Antibiotics applied to the skin may be prescribed for the treatment of acne.
Antibiotics help control acne by killing the bacteria that cause the acne lesions to become inflamed. The sebum (oil) within the hair follicles can become infected by p. acnes bacteria, resulting in swelling and redness of the acne lesion. Killing the bacteria reduces the inflammation and reduces the severity of the acne flare.
Unfortunately, the p. acnes bacteria that can develop resistance to antibiotics. When this occurs, that particular antibiotic is no longer effective in treating acne. If antibiotic resistance is suspected, a different antibiotic or different type of acne medication may be prescribed.
Antibiotic resistance is more likely to develop following the use of a topical antibiotic. The risk of developing resistance increases if a topical antibiotic is used for long periods, and without any other acne treatments. For this reason, topical antibiotics are usually prescribed for just a few weeks or months, and used in combination with other acne medications. Oral antibiotics, on the other hand, may be prescribed for longer periods of time.
Types of Topical Antibiotics Used for Acne
- Azelaic acid (Azelex®). In addition to killing p. acnes, azelaic acid can be helpful for treating the dark spots that develop in some acne patients with skin of color (post-inflammatory hyperpigmentation). Azeleic acid is well tolerated by most people and can be safely used for long periods of time. Side effects may include skin dryness and lightening of the skin where applied.
- Benzoyl peroxide. Benzoyl peroxide is not typically thought of as an antibiotic, but it can help to slow down the growth of the P. acnes bacteria. Studies have also shown that benzoyl peroxide can increase the effectiveness of other acne medicines and reduces the likelihood of developing antibiotic resistance. However, benzoyl peroxide does not have anti-inflammatory effects. Benzoyl peroxide formulations included lotions, gels and washes. It may be prescribed for use alone or in combination with a topical retinoid (Epiduo®).
- Clindamycin. Topical clindamycin reduces p. acnes bacteria and decreases inflammation. Several branded formulations combine clindamycin with other acne medications, including benzoyl peroxide (Acanya®, Benzaclin®, Duac®) or a topical retinoid (Ziana®). When applied to the skin, clindamycin has proven safe and is well tolerated. Possible side effects include skin dryness and irritation.
- Erythromycin. Erythromycin, also available for oral use, is broad spectrum antibiotic with anti-inflammatory properties. It may be combined with benzoyl peroxide (Benzamycin®). Like topical clindamycin, erythromycin may cause skin dryness and possible irritation.
Take your acne medication exactly as directed by your doctor. Do not take more or less of it or take it more often than prescribed.
Read the medication guide that you receive with the medication for a complete list of possible side effects.