There are many factors that contribute to the development of acne. The development of acne begins with the formation of a microcomedone due to abnormal regulation of the cells within the pore. The microcomedone does not allow dead skin cells and sebum to escape from the pore. This becomes a perfect environment for the Propionbacterium acnes (p. acnes) bacteria, which create inflammation and ultimately lead to inflammatory acne lesions.
How are antibiotics used to treat acne?
Antibiotics are commonly used in the treatment of inflammatory acne. They can be used topically in the treatment of mild to moderate inflammatory acne or taken by mouth for the treatment of moderate to severe inflammatory acne. Antibiotics work in a few different ways to reduce acne. The main mechanism that antibiotics use to treat inflammatory acne is to decrease the amount of p. acnes bacteria around the pore. Antibiotics also work by reducing the concentration of free fatty acids in the sebum; free fatty acids promote inflammation and may cause comedones (whiteheads and blackheads.)
What are the most effective antibiotics for the treatment of acne?
The tetracyclines are the most commonly prescribed antibiotics for the treatment of inflammatory acne. These include the second generation tetracyclines, doxycycline and minocycline. Doxycycline and minocycline are derived from the more traditional Tetracycline and tend to be better tolerated and more effective than the older medications. All tetracyclines, including doxycycline and minocycline work by interfering with protein synthesis, exerting a bacteriostatic effect on p. acnes bacteria. Examples of doxycycline and minocycline are the brand names Doryx and Solodyn.
Macrolide antibiotics, such as azithromycin, have also shown to be effective against the p. acnes bacteria. They work by inhibiting protein synthesis to have a bacteriostatic effect; they bind to a different portion of the bacterial ribosome than the tetracyclines. Trimethoprim/Sulfamethoxazole (Bactrim) is sometimes used to treat inflammatory acne that does not respond to other antibiotic treatments.
Are oral antibiotics alone sufficient for the treatment of acne?
Oral antibiotics are rarely used as monotherapy (the only treatment used.) Topical antibiotics, benzoyl peroxide and retinoids are often using in conjunction with oral antibiotics. In-office treatments, such as the Isolaz, Photodynamic Therapy (PDT) and Blue Light Therapy, are commonly performed while taking oral antibiotics. These treatments can reduce the acne lesion count more quickly than oral antibiotics and topical medications alone.
What are the side effects of oral antibiotics?
All oral antibiotics have unique side effects; your acne specialist can review the potential side effects for the oral antibiotic that you are taking. Side effects that are potentially seen with most antibiotics used for acne are gastrointestinal upset (“stomachache”) and vaginal yeast infection.
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