Why Are Antibiotics Used For Treating Acne
Dermatologists prescribe oral or topical antibiotics to treat moderate to severe outbreaks of inflammatory acne small, red bumps, and pustules depending on the age of the client and type and grade of acne. Oral antibiotics along with topical creams and gels help to treat both teen and adult acne.
There are different views on the use of antibiotics for treating acne. A recent school of thought among many practising Dermatologists across the world is to avoid antibiotics as much as possible except only when needed to curb the emerging antibiotic resistance. Hence, nowadays, they are prescribed by the doctors only when necessary and under strict monitoring for only recommended duration according to the guidelines. However, it is advisable to avoid using antibiotics for controlling acne during pregnancy.
How Do Antibacterial Acne Products Work
Topical and oral antibiotics for acne are both prescription-only. They alter the very bacterial structure of the acne-causing agents, andperhaps more importantlyare anti-inflammatory. Antibiotics have a high success rate of as much as 70% after a few months of treatment, according to the Canadian Medical Association Journal. They arent intended for long-term use, however, as theyre shown to cause bacterial resistancewhich means that bacteria can become stronger and stop responding to the medication altogether. This can affect other bacteria in your body, including the bacteria you need.
Tip! Be sure to understand the difference between antibiotics and benzoyl peroxide. Benzoyl peroxide creates a hostile environment for bacteria, while prescription pills and antibiotic creams alter the very structure of the problem-causing agents.
Benzoyl peroxide is often used as a supplemental treatment with antibiotics, and also as the recommended care regimen after a relatively short period of antibacterial use. Read more aboutbenzoyl peroxide and its role in fighting acne from The Journal of Clinical and Aesthetic Dermatology.
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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How Do Antibiotics Treat Acne
A bacterium called Cutibacterium acnes plays a key role in the development of acne by releasing enzymes that break down surrounding oils and skin cells, and triggering inflammation.
Antibiotics are medications that target bacteria some can directly kill bacteria and others work by preventing their growth and replication. In addition to fighting bacteria, many antibiotics have anti-inflammatory effects.
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
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When To See A Dermatologist
You can make a dermatologist appointment any time you want. Thereâs no such thing as too little acne to see a dermatologist about. âThere is very little downside,â Nagler says.
Go right away if you have acne scars, painful nodules — hard bumps — or deep cysts. And get in soon if over-the-counter products havenât worked for more than 3 months or if your self-esteem is worse because of your acne, Arthur says.
At your appointment, your doctor will look at your acne, prescribe medicine to apply to your skin , and maybe also pills to help further.
Dont Wait To Treat Acne
You may think of acne as a teenage problem, but its not uncommon for acne to appear around age 9. The earlier it comes, the earlier it may go. However, those who start puberty later may have acne into their 20s.
Acne usually subsides on its own, but treatment is important if your child is bothered by his or her appearance, says Dr. Kassouf. Its also important if youre concerned about long-term effects. Severe acne can leave scars and cause skin discoloration.
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Acne Treatments During Pregnancy
Almost everyone experiences acne at one time or another. Its most common among teenagers. However, adults can have a breakout now and then, especially during pregnancy. But pregnant women with acne may not have all of the same treatment options as others.
Most of the medications used to treat acne in teens and adults are not safe to use during pregnancy, or the safety of the drug isnt known.
Topical retinoids are category C drugs. This means that animal studies have shown that theyre harmful to a developing fetus if given in large amounts. Check with your doctor before using tretinoin.
Isotretinoin and tetracycline can harm a fetus. Isotretinoin has been linked with birth defects, and tetracycline can discolor your babys teeth. Do not use either of them during pregnancy.
The acne products that are safe to use during pregnancy are the ones that use benzoyl peroxide.
Oral Antibiotics In Acne
The oral antibiotics most commonly prescribed in New Zealand for acne include:
- Tetracyclines doxycycline , limecycline , minocycline . These are not suitable for children younger than 10 years old because they may stain teeth yellow
- Cotrimoxazole Trisul®, Deprim®
Side effects and risks of oral antibiotics
- Allergy oral antibiotics can cause a variety of rashes in those susceptible. These can be mild or life-threateningly severe. Allergy to a tetracycline or to erythromycin is very uncommon, but more than 2% of those on trimethoprim or cotrimoxazole become allergic to it. Tell your doctor if you have ever reacted badly to an antibiotic.
- may be a problem for those taking doxycycline. Taking the medicine after the evening meal reduces the risk of sunburn. Dress up and protect your skin from exposure to the sun.
