Antibiotic therapy was once the golden boy for acne treatment. The discovery of acne-associated bacteria set the stage for the grand entrance of this treatment. But unfortunately, the high only lasted so long.
Now, antibiotics have been relegated to the role of adjunctive agents, with its use limited to a few months at the most. What is behind this therapy’s fall from grace? And how helpful can it still be to the fight against acne?
How antibiotics work against acne
Here’s a fact that surprises a lot of people: Your skin is rife with bacteria. No matter how much you scrub, exfoliate, or peel your skin, it’s always going to be crawling with microscopic organisms.
Here’s another fact that surprises a lot of people: That’s not a bad thing. The skin microbiome is not completely understood yet, but research has already shown that some bacterial strains play a valuable role in protecting our skin from pathogens and priming our immune system to fend off attacks.
The problem is when the delicate balance of the skin ecosystem is disrupted, favoring the growth of one type of microorganism. Incidentally, this is one important mechanism behind acne.
Propionibacterium acnes is a species of bacteria that is commonly found on the oily parts of our bodies. Our sebaceous glands are considered prime real estate for P. acnes because it grows best in anaerobic environments and processes lipids for energy. Both clear-skinned and blemished people have them, but studies show that the latter have bacterial strains that are more pathogenic than others. When the pore is blocked, this bacteria thrives and multiplies. The enzymes it releases break down the components of our skin and triggers an inflammatory response. And presto--you have a pimple.
With this discovery, experts in the field looked to antibiotics to solve the problem. The most commonly used topical antibiotics are erythromycin and clindamycin, while the systemic antibiotics include doxycycline and minocycline. They stop P. acnes from synthesizing the enzymes and proteins it needs to survive. By regulating the bacterial population, the incidence of zits would be lowered.
In addition to preventing bacterial proliferation, antibiotics also have anti-inflammatory properties. Acne is an inflammatory condition, so the drug’s ability to prevent migration of white blood cells and modulate the production of inflammatory substances is a big plus.
The results were promising. In a 1987 study, 47% of clindamycin users and 48% of erythromycin users reported good to excellent improvement on their facial acne condition after 12 weeks of treatment. Use of oral minocycline was found to reduce inflammatory acne by 45.5%, with 16.6% rated as “clear” or “almost clear”.
The problem with antibiotics
Despite the good response to antibiotics, their use has been tightly regulated in the last few years. There are several reasons for this.
Increasing antibiotic resistance
At the back of everyone’s minds was the problem that always followed after widespread use of antibiotics. The commercial use of penicillin started in 1943, but three years earlier, there were already scientific reports of penicillin-resistant staphylococcus.
In the following decades, researchers attempted to stem the issue of antibiotic resistance with the introduction of new drugs, but with the speed and ease at which bacteria can trade genetic information, it would only be a matter of time till they caught up. Almost as soon as antibiotics were introduced to stop acne-related bacteria, measures had to be taken to prevent it from becoming obsolete.
But as it happens, the attempt was in vain. As early as the 1980s, researchers found that long-time erythromycin users required a drug concentration 100x higher than first-time users in order to have the same skin-clearing effect. In the 40 years since then, stricter controls have been put in place , but you can bet it has not reversed the trend.
Addresses only one cause of acne
If P. acnes was the culprit behind acne, then targeting it would resolve all lesions. But it did not. As we now know, acne is a multifactorial disease that is associated with genetics, lifestyle, and environment. While antibiotics are effective at controlling bacterial colonies, they don’t do much to decrease keratinocyte proliferation, reign in hormones, or curb the production of sebum.
Disruption of other body microbiomes
It would be well and good if we could ensure that antibiotics target only the bacteria associated with acne, but unfortunately, their effect can extend to other microorganisms in the body. The normal microflora in our gut and respiratory tract have protective functions, and studies show that long-term use of anti-acne antibiotics strip us of that advantage.
A study found that people who have been using antibiotics for acne are 2.15 times more likely to develop an infection in the upper respiratory tract than those who have been using other treatment modalities.
Research has shown that there is an association between breast cancer and those who have used antibiotics for over 3 months. Among the participants of the study, the most common reason behind their antibiotic use was for acne treatment.
How to use antibiotics for acne treatment
Antibiotics can still be an effective way to decrease the severity and incidence of breakouts if they are used properly. Protocols used by dermatologists now advise against using these drugs as monotherapy and limiting their usage to a few months at the most.
Antibiotics, whether oral or topical, are best used in combination with drugs that target other acne-contributing factors. Topical retinoids, benzoyl peroxide and azelaic acid are some popular choices. There are even products that combine these for more convenient use.
Dermatologists also make sure to control the amount of time they prescribe antibiotics for treatment. It may be difficult to stop using antibiotics if it has significantly improved your skin condition, but know that straying from your doctor’s advice will only lead to decreased effectiveness in the long run.
Conclusion
The use of antibiotics still has a place in the battle against acne, but in order to keep that place, regulations against its use should be followed. Following your dermatologist’s instructions about combination therapy and maximum usage will allow you to make the most of its acne-fighting properties.
This content is for general information only and is not a substitute for medical advice.
Resources:
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