Systemic antibiotic therapy in the treatment of acne

One of the key pathogenetic mechanisms of acne development is excessive growth of microorganisms Cutibacterium (Propionibacterium) acnes.

Cutibacterium acnes – gram-negative anaerobic microorganisms that live deep in the follicles and stimulate the production of pro-inflammatory mediators and lipases. Excessive reproduction of bacteria against the background of hyperproduction of sebum in acne contributes to the aggravation of the inflammatory process and worsening of the course of the disease.

According to international protocols, patients with moderate to severe acne should be given systemic antibiotic therapy. In this article on estet-portal.com we will look at some aspects of the use of antibiotics in the treatment of acne.

The use of systemic antibacterial agents in the treatment of acne

Systemic antibiotic therapy is now widely used in the treatment of moderate to severe acne. Antibacterial drugs should be combined with topical acne therapy: benzoyl peroxide and topical retinoids.

Given concerns about the increased prevalence of antibiotic resistance, current acne treatment guidelines recommend the use of systemic antibiotics for no longer than 3-4 months.

However, clinical improvement must be maintained by continuous use of topical retinoids (if necessary – in conjunction with benzoyl peroxide).

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Acne treatment: tetracyclines – antibiotics of choice

In the treatment of acne, the antibiotics of choice are tetracycline drugs that can effectively inhibit the growth of Cutibacterium acnes microorganisms and exhibit anti-inflammatory effects.

In the treatment of acne, the antibiotics of choice are the tetracyclines.

Tetracyclines help to reduce the degradation of retinoic acid and enzymes, have anti-apoptotic and antioxidant properties, and also regulate cell proliferation. In the United States, the most commonly used treatments for acne are minocycline and doxycycline.

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Tetracyclines in the treatment of acne: rationale for low dose efficacy

In patients with moderate to severe acne, doxycycline 40 mg daily has been shown to be as effective as doxycycline 100 mg daily.

In a clinical study, reported side effects, in particular gastrointestinal disturbances, were less common in patients treated with 40 mg of doxycycline per day than in those treated with 100 mg of the drug.

Therefore, international guidelines recommend the use of low doses of doxycycline in the treatment of moderate to severe acne.

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Other antibacterial agents used in the treatment of acne

Other systemic antibacterials that are used to treat acne include trimethoprim-sulfamethoxazole, penicillins, cephalosporins, and macrolides. However, there are only limited clinical trial results to support their effectiveness in treating acne.

The use of other groups of antibiotics (not tetracyclines) in the treatment of acne is advisable only if tetracyclines are intolerant.

Thank you for staying with estet-portal.com. Read other interesting articles in the "Cosmetology" section. You may also be interested in Macrolides: how safe is prescribing popular antibiotics

Translated from The New England Journal of Medicine