Approaches to limit systemic antibiotic use in acne: Systemic alternatives, emerging topical therapies, dietary modification, and laser and light-based treatments

Abstract

Acne is one of the most common diseases worldwide and affects approximately 50 million individuals in the United States. Oral antibiotics are the most common systemic agent prescribed for the treatment of acne. However, their use may be associated with a variety of adverse outcomes including bacterial resistance and disruption of the microbiome. As a result, multiple treatment guidelines call for limiting the use of oral antibiotics in the treatment of acne, although actual prescribing often does not follow these guidelines. In this review, the rationale for concerns regarding the use of oral antibiotics for the management of acne is reviewed. In addition, we will discuss our approach to complying with the intent of the guidelines, with a focus on novel topical agents, dietary modification, laser and light-based modalities, and systemic medications such as spironolactone, combined oral contraceptives, and oral isotretinoin. Antibiotic resistance is a growing problem across medicine and rates of antibiotic resistance among isolates of Cutibacterium (formerly Propionibacterium) acnes have been rising, including to tetracycline-class antibiotics. 1-4 In addition to resistance among C. acnes, the use of oral antibiotics is associated with disruption of the normal flora, bacterial resistance among other organisms, and increased rates of upper respiratory infection and pharyngitis. 5-8 Antibiotic use may also be associated with inflammatory bowel disease and collagen vascular disease. 7-16 Finally, there may be an association between the use of oral tetracycline-class antibiotics and risk of breast and colon cancer. 17,18 As a result, there have

Is mean platelet volume an inflammatory marker in acne patients treated with isotretinoin?

“…Oral contraceptives containing estrogen and spironolactone are regarded as second-line treatment choices in females with inflammatory acne (3,4). Moreover, it has been suggested that pulsed dye laser and 1,450 nm diode laser could be therapeutic alternatives (5).…”

Argon Plasma: A New Approach for the Effective Treatment of Inflammatory Acne Vulgaris and Enlarged Pores in Asian Patients

“…First, and most important, was in minimizing the development of antibiotic resistance, which is associated with disruption of the normal flora, bacterial resistance among other organisms, and increased rates of upper respiratory infection and pharyngitis. 16 Oral antibiotics are the most common systemic agent prescribed for the treatment of acne. However, antibiotic resistance is a growing problem across medicine and rates of antibiotic resistance among isolates of P. acnes have been rising, including to tetracycline-class antibiotics.…”

Treatment of acne with spironolactone: a retrospective review of 395 adult patients at Mayo Clinic, 2007–2017

“…This timeline to improvement was not surprising because previous literature has supported the notion that hormonal therapies can take several months to effect a clinical improvement. 12,13 Our data suggest that it is important to counsel patients about the expected timeline to efficacy so they do not discontinue spironolactone treatment prematurely.…”