Acne treatment – antibiotics- Musings of an NYC dermatologist

Acne vulgaris is a multi-factorial (meaning a lot of different things cause it), inflammatory skin disease.  Antibiotics have been an important part of acne treatment for decades.  Acne, however, is not an infection.  This makes many people ponder the questions, if acne is not an infection, then why do we treat it with antibiotics?

Bacteria are one of the contributors to the formation of acne lesions.  Antibiotics reduce Propionibacterium acnes (P. acnes), a species of bacteria which is part of the normal skin flora, particularly in the hair follicles of the oily areas of the face and upper trunk,  which are the acne-prone areas.  P. acnes is thought to contribute to acne as the result of the pro-inflammatory byproducts in makes when the organisms consume the fatty acids in the hair follicle.  Antibiotics used in acne treatment have both direct and indirect affects on reducing inflammation.   In reducing the amount of P. acnes in the skin, antibiotics can have an indirect antiinflammatory effect.  In reducing the body’s inflammatory response that results in redness, swelling and pus formation antibiotics have a direct antiinflammatory effect.

Interestingly, there is also some data that antibiotics, such as doxycycline, can also reduce comedone formation (i.e. the formation of the plugs we call whiteheads and blackhead which are the primary lesions of acne vulgaris).

Remember, in order to reduce the risk of antibiotic resistance, use a benzoyl peroxide product if one is using an oral, or even topical, antibiotic for acne treatment.

Posted in: Cosmetic Dermatology, General Dermatology