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Why It Is Important To Do This Review
Acne is the eighth most globally prevalent skin condition and the second most debilitating skin disease . It is a chronic and common condition with recurrences and relapses during puberty and adolescence. It may persist into adulthood and may result in significant emotional disturbance as well as physical scarring . The degree of scarring relates to the duration of acne, and it is therefore important to ensure that effective treatment is commenced in a timely fashion.
Many topical acne preparations that contain antibiotics as mono or combination therapy are available. However, there is a lack of comparative data on the most appropriate choice, taking efficacy, compliance, tolerability, and overall patient satisfaction into consideration . The issue of increasing antibiotic resistance highlights the need for the optimal use of both topical and systemic antibiotics in practice . Furthermore, there is no standardised validated grading system for assessing acne, and this hinders comparisons between clinical trials .
Many Cochrane Reviews have addressed different aspects of acne vulgaris, including interventions for acne scars , complementary therapies for acne , minocycline use , and use of combined oral contraceptive pills in acne . Our aim with this review is to provide evidence that may help inform recommendations for the use, retention, or withdrawal of topical antibiotics for acne in clinical practice.
We Need To Change How We Use Antibiotics
Thanks to using higher-than-needed doses of antibiotics and keeping patients on them for longer than recommended, the P. acne and other skin bacteria, like Staphlyococcus aureus have developed resistance to multiple topical and oral antibiotics used to treat this disease chronically. For instance, 20 or 30 years ago, the antibiotic erythromycin was used frequently to treat acne, but now both bacteria are uniformly resistant.
So far we have not seen too much resistance to the tetracycline class of antibiotics used today, but they too will be on their way out if we do not change our prescribing patterns.
This is frustrating because antibiotics dont need to kill bacteria to treat acne. Clearing P. acnes from the area can be helpful, but the bacteria is just one stimulus of inflammation, so removing it is an assist, not a win. And research has shown that the desired anti-inflammatory effects can be achieved at sub-antibacterial dosing. This means that the needed dose is so low that it cant kill good bacteria or challenge pathogenic bacteria to become resistant.
And antibiotics should never be prescribed on their own to treat acne. In fact, treatment guidelines always recommend that antibiotics be combined with a nonantibiotic topical treatment.
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Why Antibiotics Dont Work As Well As They Should
It has long been noted that antibiotics only work for about half of the population, and produce only moderate effectiveness.12 When they do help, they often only work for a short period of time. This is because acne tends to get used to both oral and topical antibiotic treatments and become resistant to it.7,13
As more research comes to light, it appears antibiotics are not helping clear acne as well as they once did. Researchers theorize this may be directly related to increased bacterial resistance across the entire population.13
It has become accepted practice that antibiotics must always be used in conjunction with other topical treatments because this helps reduce the chance for resistance, and because antibiotics do not work well enough on their own.
The following illustration shows how antibiotic resistance occurs.
A large study conducted by British Journal of Dermatology studied 4274 acne patients and found that since 1991 an average of 51% of patients harbored colonies of resistant bacteria.14
Other studies have shown similar levels of antibiotic resistant acne bacteria.15-20
Interestingly, researchers are finding similar levels of resistance in both patients treated with antibiotics and those untreated as well, although those untreated have somewhat lower levels of resistance.21 This is because it is quite easy to pass antibiotic resistant strains of bacteria to people close to you.22 All you have to do is touch your skin and then touch someone else. Voila.
The Future Of Acne Treatment
A future direction in acne treatment development is utilizing agents that can kill P. acnes but that dont lead to microbial resistance.
For instance, there are studies using synthetic antimicrobial peptides, tiny strings of amino acids that can physically destroy P. acnes. This remedy would likely be used in conjunction with other therapies that can treat other causes of acne.
Even more promising is the use of nitric oxide, one of the most important and potent biological molecules, which can both kill P.acnes without the risk of it or any other bacteria developing resistance and inhibit multiple elements of inflammation involved in the formation of the vicious pimple. The limitation to date has been delivery, as nitric oxide is highly unstable.
But nanotechnology might provide a way of delivering nitric oxide to treat acne. I, along with collaborators at the Albert Einstein College of Medicine and the University of California, Los Angeles, have shown that a nanoparticle capable of generating low levels of nitric oxide over time could hit all the key pathologic elements that lead to acne.
In the meantime, if you are prescribed antibiotics for acne, ask your doctor how long you need to take them and if the dose is appropriate. And try to avoid popping those zits.
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How Do You Cure A Rash
A moisturizing cream such as aloe vera lotion applied to the rash may help relieve itchiness until a person with a rash can get medication prescribed by a doctor. Natural remedies that may help prevent the itching of rashes include soaking in a barely warm, not hot, bath with about 3 cups of baking soda added.
Data Collection And Analysis
For standardisation of data collection and analysis, some parts of the methods section of this protocol use text that was originally published in the Cochrane Handbook for Systematic Reviews of Interventions .
