The idea of your pores getting clogged up with bacteria is disturbing to say the least. But that’s exactly what’s happening under every angry pimple. So one solution to put your mind and your skin at ease is to kill that bacteria and stop it from colonizing your face.
Today we’ll talk about two of the most common antibiotics used to treat acne, how they work, and what you can do to maximize their effects.
Anti-acne antibiotics
In the world that we can only see through the microscope, a battle for survival rages on. Just as we fight for survival, so do the tiny bacteria and fungi that live in the environment. Naturally, these microorganisms develop defenses to protect themselves against other microorganisms. We humans took advantage of that and the product was the group of drugs called “antibiotics”.
An antibiotic is any substance produced by a living microorganism that is capable of destroying or inhibiting the growth of another microorganism. There are many antibiotics that have been used to treat acne, but the most popular are clindamycin and erythromycin.
Clindamycin
Clindamycin, made from the bacteria Streptomyces lincolnensis, has been used to treat acne for over 50 years. It reversibly binds to the 50S ribosomal subunit, effectively throwing a wrench into the bacteria’s plans for domination by preventing it from making proteins. Without the ability to synthesize proteins, microorganisms cannot survive and proliferate. As such, it can be a bactericidal or bacteriostatic agent depending on the target species.
It’s particularly effective against anaerobes, making it a shoo-in for acne therapy. Remember that Propionibacterium acnes thrives best in a pore that has been fully-blocked and therefore, airless.
Another reason why clindamycin makes for a good acne treatment is because it has few side effects when used topically. Very few patients report dryness, redness, peeling, or pain when used as recommended. It may also be administered orally, although this may disrupt the normal, healthy bacteria that live in the gut and cause diarrhea.
Erythromycin
Erythromycin, from the bacteria Streptomyces erythreus, is another popular antibiotic used to clear the complexion. It has the same mechanism of action as clindamycin, but it targets a broader spectrum of bacteria. This may initially seem like a good thing, but it increases the risk of damaging the beneficial microflora of our bodies. Erythromycin is mostly a bacteriostatic agent, which means that it prevents bacteria from reproducing rather than killing them outright.
The problem of antimicrobial resistance
While antibiotics have long been used against acne and other diseases, how they are used is now changing. While the strains of P. acnes susceptible to antibiotics have died off, the few strains that, by some fluke of nature, are resistant to it have proliferated. Without competition, they can become the dominant strain.
This means that if we keep using clindamycin and erythromycin in the same way that they were prescribed decades ago, then we will inadvertently help develop bacterial strains that they are no longer effective against.
To prevent this from happening, antibiotics are now used in conjunction with other treatments. These may boost their effectiveness against bacteria, or target the other factors in the pathogenesis for acne.
Antibiotics + Antiseptics
Antiseptics also get rid of acne-causing bacteria, but instead of targeting the microorganism itself, they target the environment it lives in. By making the surroundings untenable, antiseptics discourage infection.
A good example of an antiseptic used for acne treatment is benzoyl peroxide. This compound enters the skin and undergoes an oxidation reaction which, true to its name, introduces oxygen in the blocked pore. And for the anaerobic Propionibacterium acnes, this is bad, bad news. And the good thing is, there have been no reports about resistant strains when benzoyl peroxide is used.
Combining antibiotics with antiseptics is a good way to minimize the risk of resistance and attack the bacteria from two fronts. There are products that you can buy that combine these two active ingredients. Otherwise, check how you can layer your antibiotic product and antiseptic product to maximize their effects.
Antibiotics + Topical tretinoin
Another way to potentiate antibiotic activity is to combine it with topical tretinoin. While antibiotics take care of the bacterial overgrowth in blocked pores, tretinoin prevents blocked pores from happening in the first place. It helps increase the turnover of cells so that dead ones don’t get stuck in the pore openings. It also has anti-inflammatory and oil reduction abilities that also prevent zits from forming.
Using antibiotics and topical tretinoin packs a one-two punch to acne. This deadly combo targets the major factors in the pathogenesis of acne, making it much more powerful than antibiotics used alone.
There are products that combine the two, making for a simpler skincare routine. If you use two separate products, the usual recommendation is to use the antibiotic in the morning and the tretinoin at night. Consult with your doctor what would work best for your skin type.
Conclusion
Antibiotics are important to acne therapy because they target the bacterial component of acne pathogenesis. However, reports of emerging resistant strains have rendered antibiotic monotherapy dangerous.
The benefits of combining antibiotics with other acne treatments include reducing risk of resistance (particularly when paired with benzoyl peroxide) and supercharging its skin-clearing effect by targeting other factors involved in the formation of acne.
This content is for general information only and is not a substitute for medical advice.
Resources:
Dessinioti, C., & Katsambas, A. (2017). Propionibacterium acnes and antimicrobial resistance in acne. Clinics in dermatology, 35(2), 163–167. https://doi.org/10.1016/j.clindermatol.2016.10.008
Feneran, A. N., Kaufman, W. S., Dabade, T. S., & Feldman, S. R. (2011). Retinoid plus antimicrobial combination treatments for acne. Clinical, cosmetic and investigational dermatology, 4, 79–92. https://doi.org/10.2147/CCID.S13873
Murphy PB, Bistas KG, Le JK. Clindamycin. [Updated 2020 Jun 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519574/
