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“Super Acne”: is antibiotic resistance making acne harder to treat?

September 21st 2016 / Anna Hunter

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Fears are growing around antibacterial ingredients in skincare and the use of antibiotics to treat acne, as drug-resistant infection is on the rise, but exactly how, if and when should antibiotics be used?

The overprescription of antibiotics is becoming more and more of a concern globally, with more bacteria outsmarting medication, antibiotics being prescribed in inappropriate circumstances and a lack of new antibiotics in development. The concern regarding antibiotic resistance led the US Food and Drink Administration (FDA) to ban the sale of antibacterial soaps across the pond a fortnight ago, on the grounds that the supposedly germ eradicating washes and gels could do more harm than good to our health. As for our skin, doctors are becoming increasingly wary of the overprescription of antibiotics in the treatment of acne, as a recently published study presented at the British Association of Dermatologist’s Annual Conference indicated that a large proportion of patients are taking antibiotics to treat acne for a longer period than is advised, possibly leading to the a resistance in the bacteria associated with acne (propionibacterium acnes).

Given that the majority of teenagers suffer with acne, and that acne affects 1.3 million adults in the UK, a resistant strain of acne is certainly a scary prospect, especially considering that, according to Dermalex, 52% of those with acne believe that they’ll never have clear skin again. Luckily, cosmetic dermatologist to the stars Dr Sam Bunting assures us that an effective treatment plan for clear skin is attainable, and that it can involve a controlled and safe course of antibiotics. We subjected Dr Sam to our “super-acne” angst, and she assured us not to panic…

Get The Gloss: What is the current advice in terms of the prescription of antibiotics to treat acne?

Dr Sam Bunting: “Antibiotics are indicated as treatment for moderate to severe inflammatory acne, so they shouldn’t be used in mild inflammatory disease or comedonal acne, where there are no red, inflamed papules (bumps) or pustules (red bumps with whiteheads).”

GTG: How can antibiotics help over other forms and treatment, and what are the primary risks of taking them?

Dr Sam: “I use them in moderate to severe disease where there may be risk of scarring and if disease is widespread, so involving the chest and back. The key is to use the right antibiotic in the right patient for the right length of time.”

“A common side effect with oral antibiotics is thrush. Doxycycline can be associated with photosensitivity and minocycline has been linked to pigment deposition of the skin, mucus membranes, and teeth.”

GTG: How long should you take antibiotics for acne?

Dr Sam: “If prescribed to the appropriate patient, the response should be reviewed at three months. In certain cases, a longer course may be indicated, for example, in someone who isn’t a candidate for oral contraceptives or isotretinoin because of other health issues, or in someone who has active disease but struggles to tolerate topical therapy. I think that it’s vital that oral antibiotics are never given as a single therapy. They should always be combined with a topical retinoid and, ideally, benzoyl peroxide topically.”

GTG: Do antibiotic creams present the same issues as oral antibiotics in terms of antibiotic resistance?

Dr Sam: “Resistance is less likely with the combined use of benzoyl peroxide.”

GTG: What are the alternatives in terms of treating severe acne? What have you found to be most effective in general in clinic?

Dr Sam: “I don’t avoid the use of antibiotics, but I do stick to the following guidelines. If a patient isn’t responsive after trying oral and topical combinations for a defined period of time, that’s when alternative oral treatments like anti-androgens come into play.”

GTG: I've taken antibiotics for acne in the past- should I be concerned regarding antibiotic resistance unrelated to acne?

Dr Sam: “We predominantly use tetracyclines now in treating acne as resistance to erythromycin has increased, so it’s becoming a less useful tool. Provided it’s used for an appropriate timeframe (so not longer than six months) and that it’s used with topical benzoyl peroxide, the risk of antibiotic resistance should be low.”

The takeaway? There’s no need to stress (frustratingly that can makes acne worse); as long as you’re going by the book, “super acne” shouldn’t be able to take hold. If you are looking for other ways to get a grip on your acne, follow the journey of our adult acne diarist here, and explore Dr Sam’s advice regarding alternative treatment.

Subscribe to Dr Sam’s Youtube channel and follow her blog for further expert wisdom

Follow Dr Sam on Twitter and Instagram @DrSamBunting

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