Rapamycin and Acne

Has anyone experienced a worsening or development of acne since starting rapamycin? I’ve experienced a development of acne which appears to coincide with my biweekly sirolimus dosing regimens. I did a literature search on the topic and came across this article:

Acne in recipients of renal transplantation treated with sirolimus.pdf (2.1 MB)

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Yes, a minor pimple or two, maybe every other dose. Before I had none.

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Seem to have a couple out of nowhere.

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Yes, like the others, maybe a few more.

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I’ve seen some fairly significant cases mainly in younger males.

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Here’s another publication on the topic of rapamycin and acne:

Sirolimus-induced acneiform eruption.pdf (312.1 KB)

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For the most part my facial skin is thicker and better… however, I get the odd single yellow pimple… pretty random… that easily goes away… I assumed it was the rapa. Never had any before using it

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I never get acne but got several big cysts when I first titrated up my Rapa and preceded the dose with Grapefruit Juice.

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Thanks for sharing because I thought mTOR inhibition was aligned with decreased acne development. Here are some key take aways from this paper

• Acne is an mTORC1-driven anabolic and inflammatory skin disease.
• High glycemic load and milk/dairy consumption as well as pro-inflammatory signals enhance mTORC1 signaling.
• Anti-acne agents in clinical use operate by indirect or direct mTORC1 inhibition.
• Future anti-acne drugs are either natural or synthetic mTOR-inhibitors.
• Future acne therapy should be a combination of nutrition therapy with a paleolithic-type diet supported by pharmacological attenuation of enhanced mTORC1 signaling.

So I don’t really understand how rapamycin can stimulate acne.

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Interesting find on this paper Krister…

Here is the full paper on Sci-Hub:

The role of mTORC1 in acne pathogenesis and treatment

https://sci-hub.se/10.1586/17469872.2013.846514

It would be interesting to see if topical rapamycin cream could help in mitigating the rashes or acne that sometimes people see with systemic / oral rapamycin use…

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I stumbled upon this article on the internet. This text was something that created little bit a aha moment for me.

Treating an infected pimple involves killing the bacteria that causes the infection. Medications to treat regular pimples will not treat infected pimples, although they can help reduce the spread to other areas. When an infection is severe, a doctor may prescribe antibiotics, which can help reduce bacteria and inflammation. However, they may be less effective if a person takes them lots of times. Antibiotics are available as creams or oral tablets.

My guess regarding the acne after high rapamycin dose is that the innate immune system is suppressed. On our face and body we have totally around 40 trillion bacterias. Some are good and some not so good. When the innate immune system is lowered we get more easy a bacterial infection like acne. But I would guess that rapamycin acne differs from the traditional acne when mTOR is elevated. Rapamycin acne is probably more a primary cause of increased risk for bacterial infection because of the lowered effect of the innate immune system.

This is good aligned also with why quick high dose of rapamycin can lead to mouth ulcer (mouth sore) which usually is caused by bacteria or virus infection. But I would guess that the common mouth ulcer combined with rapamycin is caused by bacteria. In the mouth we have a ton of bacteria.

Are mouth sores viral or bacterial? While viruses are the most common infectious cause of mouth sores, bacteria can cause oral lesions too.

It makes me also think about a thing what dr Alan Green has pointed out regarding rapamycin.

Rapamycin decreases the activity of INNATE IMMUNE SYSTEM. This is the first line of defense against bacterial infection. … Older people are at increased risk of bacterial infection. Rapamycin increases this risk. DO NOT TAKE RAPAMYCIN UNLESS YOU HAVE IMMEDIATE ACCESS TO Z-PAK OR OTHER ANTIBIOTIC. There is NO FREE LINCH. Rapamycin decreases activity of innate immune system which is very good for most age-related disease; but not good for bacterial infection.

So why rapamycin can lead to acne is not strange when we start looking at it. I wrote a other post regarding decline in immune system when it comes to rapamycin, calorie restriction, fasting, exercise etc.

Does this mean that we should stop with rapamycin, calorie restriction, fasting, exercise etc. No, and as I said in the post above I usually advocate not to practice for example extended fasting when you are sick or during periods when the risk of getting sick is high. But also not practice it when the body needs to heal from for example a fracture or a wound because then the body needs more anabolic processes to be triggered to heal instead of triggering to much of the catabolic processes and things that can lower the immune system.

One interesting question regarding this topic is if the acne is signal of a side effect that the dose regime is little bit to high? If the acne is just something that happens in the beginning of the rapamycin journey than probably that is not something to think so much about but if a person get acne problems every time that person takes rapamycin than it can be a signal that the dose is little to high. Our body gives us different signals on how to navigate in this life. So my guess is that this signal is probably something that is good to have an eye on. Or what do you all think?

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Thanks for your detailed post. I have had only a single experience with a mouth sore / ulcer - somewhere down around the dose level of 5mg/week. I had recurring issues with a rash on my wrist (under my Fitbit on my wrist - so some sort of contact dermatitis it seems, when dosing between 8mg and 12mg per week. This went on for months - every time I dosed I would get the rash under my Fitbit… So, eventually I just stopped wearing my Fitbit and the problem has not arisen again. No more rash. And since then, I’ve tested as high as a around 28mg dose (once, a total of 8mg rapa with grapefruit juice - so only an estimate) and not side effects noticeable (e.g. skin wise, visible).