- Gastrointestinal disturbance affects about 5% of patients and includes nausea, colicky pain and diarrhoea.
- Thrush affects 5% of treated women and most often affects the vagina. Thrush can also affect the oral mucosa or body folds , particularly in diabetics or in obesity. Thrush is less likely with erythromycin than with tetracycline.
- Bacterial resistance may occur but is less common with the use of oral antibiotics than with topical antibiotics.
- Acne antibiotics are unlikely to result in failure of the oral contraceptive pill but if you are concerned, add a barrier method and talk to your doctor about your risks.
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The Four Most Commonly Prescribed Acne Medications
#1: Tretinoin
Despite providing only moderate benefit to acne, tretinoin is the single most frequently prescribed acne medication. Various treatment guidelines, such as those recommended by the American Academy of Dermatology, consider topical retinoids, such as tretinoin, to be the preferred treatment for acne, except in severe cases. Many guidelines continue to recommend topical retinoids as the first choice of treatment for mild-to-moderate acne. However, it should be noted that since retinoids like tretinoin only produce partial clearing of acne, they are almost always prescribed alongside other treatments.
Tretinoin has been one of the primary acne treatments for over 40 years, largely because of its ability to:
- Help skin cells shed, thus keeping the skin turning over properly and preventing clogged pores
- Treat mild acne lesions as well as papules and pustules, which are inflamed “pimples” or “zits,” when used in combination with other medications
- Prevent acne-induced scarring
- Prevent disease progression – in other words, preventing acne from getting worse2
The following research from the Journal of the American Academy of Dermatology, American Journal of Clinical Dermatology, and Journal of Dermatological Treatment speak about how retinoids help unclog pores, and can help clear acne when used alongside other medications.
Expand to read details of research
#2: Isotretinoin
#3: Clindamycin/Benzoyl Peroxide combination
#4: Minocycline
What Is Acne Anyway
Acne is a chronic inflammatory skin condition, characterized by blackheads and whiteheads , pimples, and deeper lumps . They are caused when hair follicles are clogged with oil, bacteria and dead skins cells, and can occur on the face, neck, chest, back, shoulders and upper arms.
While once thought to be a direct result of overactive sebaceous oil glands, now we know that inflammation is the driving force behind acne. In fact, this inflammation can be seen in the skin even before a pimple pops up. And clogged follicles can also stimulate more inflammation.
The bacterium that lends its name to the condition Propionibacterium acnes, is just one of the factors that stimulates this acne-causing inflammation.
Hereditary and genetic factors, hormones, emotional stress and even diet can also bring on the zits. For instance, foods with a high glycemic load such as white grains and sweets have been linked to acne, as they can increase oil production and skin cell turnover. This ultimately causes a backup in the pores and follicles on our skin creating a nice environment for the inflammation-inducing P. acnes to flourish.
When that happens, these enzymes contribute to the formation of the big, angry, red, cystic acne lesion, and they can also contribute to the creation of pitted scars.
This is why antibiotics are used to treat acne, but also rosacea, razor bumps and scarring hair loss, to name a few other dermatological conditions.
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Oral Antibiotics For Acne
Oral antibiotics work systemically. This means that instead of being applied directly to lesions, they are ingested and absorbed by the blood and carried to where bacteria have accumulated.
Since the entire body is exposed to oral antibiotics, theyre more likely to cause side effects. For this reason, dermatologists reserve them for more severe forms of acne.
Oral antibiotics should be combined with topical retinoids and benzoyl peroxide to increase effectiveness of the antibiotic and decrease the risk of bacterial resistance.
The oral antibiotics most often prescribed for acne treatment are macrolides and tetracyclines.
Treatment Of Acne On Nhs:
The first option does not need a lot of explanations. GP can prescribe an antibiotic for acne management after the consultation with a patient.
The supply of medication on NHS prescription is free of charge for anyone aged 18 years and under and in full-time education. Patients who are 19 years or over may also be eligible for free prescriptions or apply to be exempt from paying for NHS prescription charges.
Quick FAQ
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What Do Doctors Prescribe For Cystic Acne
The first-line therapy for cystic acne involves a combination of drugs that target specific mechanisms of acne development. The standard combination drug therapy will include benzoyl peroxide face wash or cream to unclog pores, reduce swelling, and control bacterial growth, a topical retinoid to help unclog pores, topical and oral antibiotics to kill bacteria, and possibly an oral retinoid to shrink the size of oil glands. Other medications might include corticosteroids to reduce swelling or oral contraceptives to reduce androgens.
