May 20, 2022

Topical, oral and other options

Antibiotics can help treat severe and painful acne caused by bacteria on the skin. They can also help reduce inflammation more generally, which can reduce swelling and reduce the risk of scarring.

A dermatologist may recommend topical antibiotics, which a person applies to the skin, or oral antibiotics, which a person takes in pill form.

However, it is important to note that prolonged or repeated use of oral antibiotics carries risks. They can hurt healthy bacteria in the gut, upsetting someone’s gut flora balance.

Frequent prescription of antibiotics can also contribute antibiotic resistance, which occurs when bacteria evolve to survive antibiotic treatment.

Whether antibiotics are the right choice for a person depends on their particular situation.

This article will review the effectiveness of antibiotics for acne, types available, side effects, risks, and other acne treatments.

Acne develops when hair follicles, or pores, become clogged with dead skin or oil. Several things can contribute to this, including:

  • have oily skin
  • hormonal changes or imbalances
  • genetic
  • inflammation
  • excessive sun exposure
  • certain medications

However, bacteria also play a role.

Many species of bacteria live naturally on the skin. Some are beneficial, while others can cause problems if they become too prevalent. Scientists know that several species of bacteria can make acne worse, including:

  • Cutibacterium acnesformerly called Propionibacterium acnesin adolescents
  • Staphylococcus epidermiswhich increases inflammation

Antibiotics help slow or stop the growth of harmful bacteria on the skin. However, many studies have shown that antibiotics can help treat moderate to severe acne, regardless of the underlying cause.

For example, a study 2019 tested the efficacy of azithromycin at different doses. The antibiotic was both effective and generally well tolerated.

A study 2018 compared pulsed doses – short periods of antibiotics – to longer doses of doxycycline and found both to be effective.

Additionally, a 2017 report compared several classes of antibiotics, including tetracyclines, macrolides, and trimethoprim-sulfamethoxazole, for the treatment of inflammatory acne. All have been effective.

In 41 articles comparing antibiotics to each other, to placebos or to other treatments, the researchers could not find evidence that one type of antibiotic was superior to another.

Topical antibiotics are applied directly to the skin. Clindamycin and erythromycin are the most common topical antibiotics.

A Cochrane Review 2018 points out that these antibiotics work best for inflammatory acne, which develops when bacteria enter clogged pores. Other types of acne may not respond as well.

Topical antibiotics come in many forms, including gels, lotions, and pads. Because they are localized, topical antibiotics do not affect the intestinal flora. As a rule, they also do not cause systemic side effects.

However, they can still play a role in the development of antibiotic resistance. For this reason, the American Academy of Dermatology (AAD) recommends using topical antibiotics in addition to another treatment, such as retinoids or benzoyl peroxide.

the AAD recommends oral antibiotics for moderate to severe acne that does not respond to other treatments or for inflammatory acne that does not respond to topical antibiotics.

The most studied antibiotics for acne are tetracyclines and macrolides. Other types of antibiotics, such as doxycycline and minocycline, have less evidence behind them. Still, doctors can prescribe other types if a person doesn’t see any improvement.

Similar to topical antibiotics, the AAD recommends that people not use oral antibiotics alone. Combining medication with benzoyl peroxide or retinoids can make treatment more effective and maintain results after treatment ends.

To reduce the risk of antibiotic resistance, it is also important to take oral antibiotics for as short a time as possible. However, this can be difficult, as longer or repeated treatments can improve results.

A 2020 review Previous research has analyzed studies that used antibiotics for periods ranging from 3 to 24 weeks. Longer periods of use generally resulted in a greater reduction in inflammatory acne.

Some studies also suggest that pulsed doses may be effective. This is when a person takes antibiotics less frequently or in short bursts.

A study 2018 compared treatment with pulsed azithromycin, in which people took the drug one to three times a week or four times a month, with 12 weeks of constant doxycycline.

The results for each group were similar, suggesting that pulsed antibiotics may be just as effective as standard treatment.

