Antibiotics for Acne: Potential Risks?

Jeff Hautala
By Jeff Hautala, Co-Founder of Exposed Skincare

Antibiotics for acne used to be the frontline treatment, the first solution every dermatologist tried. However, research in the last ten years indicates that antibiotics are not the cure-all many of us assumed they were. Modern medicine was completely changed by the development of antibiotics, and we have been using them to fight off illness and infection for decades now, but recent research suggests we may have overdone things.

More and more people are becoming resistant to antibiotics, making their conditions significantly harder to treat. Some researchers fear that we may return to a world without antibiotics in the not-so-distant future. One potential way to curb this decline in antibiotic effectiveness is to reduce our use of antibiotics, which leaves many people wondering: is it safe to use antibiotics for acne?

Antibiotics for Acne
As antibiotic-resistance spreads through the global population, dermatologists are rethinking how often they prescribe antibiotics for acne.

The Basics: What Are Antibiotics?

Before we can dig into why antibiotics for acne are a good or bad idea, we need a brief overview on how antibiotics work. Generally, antibiotics fight bacteria. This means they can fight infections and illnesses caused by bacteria, but they don’t have any influence over those caused by a virus, like the common cold or the flu. That’s why we vaccinate for the flu, because the only other treatment is rest and fluids (although there have been some breakthroughs on antiviral medications recently). So how do antibiotics fight bacteria?

One tactic is to destroy the bacteria’s cell walls. Human cells only have membranes, so antibiotics that target cell walls automatically find the bacteria without any chance of harming your own cells. Once antibiotics break down the cell walls, the pressure inside the cell becomes too much and the cell ruptures, killing the bacterium. Amoxicillin, which is sometimes prescribed for acne, works this way.

The second popular tactic antibiotics take to fight bacteria is messing with bacterial ribosomes. Ribosomes are a part of the cell that creates the proteins used in DNA, so when antibiotics target the ribosomes and destroy or impede them, new DNA can’t be manufactured. This stops the bacteria from reproducing at the very least, and in some cases it destroys the bacteria entirely. Many antibotics for acne work this way, like minocycline, clindamycin, and erythromycin.

One last method antibiotics use to fight bacteria is breaking down bacterial DNA. Bacteria use different chemicals and proteins to construct their DNA than we do, so some antibiotics are designed to seek out bacterial DNA only and slice it. When DNA is cut, it can’t reproduce, which prevents the bacterium from reproducing, and there’s a chance it could also kill the bacterium. Levofloxacin is one antibiotic sometimes prescribed for acne that functions this way.

Why Killing Bacteria Helps Reduce Acne

Acne is primarily caused by three main factors: inflammation, bacteria, and oil production. Many acne treatments focus on killing bacteria because they contribute to pimples and cysts, the two more obvious and painful forms of acne. But without inflammation, bacteria would rarely become a problem. The bacteria that cause acne are called p. acnes, and they always live on the surface of your skin. When the skin is not inflamed, they can even help prevent acne because they consume oil and help prevent clogged pores.

However, once bacteria are trapped in a pore, pimples and cysts are often the result. Oil typically gets stuck in the pores with bacteria, which means the bacteria have extra food so they can reproduce even more quickly. When the number of bacteria reaches a certain point, the body recognizes it as an infection and sends immune system cells to fight it off.

When the immune system successfully kills p. acnes bacteria, the process generates inflammation and pus, leading to the formation of a pimple. However, sometimes p. acnes trick the immune system into attacking your own skin cells, and that is how cysts form.

P. acnes can release a chemical that bonds to your skin cells and tricks your immune system into thinking they are actually bacterial cells. This distracts the immune system, allowing bacteria to multiply unchecked, and breaks down skin cells, allowing bacteria to burrow deeper into the skin. Because the bacteria aren’t being forced toward the surface of the skin, healthy skin grows over the infection, leading to a cyst.

Prescribing Antibiotics for Acne

Two main categories of antibiotics are prescribed for acne: topical and oral, or systemic. Topical antibiotics are applied directly to the skin while systemic antibiotics are taken by mouth, and most antibiotics come in both forms.

Clindamycin and erythromycin are some of the most common antibiotics prescribed for acne, but they are growing increasingly ineffective. Minocycline is another common option, but anyone under age 22 should avoid it, as it can cause permanent blueish-black tooth discoloration. Oxytetracycline and doxycycline are also prescribed for acne and have proven relatively effective. But even the best antibiotic doesn’t clear up skin entirely.

How Effective Are Antibiotics?

Antibiotics typically have a significant effect in treating severe, cystic acne. Because cysts are generally caused by an extended infection of p. acnes bacteria and a layer of healthy skin has grown over the infection, topical antibiotics are less effective because they have a hard time getting through the healthy skin to the bacteria. Oral antibiotics are usually the better option when dealing with cystic acne.

Antibiotics for Acne
Oral antibiotics for acne can be effective in treating cystic acne, but it is an incomplete and temporary solution.

Although antibiotics can be effective in treating cystic acne, they have many limitations that prevent them from being as effective as they could be. First, it’s important to remember that bacteria are only one cause of acne. When antibiotics were first prescribed for acne, they typically cleared around 60% of acne, because inflammation and oil production were still causing some issues. This is one reason why antibiotics are typically prescribed along with another acne-fighting product, like benzoyl peroxide or retinoids.

