Antibiotics For Acne: Potential Risks?

Jeff Hautala
By Jeff Hautala, Co-Founder of Exposed Skincare

Antibiotics for acne used to be a popular first-line acne treatment by doctors and dermatologists in the United States and around the world. This is unsurprising; modern medicine was utterly changed by antibiotics, and we have been using them to fight off infection for decades now.

However, research suggests that microbial drug resistance is on the rise for various reasons, rendering treatment of thousands of conditions significantly more difficult. This includes using antibiotics for moderate to severe acne, and it leaves many people with many questions such as: Can I use medicine for acne vulgaris safely and without suffering serious side effects? Is the use of antibiotics 💊 combined with benzoyl peroxide a good treatment option, for instance? Which is better, topical antibiotics or oral antibiotics?

As resistance to acne drugs spreads through the global population, dermatologists are rethinking how often they prescribe antibiotics for acne.
As antibiotic-resistance spreads through the global population, dermatologists are rethinking how often they prescribe antibiotics for acne.

The Basics: How Do Antibiotics Work?

Before we can dig into antibiotics as a treatment for pimples — a brief overview of the three ways in which they work. Generally, antibiotics fight bacteria only, not viruses, even though research is busy changing this too.

Targeting Cell Walls

One of an antibiotic’s modes of action is to destroy bacterial cell walls 🦠. Human cells only have membranes, so these antibiotics target the pathogen without harming your own cells. Once antibiotics break down the cell wall, the pressure inside the cell ruptures the cell, killing the bacterium. Amoxicillin, which is an acne treatment, works this way.

Targeting Ribosomes

The second popular tactic antibiotics use to fight bacteria is messing with bacterial ribosomes. Ribosomes are the part of the cell that creates the proteins used in DNA, so when antibiotics target the ribosomes and destroy or impede them, new DNA can’t be manufactured. This stops the bacteria from reproducing at the very least, and in some cases, it destroys the organism entirely. Many antibiotics for acne work this way, like minocycline, clindamycin, and erythromycin.

Targeting DNA

Some antibiotics fight bugs by breaking down their DNA. To construct their DNA 🧬, bacteria use chemicals and proteins that are different from those our cells do. Some antibiotics target bacterial DNA by slicing it, which either destroys the bacterium or prevents it from reproducing. Levofloxacin is one antibiotic sometimes prescribed for acne that functions this way.

Why Killing Bacteria Helps Reduce Acne

Acne is primarily caused by three factors: inflammation, skin bacteria, and oil production. Many acne treatments focus on killing bacteria because they contribute to pimples and cysts, the two more severe and painful forms of acne.

The bacteria that cause acne are called Propionibacterium acnes (P. acnes) 🦠, and they always live on the surface of your skin. When the skin is not inflamed, they can even help prevent acne because they consume oil and help prevent clogged pores.

So What Goes Wrong?

However, sometimes bacteria are trapped in a pore, and pimples and cysts often result. Oil gets stuck in the pores with bacteria, which means the bacteria have extra food and can reproduce faster. When their numbers reach a certain point, the body recognizes the clogged pore as infected and sends immune system cells to fight it off.

How Do Cysts Form?

When the immune system successfully kills P. acnes bacteria, the process generates inflammation and pus, leading to the formation of a pimple. However, if this takes place deep under the skin, a cyst or cystic acne can form.

The precise causes of cysts are still unclear, and research is ongoing 🔬. However, it has been established that the following factors can play a role, and/or considerably exacerbate this skin condition:

  • hormone fluctuation associated with puberty, pregnancy, menopause, and a woman’s menstrual cycles;
  • polycystic ovary syndrome;
  • certain medicines;
  • hereditary factors, or
  • sweating and high humidity.

Acne is not caused by chocolate, sexual activity, poor hygiene, or spicy or greasy foods.

Prescribing Antibiotics For Acne

Two main categories of antibiotics are prescribed for acne 📝: topical, and oral or systemic. Topical antibiotics are applied directly to the skin while systemic antibiotics are taken by mouth, and most antibiotics come in both forms.

Which Drugs Are Used to Treat Acne?

Clindamycin and erythromycin are two of the commonest antibiotics prescribed to treat acne, but they are growing increasingly ineffective 📉.

