POSTED: 13 Dec 2023

What You Should Know About Treating Acne With Antibiotics

Acne is a common skin condition that affects millions of people all over the world. The physical signs of acne often cause significant emotional distress for a lot of sufferers. What also makes matters worse is that acne can be hard to treat even though there are a huge variety of medical and non medical treatments out there. One of the oldest but perhaps least well understood are antibiotic acne treatments. In this article we explore how antibiotics for acne treatment works, which are the best antibiotics for this and how to access these in the UK. We’ll also discuss risks, limitations and alternative acne treatments to antibiotics.

Which Types of Acne Can Antibiotics Treat?

This condition generally occurs when pores become clogged with excess oil and dead skin cells which in some cases leads to bacterial overgrowth and inflammation. Hormonal changes often drive it and certain medical conditions like Polycystic Ovarian Syndrome, pregnancy or menopause are common triggers. Acne is also very non discriminatory and affects all genders, skin tones and age groups (it’s not just teens). It’s important to understand there are actually a number of different types of acne and this plays a part in which treatments are best. At the most basic and simplistic level, you can group acne by whether it is inflammatory or not. This depends on the type of lesions present with non-inflammatory acne limited to comedones (blackheads and whiteheads) and inflammatory containing anything else (papules, pustules, cysts and nodules).

Antibiotics have long been a first-line treatment for acne in the UK. They are particularly effective in treating inflammatory acne types and work by reducing inflammation as well as targeting the bacteria responsible for acne. They are however less effective against non-inflammatory forms of acne like blackheads and whiteheads or more severe inflammatory lesions like cysts and nodules.

How Do Acne Antibiotic Treatments Work?

Antibiotics tackle acne in two key ways. They reduce inflammation and also curb the growth of Propionibacterium acnes (P. acnes) bacteria. Both these processes are significant in inflammatory acne. They work by entering the sebaceous (oil) glands of the skin and lower the number and the activity of P. acnes. This in turn suppresses inflammation. Overall, the effect is to reduce the severity of acne breakouts.

It’s important to note that antibiotics won’t work for all types of acne. Nor will they help with acne sequelae like hyperpigmentation or scars. They are more effective for treating inflammatory types of acne rather than blackheads and whiteheads. Whilst antibiotics can help reduce the redness and swelling associated with more severe forms of acne such as nodules and cysts, there effects are more impressive on moderate lesions such as papules and pustules. It’s also worth knowing that antibiotics for acne treatment should be part of a broader treatment plan. This normally includes other acne medicines, over the counter skincare treatments and lifestyle modifications. These work together to address the multifaceted nature of acne and provide long-lasting results. It also ensures that there is an exit plan and maintenance as antibiotics are not suitable for long-term use.

The Types of Antibiotics Used for Acne Treatment

Both oral and topical antibiotics are widely prescribed for acne. Which type your doctor gives you will depend on the type of acne you have, severity and the latest antibiotic guidelines. In the UK, acne treatment with antibiotics follows specific guidelines. These take into account effectiveness and safety profiles. Below are the most common antibiotics for acne in the UK (and a lot of other countries):

  • Topical Antibiotics: You apply these directly to the skin usually as a cream. Topical antibiotics are effective for mild to moderate acne. They target surface bacteria and reduce inflammation. In the UK, Clindamycin and Erythromycin are two of the most commonly prescribed topical antibiotic treatments for acne. They both have strong anti-inflammatory action and often found in combination treatments such as with benzoyl peroxide or retinoids (e.g. Tretinoin or Adapalene). This enhances their efficacy and reduces antibiotic resistance. They’re both also suitable for a wide range of patients and potentially safe to use during pregnancy.
  • Oral Antibiotics: These are the preference for more severe, persistent or widespread acne. They work systemically to fight bacteria and inflammation. In the UK, the most common oral antibiotics prescribed for acne are Tretracyclines, Macrolides and Treimethoprim. Tetracyclines (e.g. Doxycycline, Lymecycline, Minocycline) are the first-line oral antibiotics for acne treatment in the UK due to their effectiveness in reducing inflammation and bacterial activity. They are not suitable for children under 12 or pregnant women. Macrolides (e.g. Erythromycin, Azithromycin) are used as an alternative when tetracyclines are contraindicated for example in younger patients and during pregnancy. Whilst far less common, Trimethoprim is usually set aside as an alternative for patients who cannot tolerate other antibiotics.

When to Consider Antibiotics

Antibiotics are often used for moderate to severe acne, especially when there’s a risk of scarring or significant psychological impact. Throughout the world, you will need to see a healthcare professional who will decide whether antibiotics are appropriate. Which type of professional will depend on each individual country’s regulations. In the UK, antibiotics are usually prescribed by general practitioners (GPs) as one of the first-line medical treatments before considering referral to a dermatologist. However they may refer to a Dermatologist straight away if there is very severe acne.

The type of antibiotics that your healthcare provider will prescribe also depends on your country’s antibiotics regulations and availability. In the UK, the National Institute for Health and Care Excellence (NICE) and the British Association of Dermatologists provide guidelines for which antibiotics should be used to treat acne and when to prescribe them. This ensures that there is a standardised level of care across the country. The UK and other countries also put strict rules in place for prescribing antibiotics for acne in order to reduce the risk of antibiotic resistance. These include:

  • Limiting the duration of antibiotic courses.
  • Avoiding the use of antibiotics as the only treatment.
  • Regular review and monitoring of treatment effectiveness by prescriber.

