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Antibiotics and Acne: the Bad, the Good, and the Brand New

Tomorrow when we arrive into clinic (or this afternoon if you are reading this during your lunch break), we will invariably be greeted with patients who struggle with one of the most common diseases we treat – acne. More than likely, we will reach for topical retinoids, topical antibiotics, and the occasional systemic antibiotic. Evidence supports the short-term use of systemic antibiotics to gain control of acne and help our topical regimens overcome the disease process. Yet, in an era when concerns of antibiotic resistance are ever-present and our knowledge of the microbiome is ever-increasing – are we doing the right thing? How can we be stewards of proper antibiotic use in light of resistance…

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Featured

 Antibiotics for Acne: Groundbreaking Study Shows Why One Works Best

About three quarters of prescriptions dermatologists write are for tetracycline-class antibiotics. A new Yale study examined sarecycline, a third-generation tetracycline derivative with a narrow-spectrum activity, which targets Cutibacterium acnes, the bacterium most doctors believe is behind acne and promotes skin inflammation.

 Doctors Turning to Antibiotic Alternatives to Treat Acne, Rutgers Researchers Find

Doctors are increasingly exploring combinations of therapies, such as the antibacterial medication benzoyl peroxide and topical retinoids, medicines derived from vitamin A, instead of antibiotics for long-term treatment.

Articles of Interest

New Acne Guidelines Recommend Topical Combinations, Judicious Use of Antibiotics

Antibiotics, benzoyl peroxide, topical retinoids, and oral isotretinoin received strong recommendations for acne treatment from a panel of experts who drafted an update to the American Academy of Dermatology (AAD) clinical guidelines. The panel made 18 treatment recommendations (categorized as strong or conditional) and five good practice statements. Five strong recommendations were made for oral doxycycline, topical antibiotics (including fixed-dose combinations), topical retinoids, and topical benzoyl peroxide. Additionally, the panel strongly recommended isotretinoin for severe acne.

Rethinking Antibiotics to Treat Acne

"Waiting nearly a year for improvement means there is something wrong with the treatment plan that needs to be adjusted," says Jennie Clarke, MD, a dermatologist with University of Utah Health. "Being on antibiotics for such a long period of time is not ideal, and treatment with antibiotics is generally recommended to be limited to three months."

Acne treatment: antibiotics don’t need to kill bacteria to clear up your skin

Even though national recommendations say that a course of antibiotics to treat acne shouldn’t last more than three months, a study published in the Journal of the American Academy of Dermatology found that the average amount of time a patient is prescribed an oral antibiotic is actually over 300 days. Antibiotics may be prescribed at higher doses than what is really needed to treat acne. While antibiotics can kill the bacteria associated with acne, it’s their anti-inflammatory effects, not their antimicrobial effects, that yield the biggest skin-clearing benefits.

Antibiotics and Antimicrobial Resistance in Acne: Epidemiological Trends and Clinical Practice Considerations

The overuse of topical and/or systemic antibiotics, the long treatment courses used for acne, and the availability of over-the-counter antibiotic preparations, have led to the worldwide emergence of resistant strains in acne patients.

Antibiotics for Acne: How Much Is Too Much?

Health experts warn that taking too many antibiotics can do more harm than good. Just look at the increase in antibiotic-resistant “superbugs.”

Do I Need That Antibiotic?

For acne, alternative and effective treatments are available, like benzoyl peroxide washes, topical retinoids and products with salicylic acid... If your acne is severe, oral antibiotics like doxycycline or sarecycline won’t “cure” it, but they can improve an outbreak quickly, Dr. Barbieri said, so they may be helpful for temporarily managing your acne while pursuing other, longer-term treatments.

Doctors Try New Tactics to Fight Adult Acne

As dermatologists cut back on antibiotic use to treat acne, new combination treatments are emerging.

Doubts Raised Over Antibiotic Use for Acne

Research suggests such use is contributing to antibiotic resistance. There's also some evidence that long-term use puts people at an increased risk of illness. In one study, University of Pennsylvania researchers tracked the rate of upper respiratory tract infections in a set of acne patients.

Oral Antibiotic Treatment Options for Acne Vulgaris

Apart from the tetracycline class of antibiotics (doxycycline, minocycline and sarecycline), the potential benefit of oral antibiotics often outweighs the potential risks, and they remain a mainstay of moderate-to-severe acne treatment.

Treating acne with the tetracycline class of antibiotics: A review

This family of antibiotics includes tetracycline, doxycycline, minocycline, and sarecycline. Although linked by a similar mechanism of action, each agent has unique characteristics that should be considered carefully. Sarecycline, recently approved by the United States Food and Drug Administration, is a narrow-spectrum antibiotic and acts primarily on cutaneous bacteria such as Cutibacterium acnes. In contrast, tetracycline, doxycycline, and minocycline are broad-spectrum antibiotics—indiscriminately inhibiting bacteria in both the skin and gastrointestinal tract. Rising concerns about antibiotic resistance and the need for antibiotic stewardship may make a narrow-spectrum antibiotic a more attractive therapeutic choice for the acne patient.

Resources

Seysara (Sarecycline)

The one and only oral antibiotic developed specifically for moderate to severe acne in patients as young as 9.