Does tadalafil cause acne? This is a common concern among patients prescribed this phosphodiesterase type 5 (PDE5) inhibitor for erectile dysfunction or benign prostatic hyperplasia. Acne is not listed as a recognised side effect in UK prescribing information, nor has it emerged in clinical trials or post-marketing surveillance. Whilst tadalafil can occasionally cause non-specific rash, there is no evidence linking its mechanism of action to the hormonal or inflammatory pathways that drive acne development. This article examines the evidence, explores tadalafil's actual side effect profile, and advises when skin changes warrant medical review.

Does Tadalafil Cause Acne?

Tadalafil is a phosphodiesterase type 5 (PDE5) inhibitor primarily prescribed for erectile dysfunction and benign prostatic hyperplasia. Whilst concerns about medication-related skin changes are understandable, acne is not listed as a side effect in the UK Summary of Product Characteristics (SmPC) for tadalafil, nor has it emerged as a signal in clinical trials or post-marketing surveillance data.

The confusion may arise because patients sometimes attribute any new skin changes to recently commenced medications. However, acne is a multifactorial condition influenced by hormonal fluctuations, sebaceous gland activity, bacterial colonisation (particularly Cutibacterium acnes), and genetic predisposition. There is no evidence that tadalafil's mechanism of action—selective inhibition of PDE5 leading to increased cyclic guanosine monophosphate (cGMP) and smooth muscle relaxation—affects the pathophysiological processes underlying acne vulgaris such as sebum production or follicular keratinisation.

It's worth noting that 'rash' is recognised as an uncommon side effect of tadalafil, which might sometimes be confused with acne but typically presents differently.

That said, individual responses to medications can vary considerably. If you notice new or worsening skin changes after starting tadalafil, it is worth considering other potential causes, including coincidental hormonal changes, dietary factors, stress, or the use of other medications or skincare products. Maintaining an accurate timeline of when symptoms began relative to medication initiation can help your GP determine whether there is a genuine association or whether the skin changes are unrelated to tadalafil therapy. Always discuss persistent or troublesome skin concerns with a healthcare professional rather than discontinuing prescribed medication without guidance.

Common Side Effects of Tadalafil

Understanding the recognised adverse effect profile of tadalafil helps patients distinguish between expected reactions and unusual symptoms requiring further investigation. The most frequently reported side effects are generally mild to moderate and relate to the drug's vasodilatory properties.

Common adverse effects (affecting up to 1 in 10 people) include:

• Headache – the most prevalent side effect

• Dyspepsia (indigestion)

• Back pain and myalgia – typically appearing 12–24 hours after dosing and resolving within 48 hours

• Nasal congestion

• Flushing – facial warmth and redness

• Dizziness

Less common effects (affecting up to 1 in 100 people) may include blurred vision, eye pain, palpitations, tachycardia, hypotension, nausea, abdominal pain, increased sweating, and rash. Importantly, skin rash is recognised as an uncommon side effect, but this typically presents differently from acne.

Most adverse effects are transient and diminish with continued use as the body adapts to the medication. Tadalafil has a half-life of approximately 17.5 hours, with effects that can persist up to 36 hours (particularly the 'as-needed' formulations), which is longer than shorter-acting PDE5 inhibitors. Patients taking daily low-dose tadalafil (2.5 mg for erectile dysfunction or 5 mg for benign prostatic hyperplasia) often report fewer acute side effects compared to higher 'on-demand' doses (10–20 mg) used for erectile dysfunction.

Rare but serious side effects requiring immediate medical attention include:

• Priapism (painful erection lasting more than 4 hours)

• Sudden vision or hearing loss

If side effects prove troublesome or persistent, dose adjustment or switching to an alternative PDE5 inhibitor may be appropriate following discussion with your prescriber. Suspected side effects can be reported to the MHRA Yellow Card Scheme (yellowcard.mhra.gov.uk).

Skin Reactions and Tadalafil: What the Evidence Shows

Dermatological reactions associated with tadalafil are uncommon and typically non-specific. Post-marketing surveillance and pharmacovigilance data collected by the MHRA and European Medicines Agency (EMA) have identified occasional reports of skin-related adverse events, but these predominantly involve hypersensitivity reactions rather than acne.

Recognised cutaneous reactions include:

• Non-specific rash

• Urticaria (hives) – suggesting possible allergic or pseudo-allergic reaction

• Pruritus – generalised itching without visible rash

• Hyperhidrosis – excessive sweating

Very rare but serious skin reactions have been reported in isolated post-marketing cases with PDE5 inhibitors, though causality remains difficult to establish given the rarity and potential confounding factors. These severe reactions require immediate medical attention and permanent discontinuation of the medication.

Regarding acneiform eruptions specifically, there is no evidence in clinical trials or post-marketing data linking tadalafil to acne development. Unlike medications known to trigger acne—such as corticosteroids, androgenic hormones, lithium, or certain antiepileptics—tadalafil does not appear to influence the hormonal or inflammatory pathways implicated in acne pathogenesis.

If acneiform lesions develop during tadalafil therapy, alternative explanations should be explored, including:

• Coincidental onset of adult acne (common in men aged 25–45)

• Use of occlusive skincare products or cosmetics

• Dietary factors or whey protein supplementation

• Concurrent medications (particularly corticosteroids or anabolic steroids)

• Underlying endocrine disorders affecting androgen levels

Maintaining a symptom diary noting the timing, distribution, and characteristics of skin changes can assist healthcare professionals in determining causality and guiding appropriate management.

When to Seek Medical Advice About Skin Changes

Whilst most skin changes during tadalafil therapy are likely coincidental or benign, certain presentations warrant prompt medical evaluation. Understanding when to contact your GP or seek urgent care ensures patient safety and appropriate management.

Contact your GP if you experience:

• New or worsening rash that persists beyond a few days or progressively spreads

• Significant itching (pruritus) affecting quality of life or sleep

• Acne-like lesions that are severe, painful, or not responding to standard skincare measures

• Any skin changes accompanied by systemic symptoms such as fever, malaise, or joint pain

Seek urgent same-day medical assessment for:

• Facial swelling or swelling of the lips, tongue, or throat (potential angioedema)

Seek immediate medical attention (call 999 or attend A&E) if you develop:

• Difficulty breathing or swallowing

• Widespread blistering or skin peeling

• Painful red or purple skin rash that spreads rapidly

• Mucosal involvement – blistering or ulceration of the mouth, eyes, or genital area

• Priapism – erection lasting longer than 4 hours

• Sudden vision or hearing loss

For routine skin concerns such as mild acne developing during tadalafil treatment, schedule a non-urgent GP appointment to discuss the timeline of symptoms and explore potential causes. Your GP may recommend:

• Reviewing your complete medication list to identify other potential triggers

• Basic investigations if hormonal or metabolic causes are suspected

• Dermatology referral for persistent or severe skin conditions

• Trial discontinuation of tadalafil if a drug reaction is strongly suspected, with appropriate alternative management for the underlying condition

Never discontinue tadalafil abruptly without medical guidance, particularly if prescribed for pulmonary arterial hypertension (PAH). If you have concerns about any aspect of your treatment, your community pharmacist can provide initial advice and facilitate appropriate referral to your GP when necessary. For urgent but non-emergency concerns, NHS 111 can provide guidance on appropriate care.

Frequently Asked Questions