Antibiotics are medications that prevent the growth of bacteria. Excessive growth of bacteria in the skin and hair follicles is one of the primary causes of acne vulgaris symptoms. Propionibacterium acnes is the bacteria most commonly associated with acne vulgaris, but other types of bacteria may also be involved. Antibiotics are very commonly prescribed for the treatment of acne and there are many different types of antibiotics.
The antibiotics used to treat acne can be broadly classified into two categories: Topical Antibiotics and Oral Antibiotics. Topical Antibiotics are applied directly to the skin and their effects are generally local. Oral antibiotics are ingested and their effects are generally systemic.
Topical Antibiotics
There a many different types of topical antibiotics that have been used to treat acne vulgaris. Some types of antibiotics are often very effective against acne-causing bacteria (eg. Propionibacterium acnes), but other types are generally ineffective. Topical antibiotics are an important part of many acne treatment regimens. Topical antibiotics are routinely used to treat all types of acne (Acne Types: 1-4). However, moderate to severe acne (Acne Types: 3-4) often requires complementary treatment, in addition to the use of a topical antibiotic.
Because of the increase in antibiotic-resistant bacteria, some popular acne medications are becoming less effective (in some countries, at least). The most commonly used topical antibiotics are Clindamycin (Cleocin) and Erythromycin (E-mycin). In North America and Europe, scientists have observed a dramatic increase in the frequency of Propionibacterium acnes bacteria that are resistant to these antibiotics.
Topical antibiotics generally do not penetrate deeply into the skin and they are often ineffective (when used alone) against moderate to severe inflammatory acne (Acne Types: 3-4). Topical antibiotics are often combined with other treatments (eg. oral antibiotics, topical and oral retinoids, hormonal treatments and light/laser therapy). These combinations are often much more effective at improving acne symptoms than the individual medications alone, particularly in cases of moderate to severe acne vulgaris.
Popular Topical Antibiotics for Acne: Erythromycin (eg. Eryacne), Clindamycin (eg. Cleocin), Fusidic Acid (Fucidin), Retapamulin (Altabax), Dapsone (Aczone) and Sulfacetamide (Clenia).
Oral Antibiotics
Unlike many topical antibiotics, oral antibiotics can reach the bacteria that grow deep inside of the skin and follicles. These bacteria (eg. Propionibacterium acnes and Staphylococcus aureus) thrive deep in follicles and sebaceous glands. The growth of these bacteria contribute to acne vulgaris by triggering the inflammation that leads to the formation of pimples, nodules and cysts. Reducing the growth of these bacteria can dramatically improve acne symptoms for many patients. Oral antibiotics are typically used for patients with moderate to severe acne symptoms (Acne Types: 2-4)
There are many different types of oral antibiotics that have been used to treat acne vulgaris. Some of these medications are used frequently (eg. doxycycline and minocycline), while others are used less commonly. The efficacy of a particular antibiotic can vary significantly between individual patients.
The effectiveness of particular antibiotics can also vary by geographic location. In North America and Europe, many of the oral antibiotics that are most commonly used to treat acne (eg. Tetracycline, minocycline and doxycycline) are becoming less effective. This is because bacteria that are resistant to these antibiotics are becoming more common. Because acne inducing bacteria are becoming more resistant to some popular antibiotics, alternative medications for the treatment of acne have garnered increased interest in recent years.
Popular Oral Antibiotics for Acne: Tetracycline (Sumycin), Doxycycline (Vibramycin), Minocycline (Minocin), Co-Trimoxazole (Septra), Amoxicillin (Amoxil), Azithromycin (Zithromax), Clarithromycin (Biaxin), Dapsone and Cephalexin (Keflex).
References and Sources
Books
PDR Staff Writers. 2011. 2011 Physicians’ Desk Reference (PDR)
Habif. 2009. Clinical Dermatology
Goodheart. 2006. Acne For Dummies
Online Resources
Acne Treatment Reviews @ WebMD
Acne Treatment Reviews @ Acne.org
Scientific Research Articles
Sathish, et al. 2011. Acne and Its Treatment Options – A Review.
Fernandez-Obregon. 2000. Azithromycin for the treatment of acne.
Strauss, et al. 2007. Guidelines of care for acne vulgaris management.
Pochi, et al. 1988. Sebaceous gland activity in black skin.
Webster. 1998. Inflammatory acne represents hypersensitivity to Propionibacterium acnes.
Eady, et al. 1994. Effects of benzoyl peroxide and erythromycin alone and in combination against antibiotic-sensitive and -resistant skin bacteria from acne patients.
Ingram, et al. 2009. Management of acne vulgaris: an evidence-based update.
Schroeder, et al. 2012. Medications used for Acne vulgaris: Practice trends and the use of topical combination products.
Barratt, et al. 2008. Outcome measures in acne vulgaris: systematic review.
Eady, et al. 1993. Tetracycline-resistant propionibacteria from acne patients are cross-resistant to doxycycline, but sensitive to minocycline.
Fanelli, et al. 2011. Antibiotics, Acne, and Staphylococcus aureus colonization.
Katsambas, et al. 2004. Guidelines for treating acne.
Dréno, et al. 2004. European recommendations on the use of oral antibiotics for acne.
Toyoda, et al. 1998. An overview of topical antibiotics for acne treatment.
Eady, et al. 1993. Antibiotic resistant propionibacteria in acne: need for policies to modify antibiotic usage.
Meynadier, et al. 1998. Systemic antibiotics for acne.
Zaenglein, et al. 2006. Expert committee recommendations for acne management.
Discussion