How Long Do They Take to Work & What’s The Treatment Duration?

When it comes to treating acne with antibiotics, the time frame for seeing results and the duration of treatment can vary from person to person. This depends on the cause and severity of your acne as well as your own body’s response to medication. Whether you’re using any other treatment alongside acne, diet and lifestyle as well as your existing skincare routine also matter.

For topical antibiotics, you may start to notice improvements within 4 to 6 weeks. These treatments work directly on the skin, targeting inflammation and bacteria at the source. Oral antibiotics, which act systemically, may take slightly longer to show effects. This may be around 6 to 8 weeks. This delay is due to the time required for the medication to build up in the system and start affecting the skin condition.

How long you will need to use antibiotic treatment for acne also varies. However, for most people the treatment duration is usually 3 to 6 months. There’s a balance between stopping too early or going on for too long. If you’re lucky enough to see improvement quickly, then your doctor may still continue the treatment a little linger to reduce the risk of the acne returning straight away once you’ve stopped. However, your doctor is unlikely to what to continue beyond 6 months even if you haven’t seen results as the risk of antibiotic resistance developing increases. If this happens, it can make your acne even harder to treat in future.

Potential Side Effects & Risks

Although antibiotics are generally a safe treatment for acne, there are potential side effects that you should carefully consider and discuss with your doctor before starting treatment. Common side effects include stomach upset, dizziness and increased sensitivity to sunlight. There’s also the possibility of allergic reaction and the serious risk of antibiotic resistance.

To reduce the chance of adverse events, your healthcare provider will take a careful approach and only prescribe these for you if they think its appropriate. You will also need regular monitoring so they can adjust the treatment plan based on how your skin responds. Depending on your progress, they might change the antibiotic type or add other acne treatments, such as topical retinoids or benzoyl peroxide.

Long-term Management

The long-term use of antibiotics for acne is heavily discouraged. This is due to concerns about antibiotic resistance, risk of serious side effects including heart and liver disease. The aim is to use antibiotics for the shortest period necessary to achieve the desired results but avoid suboptimal treatment or recurrence. Then you will need to maintain these results with safer acne treatments.

Luckily, there are a number of treatments that can help build on your results, prevent new breakouts and maintain clear skin. These include over the counter skincare ingredients like benzoyl peroxide, salicylic acid and retinol or retinal. Your doctor may also consider prescription retinoids such as Tretinoin or Adapalene. Hormonal treatments like oral contraceptives or anti-androgens like spironolactone might also be used either alongside the antibiotics or if the treatment didn’t work. Lifestyle modifications also play a crucial role in long-term acne management. This includes adopting a skin-friendly diet and reducing stress which can all worsen acne.

Alternatives to Antibiotics

Although antibiotics can be an effective treatment for acne, they won’t work for everyone. They’re also not a risk-free treatment given the risks of antibiotic resistance and potential side effects. One important point is that antibiotics will also not treat post inflammatory hyperpigmentation or acne scars. These are some safe and effective medical treatments for acne:

  1. Topical Retinoids: Prescription retinoids like Tretinoin, Adapalene, and Tazarotene exfoliate the skin, prevent clogged pores and reduce inflammation. They are effective for both inflammatory and non-inflammatory acne. Retinoids can also help help fade hyperpigmentation and treat acne scars. As a bonus, they also help treat skin ageing.
  2. Hormonal Treatments: Oral contraceptives or anti-androgen medications can be effective in treating acne caused by hormonal imbalance such as menopausal or teen acne.
  3. Light and laser Therapies: LED devices and laser treatments can reduce oil production and kill bacteria which may lead to improvements in acne breakouts and overall skin appearance.
  4. Chemical peel: Certain types of peels can exfoliate the skin and unclog pores to reduce breakouts. They can also help even out skin tone and smooth texture. .
  5. Isotretinoin: For severe and/or persistent acne that isn’t responding to antibiotics and other treatments, your doctor may also consider oral Isotretinoin treatment. It’s very effective but requires close monitoring due to its potential for significant side effects.

Antibiotics have a long-standing record in helping treat certain types of acne when used properly. However, their use must be carefully balanced against the risk of antibiotic resistance and potential side-effects. If you’re struggling with acne have a through consultation with a dermatologist or other doctor experienced in treating this condition. They will advise you on whether antibiotics are appropriate for you and which ones would be suit your needs. They will also discuss alternative treatments and if any of these would help you. Remember that patience and persistence are key. Regardless of treatment, the journey to clear skin is a long one often strewn with trial and error. In addition, the best way to manage acne in the long-term acne is usually a combination of effective treatments, targeted skincare and lifestyle changes.

At City Skin Clinic, we are beyond passionate about individualisation and personalised skincare. Through our online skin clinic, we offer safe and effective treatments with prescription-strength ingredients like Tretinoin and Hydroquinone. Our doctors treat a range of skin conditions including  acnehyperpigmentationmelasma and skin ageing. To start your personalised skincare plan, book a virtual video consultation or use our online consultation form. The journey towards great skin starts here.

Authored by:

Dr Amel Ibrahim
Aesthetic Doctor & Medical Director
Founder City Skin Clinic
Member of the Royal College of Surgeons of England
Associate Member of British Association of Body Sculpting GMC Registered - 7049611

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