Minocycline is another common option, but anyone under age 22 should avoid it because in the young it has the side effect of causing permanent blueish-black tooth discoloration.

Oxytetracycline and doxycycline are also prescribed for acne and have proven relatively effective.

However, even the best antibiotic doesn’t clear up skin entirely. It could be more effective if used in combination with a good skin care routine, but more about that later.

How Effective Are Antibiotics?

Antibiotics typically have a significant effect in treating severe cysts. Because cysts are generally caused by an extended infection of P. acnes over which a layer of healthy skin has grown, topical antibiotics are less effective. Oral antibiotics are usually the better option when dealing with cystic acne.

Oral antibiotics for acne can be effective in treating cystic acne, but it is an incomplete and temporary solution.

P.acnes infections are only one cause of acne vulgaris. This is one reason why antibiotics 💊 are typically prescribed along with products containing benzoyl peroxide or retinoids.

Furthermore are antibiotics typically a temporary solution because they can only be taken for three months. This is due to the third and most significant reason for antibiotics’ ineffectiveness: antibiotic resistance.

What Is Antibiotic Resistance?

As we mentioned previously, antibiotic resistance is one of the unfortunate side effects of medication overuse. Like humans, bacteria can have random mutations in their DNA, and sometimes a bacterium will randomly mutate in a way that makes it resistant to an antibiotic. This mutation lives in its DNA, so when this mutated bacterium reproduces, its duplicates are also resistant to the antibiotic. As if that’s not enough — pathogens can transfer mutated DNA 🧬 to each other.

This is a problem for several reasons, the most immediate being that the infection can’t be effectively treated anymore. Furthermore many antibiotics have a similar chemical composition, which means multiple drug resistance.

Also, P. acnes are not the only pathogens that can develop resistance to a specific antibiotic you’re taking. Antibiotics rarely target one kind of bacterium and resistance means that small, relatively harmless colonies of bad bacteria could quickly develop into a problem. But the biggest issue with drug resistance goes beyond any individual person. Doctors are fearing it could be turning into a global crisis.

What Can You Do For Acne Treatment?

This is not a fear-mongering article meant to scare people away from asking their doctor or dermatologist 👩‍⚕️ about antibiotics as an acne treatment. As we mentioned previously, it significantly improves cysts, which can be difficult to treat using other methods.

So, if you choose prescription medicine as a treatment for cysts, we encourage you to follow these two golden rules:

Do Not Take Antibiotics For Longer Than Three Months

In this, we align ourselves with the American Academy of Dermatology guidelines — patients should take antibiotics for the shortest time possible. After three months of exposure to an antibiotic, bacteria 🦠 become increasingly likely to develop resistance, so it’s important to take the antibiotic for as short a time as possible. Voice your concerns about long-term use with your doctor or dermatologist, if they want to prescribe medicine for longer than three months.

Always Use Another Form of Treatment With Antibiotics

Using a combination of treatments can help prevent antibiotic-resistance, which is great, but it can also lead to clearer skin. Treatment of acne is never only one thing, and it’s important to deal with all the causative factors.

Additional products that include ingredients like salicylic acid or green tea extract 🍃are anti-inflammatory and can reduce excess oil production, which will help treat all kinds of pimples when used in conjunction with topical or oral antibiotics. Most of these products are available over the counter or are for sale on the Internet, such as on our site, and with good reason – there’s virtually no risk of side effects. If you’re unsure or have excessively sensitive skin, ask your doctor 👨‍⚕️ about benzoyl peroxide, but products containing it are generally sufficient treatment for mild acne.

Benzoyl peroxide and tea tree oil are bactericidal, and tea tree oil is a good anti-inflammatory too.

Generally, all acne-prone skin can be improved when treated gently and consistently, so a simple routine is one of the best complements to a medicine used to treat acne.

We recommend the Basic Kit offered here at Exposed Skin Care 🏆. Our products include all of the ingredients listed above and more, and we guarantee that following our simple three-step process will significantly improve your skin condition.

The best addition to an antibiotic for acne is a gentle skin care routine, like the 3-step process outlined in our Basic Kit.
The best addition to an antibiotic for acne is a gentle skin care routine, like the 3-step process outlined in our Basic Kit.

If your skin condition is very bad, always be sure to visit a doctor or dermatologist 👩‍⚕️ – you may need an antibiotic prescription after all.