Second, antibiotics are typically a temporary solution because they can only be taken for three months. This is due to the third and most significant reason for antibiotics’ ineffectiveness: antibiotic resistance.

What is Antibiotic Resistance?

Antibiotic resistance may prove to be one of the biggest medical issues since the advent of antibiotics, and it is impacting dermatologists’ decisions on prescribing antibiotics for acne. When someone develops antibiotic resistance, it means they have bacteria in their system that are not affected by antibiotics. This can make treating bacteria-based infections and illnesses very difficult, and it is becoming a big problem all over the world.

Like humans, bacteria can have random mutations in their DNA, and sometimes a bacterium will randomly mutate in a way that makes them resistant to an antibiotic. This mutation lives in its DNA, so when this bacterium reproduces (approximately every 20 minutes), its offspring are also resistant to the antibiotic. Additionally, bacteria can share DNA just by coming into physical contact with each other, creating even more antibiotic-resistant bacteria.

This is a problem for several reasons. The most immediate issue is that your infection or illness can’t be effectively treated with an antibiotic if the bacteria can’t be killed by it. This means acne will come back if enough bacteria become resistant and you’ll have to find a different treatment. Which leads to the second problem: many antibiotics have similar chemical makeups, which means if bacteria become resistant to one antibiotic, they could become resistant to others, even if you’ve never taken them before.

Third, p. acnes bacteria are not the only bacteria that can develop resistance while you’re taking an antibiotic. Antibiotics rarely target one kind of bacteria, they just try to kill any bacteria they find. This means that small, irrelevant colonies of bad bacteria could quickly grow into a very relevant problem, but your antibiotic, and possibly others like it, won’t be able to treat it. But the biggest issue with antibiotic resistance goes beyond any individual person.

Global Resistance

When someone’s body harbors antibiotic-resistant bacteria, it can make their illnesses and infections harder to treat, which is a problem, but when that person spreads those bacteria to others, it contributes to a growing crisis.

Let’s say you are a healthy, young person who has developed antibiotic-resistant bacteria, and you go to visit your sister who has just had a baby. You hold the newborn and stroke their face, feel their soft hair, all the natural reactions to an adorable baby. Most hospitals have you apply an antibacterial hand sanitizer, but these products typically only kill 40-60% of bacteria.

In this instance, you may have just transferred antibiotic-resistant bacteria to a new baby with a fragile immune system, or to their mom, whose immune system is also in a compromised state after the trial of birth. They could both develop illnesses or infections that are relatively mild, but because the bacteria can’t be killed by antibiotics, these simple ailments can turn very serious very quickly.

This is a problem all over the world, and it’s a difficult one to avoid. Most people harbor antibiotic-resistant bacteria, and many bacteria are airborne, so even a poorly-covered sneeze in a cramped classroom could spread antibiotic-resistant bacteria to others. This doesn’t mean that every minor infection will become fatal or that you should avoid your especially young or old loved ones, it just means that doctors and patients alike need to start taking appropriate precautions.

What Can You Do?

This is not a fear-mongering article meant to scare you away from using antibiotics for acne. As we mentioned previously, it significantly improves cystic acne, which can be difficult to treat using other methods, and your care should be your choice. If you choose to use antibiotics for acne, we encourage you to follow these two golden rules:

  1. Do not take antibiotics for longer than three months.

It’s true that there is some debate in the medical and dermatological communities about whether or not antibiotics should be prescribed for acne, but there should be no debate about the length of time antibiotics are prescribed. After three months of exposure to an antibiotic, bacteria become increasingly likely to develop resistance, so it’s important to take the antibiotic for as short a time as possible.

Some dermatologists prescribe antibiotics for more than three months because of another problem with using antibiotics for acne: they are a temporary solution. P. acnes always live on your skin, and no antibiotic can kill them all. So once you stop taking the antibiotic, acne tends to come back. However, this is also likely to happen if you take the antibiotic for too long, because your bacteria will become increasingly resistant. If your dermatologist wants to prescribe you an antibiotic for more than three months, politely ask for just three months of treatment, and if you feel comfortable, tell them you are concerned about antibiotic resistance.

  1. Always use another form of acne treatment with antibiotics.

Using a combination of treatments can help prevent antibiotic-resistance, but it can also lead to clearer skin. Additional products that include ingredients like salicylic acid or green tea extract can treat inflammation and oil production, which helps reduce all kinds of acne when used in conjunction with antibiotics, including pimples and cysts. Using other products with ingredients that can kill p. acnes through different methods, like benzoyl peroxide or tea tree oil, can also help reduce the likelihood of antibiotic-resistance.

Generally, all acne can be improved when treated gently and consistently, so a simple skin care routine is one of the best additions to an antibiotic. We recommend the Basic Kit offered here at Exposed Skin Care. Our products include all of the ingredients listed above and more, and we guarantee that following our simple 3-step process will significantly reduce your acne. You may find that after the three months on the antibiotic end, our skin care routine is enough to keep your skin clear and healthy.

The Debate on Antibiotics for Acne
The best addition to an antibiotic for acne is a gentle skin care routine, like the 3-step process outlined in our Basic Kit.