive Impact: Stress can affect cognitive function, leading to difficulties with concentration, memory, and decision-making.
10. Reproductive Health: Stress can influence reproductive health, contributing to menstrual irregularities, fertility issues, and impacting libido.
11. Chronic Pain: Stress is linked to the exacerbation of chronic pain conditions, such as fibromyalgia and arthritis.
12. Fatigue: Chronic stress can lead to persistent fatigue and feelings of exhaustion, impacting overall energy levels and daily functioning.

It's important to note that the impact of stress varies from person to person, and individuals may experience different combinations of these physical effects based on their unique circumstances. If you need help managing your stress (I sure did! And frankly, often still do even out of active cancer treatment!), remember it’s always okay to ask for help! 

Managing Acne While Taking Tamoxifen

Here are some general tips to treat adult acne. Treating acne during menopause can be tricky because it can affect how people feel about themselves and their lives.  The kind of treatment depends on what's causing the acne, how bad it is, how the person's skin has reacted to treatments before, and what kind of skin they have - whether it's dry and sensitive or thick and oily. When picking creams or ointments, it's important to be careful because they can make the skin even drier and more irritated, especially in older women who already have sensitive skin. Some treatments might include:

• Topical therapy: applying medications directly to the skin's surface to target and treat acne lesions.
• Systemic therapy: medications that are taken orally or applied to the entire body, addressing acne from within and often targeting hormonal factors influencing its development.
• Systemic antibiotics: taking oral medications that work throughout the body to reduce bacteria associated with acne and inflammation.
• Procedural therapy: involves in-office procedures such as chemical peels, laser treatments, or extractions performed by a dermatologist to address acne and improve skin texture.

You can read more detail about each of these types of treatments in this 2019 study on Menopausal Acne.

Skincare Tips

Here are some tips for caring for your skin while taking Tamoxifen:

1. Gentle Cleansing: Use a mild, fragrance-free cleanser to wash your face twice a day. Avoid harsh soaps or abrasive cleansers that may irritate the skin.
2. Moisturize: Even if you're dealing with acne, moisturizing is crucial, especially since Tamoxifen may contribute to dry skin. Choose a non-comedogenic, oil-free moisturizer to keep your skin hydrated.
3. Sun Protection: Tamoxifen may increase sensitivity to sunlight. Protect your skin by using a broad-spectrum sunscreen with at least SPF 30, even on cloudy days.
4. Avoid Harsh Products: Steer clear of products containing alcohol, benzoyl peroxide, or salicylic acid, as these can be too harsh for skin undergoing Tamoxifen treatment.
5. Fragrance-Free Products: Opt for fragrance-free skincare products to minimize the risk of skin irritation. Fragrances can be irritating, especially for sensitive skin.
6. Consult Your Healthcare Provider: Before using over-the-counter acne treatments or prescription medications, consult your healthcare provider. They can recommend suitable options that won't interfere with Tamoxifen.
7. Hydration: Drink plenty of water to stay hydrated. Hydration is essential for overall skin health and can help alleviate dryness associated with both Tamoxifen and some acne treatments.
8. Avoid Picking or Squeezing: Resist the temptation to pick or squeeze acne lesions, as this can lead to scarring and further irritation.
9. Clean Makeup Brushes: If you use makeup, regularly clean your brushes and avoid sharing them. Dirty brushes can harbor bacteria that may worsen acne.
10. Choose Non-Comedogenic Makeup: Select makeup labeled as non-comedogenic, meaning it is less likely to clog pores. This helps prevent further breakouts.
11. Consult a Dermatologist: If your acne persists or worsens, consult a dermatologist. They can provide tailored advice and may recommend specific treatments suitable for your skin type and Tamoxifen use.

Remember to communicate openly with your healthcare provider about any skin changes or concerns, as they can provide personalized guidance based on your medical history and current treatment plan.

Conclusion 

Breast cancer and its treatments can often be the “gift that keeps on giving.” Sometimes the medicines we take to help combat cancer, like tamoxifen, can create their own list of issues. Have you experienced skin issues while taking tamoxifen? Did you find anything specific that helped you? Comment below with any tips or advice you have for others going through the cancer experience. Join our community for more resources and information to help you navigate your own cancer experience. And know that you are not alone in your experience. We’re in this together!

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