Newark, NJ—Dermatologists tend to prescribe a lot of antibiotics for conditions such as acne, but that might be changing.

A series of articles in the journal Dermatologic Clinics analyzed studies on acute and long-term acne treatments over the past decade to identify trends.

“Therapeutic actives for acne have changed little in the last decade. Recognition that acne is an inflammatory, not infectious condition has led to a call for reduction in antibiotic use,” conclude the study authors from the Rutgers University School of Medicine. “This has culminated in a re-evaluation of highly efficacious combination topical therapy, improved vehicle technology, and a renaissance for spironolactone and isotretinoin.”

Laser and light modalities, although not sufficiently studied for first-line use, show promise for the future.

The study points out that, in patients using topical and oral antibiotics:
• An increase of bacteria in the back of the throat and tonsils compared with nonusers to was three times more likely
• Long-term use of antibiotics in acne treatment is associated with an increase in upper respiratory infections and skin bacteria; and
• Glucose levels are affected by long-term antibiotic therapy.

“People are more conscious about the global health concern posed by the overuse of antibiotics and that acne is an inflammatory, not infectious, condition,” explains Hilary Baldwin, MD, clinical associate professor of dermatology at Rutgers’ Robert Wood Johnson Medical School. “Overuse of antibiotics also can promote the growth of resistant bacteria, which can make treating acne more challenging.”

To avoid those problems, Dr. Baldwin points out, interest has been renewed in an older drug, the antibacterial medication benzoyl peroxide, which often is used in combination with topical retinoids. A benefit, she notes, is that benzoyl peroxide kills acne-causing bacteria, helps the skin shed more effectively, reduces clogged pores, and does not promote resistant acne-inducing bacteria strains.

The study notes that acne often continues into adulthood, affecting about one-half of women in their 20s, one-third in their 30s, and one-fourth in their 40s. Among other possible treatments are spironolactone, which appears to be particularly effective in women; hormonal therapies that target androgens in the development of acne; laser and light therapies; and diet regulation.

The study authors suggest that, in severe acne, early intervention with the retinoid isotretinoin is effective without antibiotics. “This oral medication is unique among acne therapies in that it has the potential to not just treat acne but to eradicate it. It is 80 percent effective if a complete course is taken,” notes coauthor Justin Marson, a medical student at Robert Wood Johnson Medical School. “Studies also have disproven internet theories that the medication increases the risk of depression, ulcerative colitis and Crohn’s disease.”

Use of antibiotics is expected to continue at some level, however. The researchers emphasize that those medications are highly effective for moderate-to-severe cases of inflammatory acne and are approved by the FDA as a supplement to other treatments, such as benzoyl peroxide or a topical retinoid.

“Numerous studies have shown that these combinations are fast, effective and help reduce the development of resistant strains of bacteria that cause acne, but the CDC recommend that antibiotics be used for a maximum of six months,” Dr. Baldwin explains.

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