I hasten to start the article having in mind that Acne vulgaris is not an infectious disease. However, the choice for antibiotics as treatment agents is among the leaders of many dermatologists in more severe forms of the disease. I have prescribed antibiotics to no more than five people and my experience is not entirely positive. Usually when the course is stopped, the acne recurs. The drugs used are from the group of tetracycline and macrolide antibiotics.
The mechanism of action of these drugs is divided based on:
- direct inhibition of C. acnes and bacterial lipases;
- reducing the concentration of proinflammatory free fatty acids from the skin surface;
- reducing inflammation and suppressing matrix metalloproteinases.
Most commonly used antibiotics as treatment agents
Tetracyclines. Tetracycline antibiotics are the first line of treatment for moderate to severe acne. They have good penetration into the lipid-rich domain of the hair fat follicle and microcomedones. The most used preparation in Bulgaria is doxycycline in subantibacterial dose, ie. lower than that given for infections. I will not intentionally indicate the dose regimen and the exact duration of the course, so as not to "tempt" someone in the direction of self-medication. Prolonged use of antibiotics carries its own risks and the decision to initiate such therapy should be made by your doctor.
Tetracycline antibiotics are contraindicated during pregnancy and in children under 8 years. The main side effects are associated with increased photosensitivity and gastrointestinal disorders.
Macrolides. The most commonly used are topical clindamycin combined with retinoid and azithromycin as a systemic choice. Gastrointestinal disturbances have again been reported with the use of this group of drugs. In addition, they can provoke cardiovascular conduction disorders.
The duration of antibiotic therapy should not exceed 4 months. According to international guidelines for the treatment of acne, a systemic antibiotic should not be combined with a topical antibiotic to reduce the risk of developing resistant strains. It is recommended that oral medications be combined with topical benzoyl peroxide. And as I said at the beginning, usually after stopping the course, a relapse occurs, which is extremely discouraging.
My experience with antibiotic treatment for acne is not great, because I believe that another therapeutic approach can almost always be found. I do not rule out that there is types of acnethat require antibiotics, but the general case is not. The cause of acne is never the only one, which determines the need for holistic behavior in doctor and patient.