The use of oral antibiotics in treating acne vulgaris: a new approach.
Although acne is not an infectious disease, oral antibiotics have remained a mainstay of treatment over the last 40 years. The anti-inflammatory properties of oral antibiotics, particularly the tetracyclines, are efficacious in treating inflammatory acne lesions. Common prescribing practices in Dermatology exert significant selection pressure on bacteria, contributing to the development of antibiotic resistance. Antibiotic use for acne not only promotes resistance in Propionibacterium acnes, but also affects other host bacteria with pathogenic potential. This review will summarize the commonly used treatments for acne vulgaris, and how they should be combined as rational treatment. The indications for using oral antibiotics in acne will be highlighted. Strategies described in the literature to conserve the utility of oral antibiotics will be summarized. These include limiting the duration of antibiotic therapy, concomitant use of a topical non-antibiotic agent, use of subantimicrobial dose doxycycline, and the introduction of topical dapsone.
Resident Medical Officer, Sir Charles Gairdner Hospital, Perth, Western, Australia. Georgia.farrah@health.wa.gov.au.
Georgia
http://orcid.org/0000-0003-4666-9861
G
Farrah
Consultant Dermatologist, Dermatology Department, Sir Charles Gairdner Hospital, Perth, Western Australia.
Ernest
E
Tan
D000152:Acne Vulgaris / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D000284:Administration, Oral; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects; D003879:Dermatologic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D006801:Humans; D011425:Propionibacterium acnes / Q000187:drug effects* / Q000472:pathogenicity; D012074:Remission Induction; D012867:Skin / Q000187:drug effects* / Q000382:microbiology / Q000473:pathology; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D003879:Dermatologic Agents
acne; antibiotic resistance; benzoyl peroxide; oral antibiotics; subantimicrobial dose doxycycline; tetracycline; topical dapsone; topical retinoid