People have made comments elsewhere in the forum on this issue of some side effects - like mouth sore / canker sore / (technical name “Aphthous Ulcer” ) and skin rashes as being a sign that you are getting too high a dose. While I definitely think that these side effects are something to be aware of and keep an eye on - I also think that you have to weight them with respect to the blood test results you are getting, and more generally the benefits you are seeing - to get a more inclusive, broader view of your “costs / benefits” of taking rapamycin.

So - yes - watch all side effects, but also get regular blood work (I try to do blood testing every 3 or 4 months to track my results and changes) - and of course discuss with your doctor.

Super interesting regarding your experiences. The mouth sore is a one timer as you pointed out and those cases are probably not so important to look at. Very interesting regarding the FitBit experience you had. I just feel that I needed to google that and first result I got was.

In the study, the researchers tested various watches, smartwatches and trackers for bacteria, yeast and mould. Their results revealed that each watch harboured a worrying amount of bacteria, yeast and mould, with the average scoring three times dirtier than a toilet seat.

So it is not strange that you got rashes under your Fitbit. It would be very interesting if you would make a simple experiment. If you start using it again for one or two days to see if the rashes comes back. After that you clean really good and disinfected the Fitbit with alcohol so that bacterias are killed than you try to use it again and see if the rashes comes back. My guess is that you will not get any rashes now.

This makes me also think about the bacterias on the face and here one interesting experiment can also be done. It should be possible to use some kind of face wash/cream that kills bacteria on the skin. If the person use a cream like that before the high dose of rapamycin my guess is that we will not see acne problems afterwards. That experiment would be really interesting to get a result on. If someone has problems with acne and want to try that out that would be great. What do you think about that @brandy111? Is that something you have tried or are willing to try and share the results here?

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@RapAdmin I have some curious questions

  1. Regarding the FitBit do you remember how long took it before you got rashes after you took your rapamycin dose? Did the rashes go away after some days after the dose?

  2. Regarding the mouth sore you only got once. Do you remember how long took it before you got it after you took your rapamycin dose?

One similiar question to @brandy111

  1. Regarding the acne how long does it take before you get it after you take your rapamycin dose? How long does it take before they go away?
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Krister_Kauppi, thanks for sharing your interesting analysis and hypotheses. As for myself, I have recently increased my dietary intake of Greek yogurt and kefir, so the dairy variable may have also contributed to (or caused) the acne. I noticed acne flare ups beginning a couple days after my last two rapamycin doses, so that’s when I decided to do a literature search on the topic and ask the community here for their input/experiences. My acne seems to go away at a similar rate that a large pimple would resolve.

I recently have also noticed new slightly red and dry patches of skin on my elbows and one of my fingers. Again, unsure if it’s related to the rapamycin. My next biweekly rapamycin dose is coming up in a few days… I’ll monitor to see if these skin issues worsen.

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Thank you also for sharing and great that you noticed that you also have done a dietary change which can have an impact. Keep us updated how it goes :pray:

For both the contact dermatitis / rash under the Fitbit, and also the mouth sore - it was typically a few days after the rapamycin dose. The mouth sore went away after a few more days and I’ve never had that issue again.

the rash under the Fitbit was more persistent - in part because I kept wearing the Fitbit. Cortisol cream helped make it go away, but it didn’t got away entirely before my next dose… so this was an issue for a few months total. Only after I stopped wearing my Fitbit entirely did the rash go away entirely.

Your idea of completely disinfecting the Fitbit is a good one - I may try that. Will post results if I do.

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Great sharing! It would be interesting to see before you disinfect the FitBit if you still get rashes. If you don’t there can be two reasons for that. 1) The bacterias on the FitBit has naturally died because you haven’t weared it for a while. 2) Your immune system is stronger now than before.

But hopefully you could reproduce the rashes because that would give a very nice insight if disinfecting the FitBit has an good effect. Keep up us updated if you test it.

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I have a strong suspicion that the acne I’ve been experiencing lately is down to rapamycin. I had a peculiar breakout a few weeks ago, though it’s clearing up. I developed a cluster of small spots on my forehead, in addition to acne on my scalp, neck and back. I hadn’t experienced this type of acne since my 20s, and I’m now 48. I suspect I may have pushed the dose too high (7mg per week), and this allowed the bacteria on my skin to proliferate. I had been on 6mg weekly for six months up until this point. I dropped back down to 6mg, but I may take a short break to see if things completely clear up.

Interestingly, around the same time, I evaded covid despite my wife catching it. I didn’t self-isolate, and was resigned to getting it. We got our booster shots at the same time. I’m wondering if this is because rapamycin, on the positive side, suppresses viral replication, but also impedes the immune response to bacterial infections.

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I’ve heard of quite a few young males in particular getting acne, especially with increasing doses.

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