Acne treatment Acne treatment

Topical and oral acne antibiotics

Acne antibiotics clindamycin Acne antibiotics tetracycline Acne antibiotics


Topicallyapplied antibiotic preparations are effective in killing P. acnes. Common examples include erythromycin (Aknemycin, T-Stat pads), clindamycin (Clindagel, Clindamax, Cleocin T), and sodium sulfacetamide withand without sulfur (Klaron, Rosac, Rosanil, Ovace, Rosula). These productsshould be used in combination with other topical antiacne products to minimizethe development of resistant strains of bacteria. Velac, a topical combinationproduct containing a retinoid (tretinoin) and an antibiotic (clindamycin) wasawaiting FDA approval ar press time. The rrerinoin will help to keep thefollicle open and less likely to trap P. acnes. anti­biotic previously available only in oral form, is presently being devel­opedfor topical application. Topical dapsone (Aczone) may prove helpful in treatingacne due to its antibiotic and anti-inflammatory properties.

Topicalproducts are always preferable when possible, since any oral medication can beassociated with allergic or other adverse reaction. An advantage of usingtopical antibiotic preparations is their negligible absorption into the blood.Therefore, there is no alteration in the normal balance of bacteria and fungiin the body.


Sometimes,topical preparations arc not sufficient to control acne despite regular use andgood skin care. Oral antibiotics such as doxycycline (Adoxa, Doryx, Vibramycin), minocycline (Dynacin, Minocin, Vectrin, Myrac), and erythromycin (B.E.S., Eryc,Ery-Tab) are more effective in killing bacteria and also have anti-inflammatoryproperties. Oral antibiotics, while certainly more effective than topi­caltherapies, can have a variety of side effects, including sun sensitiv­ity,gastrointestinal upset, and vaginal yeast infections if you are predisposed. Aswith any oral agent, a host of nuisance and serious side effects can occur.

Thegrowing problem of antibiotic-resistant bacteria is a serious one. The liberaland widespread use of powerful, broad-Spectrum anti­biotics(those capable of killing most bacteria in our environment) is fostering thedevelopment of new strains of bacteria. MRS A (methicillin resistant staphaureus) is being increasingly seen in communities throughout the US. This infection was previously confined tohospi­tals. If the rate at which these resistant bacteria develop outpaces theability of the pharmaceutical industry to develop new antibiotics capable ofkilling them, we are all in big trouble.

Theantibiotics used by dermatologists to treat acne are usually narrow-spectrum,weaker agents that are effective at killing P. acnes and also effective atdecreasing inflammation in the skin. They should always be used together withtopical agents to minimize the develop­ment of resistant strains of P. acnes.

Despitethe fact that there is data to support the safety of these antibiotics for thelong-term management of acne, I believe that you should always be looking foran exit strategy. If you are on one of these oral antibiotics, regular attemptsto reduce your dosage or dis­continue the medication should be made. You shouldalso review with your physician the other existing and new treatments that areavailable.


Anew approach that is effective for many acne and rosacea suf­ferers isPeriostat, a very low-dose oral doxycycline preparation. Periosiai isconsidered a subantimicrobialproduct because it does notkill bacteria; rather, its mechanism of action is based on its powerfulanti-inflammatory effects. Since it does not kill bacteria, the natural balanceof bacteria and fungi remain unaltered in the body, and theo­retically, itcannot foster the development of resistant bacteria. Extensive microbiologytesting has been performed to ensure that Periostat has no antibioticproperties. 

Periostat benefits the acne and rosacea patient by inhibiting theinflammatory cascade of effects of P. acnes. Periostat may also benefit peoplewith comedonal (white-head/blackhead) acne. In view of the real and growingissue of bacte­rial resistance, this treatment regimen is an exciting addition to our existing acne and rosacea treatments.Periostat can also be useful as a maintenance medication for people who havepreviously relied on antibiotics for long-term acne control.

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