Hello, everyone! Today, we are going to discuss the treatment of acne, particularly regarding the use of oral antibiotics. Many people may wonder why diligently applying various topical treatments still fails to eradicate acne entirely. Can oral antibiotics make a difference? Also, what side effects come with the use of antibiotics? Let’s dive deeper into these topics.
First, as acne progresses from mild comedones to severe pustules and cysts, the complexity of treatment increases. Doctors select appropriate treatment methods based on different pathological mechanisms, among which oral antibiotics are widely regarded as one effective option.
Tetracycline antibiotics are the most commonly used on the market. The history of these antibiotics dates back to 1950 when Tetracycline was first approved. Over time, Doxycycline and Minocycline were introduced in the 1960s and 1970s, respectively. The newest addition, Sarecycline, was launched in the United States in 2018, but has yet to be released in Hong Kong.
So, why are tetracycline antibiotics effective in treating acne? While antibiotics are primarily used to combat bacterial infections, the causes of acne involve various factors, including sebum production, keratin accumulation, bacterial proliferation, and inflammatory responses. Tetracycline antibiotics have antibacterial properties that can eliminate Propionibacterium acnes while reducing the concentration of free fatty acids in the skin, which decreases the inflammatory potential of bacteria. These are important mechanisms through which tetracyclines work in the treatment of acne.
When it comes to antibiotic use, the duration and course of treatment are very important. It is generally recommended to follow the doctor’s instructions and undergo a treatment course of two to three months when starting oral antibiotics. However, to avoid issues such as drug resistance, experts advise that the maximum duration of use should not exceed three months.
Antibiotic resistance is an increasingly serious problem. In 1979, the rate of antibiotic-resistant infections from Propionibacterium acnes was 20%; by 2000, this figure had risen to 64%. Therefore, whether using oral or topical antibiotics, they should be combined with other treatment methods to prevent bacteria from developing resistance.
In addition to oral antibiotics, doctors often recommend topical medications, such as topical retinoids, topical antibiotics, and benzoyl peroxide (BPO). Notably, BPO has antibacterial properties that make it less likely to lead to resistance, so using it in conjunction with oral antibiotics can enhance treatment effectiveness.
However, the use of antibiotics also has potential side effects that need to be considered. Tetracycline, which needs to be taken on an empty stomach, is now less common, while Doxycycline and Minocycline are relatively flexible, with food having minimal effects on their efficacy. However, it is advisable not to lie down for one hour after taking them to prevent acid reflux affecting the esophagus.
Additionally, tetracycline drugs can increase skin sensitivity to sunlight, so proper sun protection measures should be taken during treatment. It’s also worth mentioning that Minocycline has higher lipophilicity, theoretically allowing for better penetration into sebaceous glands, but more evidence is still needed to support its effectiveness.
For children under eight years old and for pregnant or breastfeeding women, tetracycline drugs are not recommended due to potential impacts on the development of teeth and bones. In more severe cases, doctors might consider combining oral retinoids with other treatments but emphasize that these two types of medication should never be used simultaneously.
Finally, it is noteworthy that a new drug called Sarecycline was launched in the United States in 2018, which is designed to reduce gastrointestinal side effects, but it has not yet been available in Hong Kong.