The BBC reports a case study in The Lancet, discussing the worst incident of acne ever seen on the planet (active disease below left).
German doctors were shocked at the extent of the massive, deep ulcerating sores on the chest and back of the 21-year-old man. After antiseptic and antibiotic therapy the wounds healed but left permanent scars, The Lancet reported.
Experts said steroid-induced acne was usually much milder. Figures from the British Crime Survey put the number of steroid users at 42,000 but some experts believe the true figure could be twice as high.
They have been banned by many sporting bodies, including the International Olympic Committee, because of their danger to health and the potential for competitive advantage.
Known side-effects include potential damage to major organs in the body such as the liver and heart.
Dr Peter Arne Gerber, from the Department of Dermatology at Heinrich-Heine-University in Düsseldorf, Germany, said moderate amounts of the drug could cause big problems. "Usually in people taking moderate doses of the drug you see some sort of mild acne but in severe cases it can ulcerate. "The doses this man was taking were within the doses that are used among bodybuilders."
Sounds like the patient wasn't too bright, continuing to use the drugs, even when he looked like a leper, and blasted his genital into oblivion (scarred results below).
He eventually stopped but by then it was found the steroid abuse had also caused a low sperm count and shrunken testicles.
"There is probably a dose-effect with the steroids but it's also dependent on how the individual reacts," he said.
"It is questionable whether he will be able to start building muscle mass again - he may not be able to perform the exercises due to the scarring."
There is a call for studies at doses of anabolic steroids used on the street. What IRB (Internal Review Board for ethical studies) would ever approve that?
He added there was a lack of studies examining the side effects of steroid abuse and called for "robust scientific research" to establish exactly what effects anabolic steroids have on heavy users.