Selection of studies
After removal of duplicates, two independent authors, MG and CL, will screen the titles and abstracts identified in the initial search results to decide which trials are eligible for inclusion. If it is not clear from the title or abstract, or in case the study meets our inclusion criteria, we will retrieve the full text of the paper. The authors will independently read and analyse the full text of each study in order to confirm if it meets the predefined inclusion criteria. We will resolve any disagreement in study assessment by referring to a third author . We will record the reasons for exclusion of the read fulltext papers in the ‘Characteristics of excluded studies’ tables.
Data extraction and management
Assessment of risk of bias in included studies
Two authors, MG and CL, will independently assess the risk of bias of the eligible studies, using the following criteria suggested in the Cochrane Handbook for Systematic Reviews of Interventions . A third author will resolve disagreements. We will record the results in the ‘Risk of bias’ tables within the ‘Characteristics of included studies’ tables, according to the following categories of bias.
Selection bias
Performance bias
Detection bias
Attrition bias
Reporting bias
Other bias
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Appendix 2 Medline Search Strategy
1. exp Acne Vulgaris/ 2. acne$.ti,ab. 3. 1 or 2 4. Dapsone/ 5. Erythromycin/ 6. exp AntiBacterial Agents/ 7. Tetracycline/ 8. .ti,ab. 9. or/48 10. .ti,ab. 11. Ointments/ or Gels/ 12. administration, topical/ or administration, cutaneous/ 13. .ti,ab. 14. or/1013 15. 9 and 14 16. topical antibiotic$.ti,ab. 17. Clindamycin/ 18. Metronidazole/ 19. .ti,ab. 20. aminoglycosides/ or gentamicins/ 21. Neomycin/ 22. .ti,ab. 23. Macrolides/ 24. Sulfacetamide/ 25. sulfonamide antibiotic$.ti,ab. 26. meclocycline$.ti,ab. 27. Lincoside$.ti,ab. 28. Quinolones/ 29. Quinolone$.ti,ab. 30. Chloramphenicol/ 31. Chloramphenicol.ti,ab. 32. Fusidic Acid/ 33. Fusidic acid$.ti,ab. 34. Nitromidazole.ti,ab. 35. Mupirocin/ 36. mupirocin$.ti,ab. 37. bactroban.ti,ab. 38. pseudomonic acid$.ti,ab. 39. Pleuromutilin.ti,ab. 40. retapamulin.ti,ab. 41. Polypetide$.ti,ab. 42. Bacitracin/ 43. bacitracin.ti,ab. 44. Polymyxins/ 45. polymyxin$.ti,ab. 46. or/1645 47. 15 or 46 48. randomized controlled trial.pt. 49. controlled clinical trial.pt. 50. randomized.ab. 51. placebo.ab. 52. clinical trials as topic.sh. 53. randomly.ab. 54. trial.ti. 55. 48 or 49 or 50 or 51 or 52 or 53 or 54 56. exp animals/ not humans.sh. 57. 55 not 56 58. 3 and 47 and 57
Medically reviewed by Sophia Yen, MD, MPH
The above situation is totally normal, albeit maybe a bit scary. So lets discuss everything you need to know about oral ant
Causes Of Genital Herpes
There are two types of HSV:
Genital herpes is caused by both type 1 and type 2 HSV.
In some cases it is also possible to become infected by coming into contact with other parts of the body that can be affected by HSV, such as the eyes and skin. For example, you can catch genital herpes if you have oral sex with someone who has a cold sore. A cold sore is a blister-like lesion around the mouth that is also caused by HSV.
Genital herpes cannot usually be passed on through objects, such as towels, cutlery or cups because the virus dies very quickly when away from your skin. However, you may become infected by sharing sex toys with someone who has the virus.
Genital herpes is particularly easy to catch when an infected person has blisters or sores. However, it can be caught at any time, even when someone has no symptoms at all.
Once you have been infected with HSV, it can be reactivated every so often to cause a new episode of genital herpes. This is known as recurrence.
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Description Of The Condition
Acne is a multifactorial inflammatory skin disease affecting 70% to 90% of individuals from the age of 12 to 24 years . Although acne is classically a selflimiting disease of adolescence, evidence suggests it is occurring at earlier stages of puberty and is also lasting longer . It is currently considered a chronic disease . Persistent acne beyond teenage years is more common in women than men and may be associated with hormonal imbalances .
Acne is centred around the pilosebaceous unit . Therefore, acne is predominantly located in areas rich in sebaceous follicles, such as the face, back, and chest . It is a polymorphic disease that can present with open and closed comedones , inflammatory lesions , and subsequent atrophic or hypertrophic scars .
Clinical forms of acne, classified by the predominant type of lesions, include comedonal acne, papulopustular acne, and nodular or conglobate acne. For research purposes, lesions may be further categorised into inflamed and noninflamed , and the number of lesions per patient is counted and documented . Many clinical trials also capture global assessments including patient perspectives .