Antibiotics For Acne Treatment
Antibiotics are commonly prescribed for the treatment of acne. Antibiotics may be used on the skin or taken by mouth .
Antibiotics help control acne by killing the bacteria that cause the acne lesions to become inflamed. The sebum within the hair follicles can become infected by p. acnes bacteria, resulting in swelling and redness of the acne lesion. Killing the bacteria reduces the inflammation and reduces the severity of the acne flare.
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Treatments That Help Eliminate Acne
For the average kid or teen with acne, Dr. Kassouf recommends:
- Skin washes with benzoyl peroxide or salicylic acid. Benzoyl peroxide kills bacteria on the skin and helps remove oil and dead skin cells. Salicylic acid helps unclog pores.
- Skin washes with a sulfa base. These can diminish bacteria and yeast in order to decrease inflammation and can be safely used with other topical products, as well as less irritating for sensitive skin.
- Topical retinoids. Creams with retinoids can break up whiteheads and blackheads. These retinoids make dead skin cells less sticky so that they can clear out of the pores more easily and not only treat the active acne but help prevent it from coming back.
- Topical antibiotics. Apply them directly to the skin to control bacteria and inflammation.
Usually, we start with skin washes and add topical retinoids next, says Dr. Kassouf. We only add a topical antibiotic if the first two treatments arent enough.
Its critical to use topical antibiotics with benzoyl peroxide, she notes. Benzoyl peroxide kills bacteria in a different way than antibiotics. Using them together makes it less likely that bacteria will become antibiotic-resistant.
Oral antibiotics are for severe cases. However, applying antibiotics to the skin can cause fewer side effects than swallowing antibiotics that circulate through your body.
In general, topical antibiotics can be used longer than oral antibiotics, says Dr. Kassouf.
Why Use Prescription Acne Medication
While over-the-counter acne medication are effective at managing minor outbreaks of facial acne, many people experience persistent acne that just doesnt go away with regular, store-bought treatments.
Up to 50 million people in the United States are affected by acne annually, ranging from mild breakouts to severe cystic acne.
Over the last few years, theres also been a rise in the number of adults seeking treatment for acne often acne that developed specifically in their adult years, rather than originally forming while they were in adolescence.
Prescription acne medication offer a stronger level of acne treatment than store-bought products, making them essential for many people with persistent, cystic or other severe cases of acne.
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Physical Removal And Surgery
Dermabrasion and laser light therapy, while commonly used for mild cases of acne, are not considered successful treatments for cystic acne. Because of the risk of acne scars, many dermatologists reserve surgical treatment only for painful nodules or cysts. In those cases, the nodules will either be removed or drained .
Use Of Private Services To Get Antibiotics For The Treatment Of Acne:
Larger pharmacy chains such as Boots and Lloyds Pharmacy offer online private services, allowing patients to pay for the online consultation and supply of prescription-only medication. Patients pay for the cost of the medication regardless of their age. The cost of a prescription is usually included in the price of the product.
For example:
- With Boots Acne Online Clinic, patients can choose from topical products, such as Skinoren and Duac .
- Lloyds Pharmacy Online Doctor offers topical treatment as well as oral antibiotics for acne treatment.
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How Can I Prevent Acne
- Gently wash your face twice a day and after sweating.
- Shampoo your hair regularly.
- Do not pick or squeeze your acne this increases the risk of scars.
- Keep your hands off your face. Wash your hands before applying make-up.
- Be careful what you put on your face, and avoid ingredients that promote acne.
- Stay out of the sun and off tanning beds excess tanning can damage your skin.
- See a dermatologist if you feel shy or products don’t work.
Antibiotics Just Dont Work That Well For Acne
If the root cause isnt bacteria, this may be one reason that antibiotics have such a spectacularly high failure rate when it comes to acne treatment.
In fact, a dermatological study performed in the UK revealed that 82% of the study patients failed multiple courses of antibiotic treatments. Almost a third of patients who used isotreninoin relapsed after treatment. Perhaps due to their low success rate, doctors often prescribe several antibiotics, one after another.
In fact, over the past 4 decades, P. acnes has become more and more resistant to standard antibiotic treatments. A paper published by The Medical Journal of Australia claimed that acnes resistance to antibiotics increased from 20% in 1978 to 62% in 1996.
And since traditional acne antibiotics just dont work as well as they used to, different types of antibiotics are being used to treat acne.
The result?
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