Got Moon Face? Tips on Causes and Fixes

“Moon face” is swelling that makes the face look puffy and round, like a full moon. It’s often caused by long-term use of a steroid medication such as prednisone, but it can also signal a health condition such as Cushing’s syndrome or an underactive thyroid. Managing the underlying cause often leads to symptom improvement.

Why Does Moon Face Happen? 

Moon face can arise from several causes, with long-term use of corticosteroids being among the most common.

1. Corticosteroids

Corticosteroids like prednisone can increase appetite, leading to weight gain. They can also cause fat deposits to shift. Another side effect, increased water retention, contributes to swelling and additional weight gain.

All of these factors can make your cheeks get puffy and fill out your jawline, causing moon face. The effects stem from the fact that corticosteroids act like cortisol, a stress hormone that the body produces naturally. Amongst its many roles, cortisol regulates insulin levels and balances fluid and salt.

Corticosteroids are used for various conditions, but moon face is commonly linked to long-term use. Conditions treated with these drugs include:

• Severe hives
• Skin disorders, such as eczema
• Inflammatory diseases, including asthma, inflammatory bowel disease (IBD), ulcerative colitis, and arthritis
• Nerve-related pain, like severe sciatica
• Autoimmune diseases, such as Addison’s disease, lupus, and multiple sclerosis
• Respiratory conditions, like chronic obstructive pulmonary disease (COPD)
• Certain cancers, including lymphatic and blood cancers

2. Cushing’s Syndrome

High cortisol levels can lead to Cushing’s syndrome, a hormonal disorder. This often results in weight gain and facial swelling, making moon face a common symptom.

These are part of a group of symptoms known to cause what’s called a Cushingoid appearance (or Cushingoid facies).

Cushing’s syndrome is usually caused by long-term use of corticosteroids, but it can also result from a tumor.

Three tumor types can cause Cushing’s syndrome:

• Pituitary adenomas: Non-cancerous growths on the pituitary gland, located at the brain’s base. They cause excess cortisol production.
• Ectopic ACTH-producing tumors: Often found in the lungs, these tumors produce adrenocorticotropin hormone (ACTH), leading to increased cortisol. They can be cancerous.
• Adrenal tumors: Usually benign growths on the adrenal gland (one on each kidney). They can also be cancerous.

The cortisol imbalance that characterizes Cushing’s syndrome affects several body systems, which can lead to additional symptoms such as reddish-purple stretch marks, acne, thinning skin, and more.

3. Hypothyroidism

When you have hypothyroidism, your thyroid gland doesn’t make enough thyroid hormone. This hormone helps metabolize sugar molecules, so a lack of it may cause them to build up in the skin.

Sugar molecules attract water. The more you have, the more fluid you can retain. This can make your face swell.

Hypothyroidism can lead to other symptoms, including:

• Fatigue
• Weight gain
• Joint and muscle pain
• Cold intolerance
• Slowed heart rate
• Depression

Hypothyroidism can be an autoimmune response, with antibodies attacking thyroid cells. It can also occur after you’ve had radiation treatment or because you had your thyroid gland removed.

4. Diabetes and Insulin Therapy

People who have diabetes or insulin resistance may also gain weight as the body stores excess blood sugar as fat. Over time, this weight gain may give the face a rounder, puffier appearance.

In rare cases, taking insulin to control diabetes can lead to a buildup of fluid in parts of the body, including the face.

5. Weight Gain

Any weight gain can make your face look rounder, especially when combined with fluid retention. Remember, Cushing’s syndrome can also affect children, often leading to symptoms of overweight and obesity.

Emotional and Physical Effects of Moon Face

Extra fat and water retention can dramatically change your face, making it feel unfamiliar. This might lead to low self-esteem and depression.

The emotional stress caused by moon face itself can be made worse by depression or mood changes that stem from the underlying cause. Corticosteroids and Cushing’s syndrome, for example, can have these effects.  

While moon face does not threaten your physical health, its causes can.

For example, corticosteroids change how your body stores fat. Moon face is one way this affects you. You may also develop a “buffalo hump,” which is extra fat on the back of the neck. Many people also gain weight around the abdomen and middle of the body.  

Abdominal body fat raises your risk for metabolic syndrome, a group of conditions that increases the likelihood of heart disease, stroke, and type 2 diabetes.

Finding Relief from Moon Face Symptoms 

How quickly moon face goes away depends on the cause, but it often resolves once the cause is treated. When corticosteroids are the cause, moon face typically resolves when you stop the medication. Other causes may require medication or, sometimes, surgery.

Stopping Corticosteroids

If you stop taking your corticosteroid, your face should eventually return to normal. However, it’s extremely important that you do not stop them abruptly.

The dosage needs to be gradually reduced (tapered) under the guidance of a healthcare provider. If you stop all at once, your body may not have enough cortisol. This can lead to:

• Extreme tiredness
• Weakness
• Upset stomach
• Weight loss
• Changes in skin color
• Mouth sores
• Salt cravings

If moon face is bothering you, talk to your healthcare provider. They can decide if stopping the medication is an option for you and, if so, create a tapering schedule.

How quickly the dosage is lowered depends on how long you’ve been taking the drug and at what dosage. If you’ve been taking corticosteroids for a long time at a high dose, you may need to lower the dose very slowly every week or every few weeks.

Medical Treatments

If Cushing’s syndrome, not corticosteroids, causes moon face, your doctor might prescribe medication to control cortisol production. Options include:

• Nizoral (ketoconazole)
• Lysodren (mitotane)
• Metopirone (metyrapone)

Surgery also may be needed to remove a tumor. If treatment is effective, all of the symptoms of Cushing’s syndrome, including moon face, will eventually disappear.

If hypothyroidism causes moon face, your doctor may prescribe medications like levothyroxine to replace missing thyroid hormones. Once treatment works, the moon face should gradually disappear.

Tips to Stop Moon Face Before It Starts

Moon face is a symptom of an underlying cause, so prevention of moon face focuses on resolving the medication side effects or the thyroid condition that leads to it.

For example, type 2 diabetes that’s not well controlled can co-occur with Cushing’s syndrome. So, managing your diet and taking your diabetes medication may help to limit the effects.

Moon face due to weight gain resolves with weight loss. Since you can’t target weight loss to specific areas, facial exercises won’t work. A healthy diet and regular physical activity can help you lose weight everywhere, including your face.

You can reduce how much your face swells by:

• Reducing salt intake: Salt increases fluid retention.
• Drinking more water: Poor hydration makes your body hold onto fluid.
• Getting adequate sleep: A lack of sleep can cause inflammation which can lead to facial swelling.

When to See a Healthcare Provider

It’s important to discuss your symptoms with a healthcare provider to ensure an accurate diagnosis of what’s causing moon face. If you’ve tried lifestyle changes at home and it’s not improving, it’s time to see a healthcare provider.

A healthcare provider can discuss treatment options and identify any serious concerns. While moon face itself isn’t usually threatening, the underlying cause might be. Related symptoms like a slow heart rate from prednisone should be evaluated immediately.