What Gets The Best Results: Antibiotic
Which antibiotic cream you choose to treat your acne is partially down to individual response. Simply put, some people just get on better with certain treatments compared to others, even though they are very similar.
Overall, we would normally recommend using one of the combination treatments available at The Independent Pharmacy over the antibiotic-only treatments, as they have been shown to have better effects on the symptoms of acne, and tend to work faster. Combination treatments also reduce the chance of antibiotic resistance. However, one of our medical team will make their recommendation based on your initial consultation.
For example, antibiotic combination creams such as Duac are a good, cost-effective choice for acne sufferers who cannot take oral antibiotics but still want an effective treatment for their condition.
However, everyone will find that their body responds to topical treatments differently, so its best to find one that suits you, clears up your acne and doesnt irritate your skin.
If in doubt about your medication, seek advice from your doctor you may want to think about changing to a different treatment.
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Antibiotic Resistance And Other Safety Issues
You should not rely on antibiotics to control your acne long term. Taking antibiotics for too long can increase the risk of antibiotic resistance and other side effects.
Infections caused by antibiotic-resistant bacteria can be dangerous and difficult to treat. The Centers for Disease Control and Prevention recommends limiting antibiotic use for acne to no longer than 3 months. There might be special cases in which antibiotics would be recommended for longer, but its especially important to see your provider for regular follow up care if this is you.
After you stop taking antibiotics, your provider will likely recommend that you continue using a topical retinoid medication and benzoyl peroxide to keep your skin clear, even if you dont get anymore breakouts. If you stop using medications, its very likely your acne will come back.
Due to safety concerns, providers are prescribing minocycline less often. Some possible side effects include liver problems, autoimmune issues, and pigmentation . Pigmentation can happen on the skin or inside the body and may be permanent.
Doxycycline can cause stomach upset. It can also make your skin more sensitive to the sun.
Women who are pregnant and children under 8 years old shouldnt take tetracyclines like minocycline or doxycycline. Oral erythromycin or azithromycin are better options. All antibiotics can cause diarrhea, nausea, and stomach upset.
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Inflammatory bowel disease
Complications Of Cold Sores
For most people, cold sores get better in time with over-the-counter treatments and self-care. However, for people with weakened immune systems, cold sores can be more severe and spread more widely.
Uncommon complications of cold sores include:
- bacterial infections where the cold sore is crusty and has pus
- cold sores that spread to the eyes see your doctor immediately since this can lead to eye damage
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What If Antibiotics Dont Work For Me
One thing to keep in mind is that antibiotics may not work for everyone. Sometimes, they dont work at all. Other times, they may just help for a short time. If this happens to you, you might have nodulocystic or adult female acne, and antibiotics may have limited use. Otherwise, there are other treatment options for different types of acne.
Oral antibiotics improve most cases of nodulocystic acne. If they dont help, the acne keeps returning, or theres a risk of scarring, providers may recommend isotretinoin . For AFA, oral antibiotics provide temporary improvement, but its usually incomplete and short lived most people have flare ups once they stop taking antibiotics. For these women, antibiotics are useful as a bridge to hormonal therapies like birth control pills and/or a medication called spironolactone.
Side Effects Of Using Neosporin For Acne
- Increases The Antibiotic Resistance In Bacteria
Using the wrong medication for too long can cause the bacteria to build resistance against the antibiotics . The medication then would stop working even against those strains of bacteria it was previously effective against.
Even if it has no impact on your acne, excessive use of Neosporin where it is not needed can decrease its chances of being effective when you apply it to another wound or an injury.
- May Damage Your Skin
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Prolonged use of Neosporin for acne can have an adverse impact on your skin. Antibiotics, such as those present in Neosporin, alter the skin microbiome . They damage the upper layer of the skin and may leave it susceptible to acne and other infections.
Another component of Neosporin, called Neomycin, may cause allergic contact dermatitis .
- May Aggravate Your Acne
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Neosporin contains comedogenic components . Clogged pores also may cause acne and trigger folliculitis , .
Do these side effects mean you should never use Neosporin for treating acne? Not really. Certain situations warrant the use of Neosporin for acne treatment.
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How Do Antibiotic Acne Creams Work
Antibiotic creams work by controlling and killing the skin bacteria that is associated with acne. This common bacteria feeds on the sebum produced by the skin, creating waste products and fatty acids that contribute to the condition and worsen acne symptoms. This can cause the skin to become more inflamed and infected.
The anti-inflammatory action of topical antibiotics can reduce the swelling, redness, and discomfort of acne spots.
Antibiotic creams also help to keep your pores more open, reducing the effects of acne.
Your doctor or pharmacist will prescribe an antibiotic cream that is suitable for your type of acne, as well as instructions on how and when to apply it.
