MDacne
A proliferation of the acne bacteria (p. acnes) + the reaction of the skin's immune system to these bacteria is believed to be the direct cause of inflammatory acne. Topical (as well as systemic) antibiotics were the pillars of acne treatment for years and unfortunately are still popular among many Dermatologists and family physicians today. The high use of these topicals has contributed to the increase in resistant strains of p. acnes over time. Antibiotic resistance represents a significant international public health concern as it may lead to reduced clinical responses, a potential increase in the pathogenicity of p. acnes and increased resistance in more pathogenic organisms.
The risk of topical antibiotics in acne
Multiple studies show that most strains of acne bacteria are resistant to antibiotics’ highest resistance was shown the commonly used topical antibiotics, clindamycin and erythromycin.
The residence rate in the US is overwhelming. 79% percent of p.acnes strains were found to be resistant to clindamycin and 81% of strains of p. acnes in the US were found to be resistant to erythromycin. The number in other countries and similar. In Europe, data from six countries revealed that antibiotic-resistant p. acnes was present in 67.8% of patients. The highest rates of resistance were found in Spain (93.6%) Greece (78.2%) and Italy (65.8%), and combined resistance to clindamycin and erythromycin was much more common than resistance to tetracyclines.
Should we use topical antibiotics for acne?
All Updated acne treatment guidelines, of the American Academy of Dermatology, European Academy of Dermatology and Asian consensus acne treatment committee advise against the use of topical antibiotics as a single acne therapy. Using topical antibiotic combined with other anti-acne agents is still a doubtful option. Based on the rapidly rising resistance to topical antibiotics it seems that these antibiotics should be removed from the anti-acne arsenal and not used at all.
What are the best topical therapies for acne?
To provide better anti-acne treatment to our patients we need to refocus on our most effective anti-acne ingredients, namely benzoyl peroxide for inflammatory lesions and salicylic acid and retinoids for the non-inflammatory lesions. These ingredients, used in the right formulations will allow highly effective treatments without the risk of bacterial resistance.
Resistance to antibiotics in acne treatment – detailed data
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