Many people tolerate antibiotics well. However, side effects are still possible. Potential side effects vary depending on the type of antibiotic someone is using.

Topical antibiotics may cause:

  • mild dryness or irritation
  • skin peeling
  • contact dermatitis due to allergy

Oral antibiotics may cause:

  • yeast infections
  • gastrointestinal symptoms, such as nausea, vomiting, or diarrhea
  • permanent tooth discoloration
  • skin more sensitive to UV
  • interactions with other drugs and medications

Severe allergic reactions

Some people are allergic to certain antibiotics. Rarely, taking them can lead to anaphylaxis.

A die most serious risks of antibiotic use is antibiotic resistance. This happens when bacteria evolve so that they are no longer affected by a specific drug.

Antibiotic resistance can mean that an antibiotic no longer works for an individual. It can also contribute to the growth of “super bacteria”, which are difficult to treat.

Antibiotics also affect the microbiome, which is the ecosystem of bacteria, yeasts and other microorganisms that live in the gut. A balanced and diverse microbiome is essential for overall health.

A study 2020 describes antibiotics as “major disruptors” of the microbiome and states that it is possible that this disruption could lead to chronic health problems.

Low levels of beneficial gut bacteria are associated with a number of chronic diseases, such as inflammatory bowel disease (IBD), obesity, and type 2 diabetes. However, it remains unclear whether the changes of the intestinal flora play a direct role in the onset of these conditions.

Other potential risks of using oral antibiotics depend on the drug. They can include:

  • permanent tooth discoloration
  • skin hyperpigmentation
  • reduced bone growth
  • harm to a developing fetus during pregnancy
  • drug hypersensitivity syndrome

Because of the impact of some antibiotics on bone growth, doctors should not prescribe them to people who are still growing or who are pregnant.

Antibiotics aren’t the only option for treating moderate to severe acne. Some other treatment options include:

  • Topical treatments: Benzoyl peroxide and retinoids are among the most effective topical acne treatments. Inflammatory acne may also respond well to topical dapsone gel, especially in women. Salicylic acid can be helpful in reducing fat and unblocking pores.
  • Oral isotretinoin: This oral form of vitamin A can help treat treatment-resistant acne and severe nodular acne.
  • Hormonal treatment: Hormonal contraceptives containing estrogen may help some women with acne. Spironolactone, a drug that reduces the effects of androgens, may also help.
  • Treatment of scars: Azelaic acid can help minimize pigmentation that lingers after acne lesions have healed. Microneedling, laser therapy, and other procedures can also reduce the appearance of acne scars.

the AAD points out that there is not enough evidence to support specific dietary changes for acne. However, a item 2021 note that foods with a high glycemic index can make acne worse. This includes sugary foods, such as cakes, candies, and sodas.

Eating a balanced, healthy diet with fewer high glycemic index foods can help some people. For others, reducing or stopping milk intake helps.

Before you begin acne treatment, it helps to have all the facts. A person may want to ask a doctor the following questions:

  • What type of acne do I have?
  • Will topical antibiotics help?
  • What about oral antibiotics?
  • What are the benefits and risks of the recommended treatment?
  • Can I use antibiotics along with other treatments, like benzoyl peroxide?
  • Is this treatment safe if I am pregnant or breastfeeding?
  • Does this treatment interact with any medications, supplements or medical conditions?
  • How long will the treatment last?
  • Could pulsed doses help me?
  • Are there alternatives?
  • What if it doesn’t work?
  • Can acne scars be treated at the same time?

Antibiotics for acne can reduce the presence of bacteria on the skin that is associated with acne and inflammation. Doctors typically prescribe them for people with inflammatory acne or those with moderate to severe acne that does not respond to first-line treatments.

While the evidence shows a number of antibiotics can help reduce symptoms, topical and oral antibiotics have some potential risks.

Topical antibiotics are less likely to cause systemic side effects, such as digestive upset, but they can still contribute to antibiotic resistance.

It is important to discuss all the pros and cons of this treatment with a dermatologist.