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 makes matters worse is that acne can be hard to treat, even though there is a huge variety of medical and non-medical treatments out there. One of the oldest treatments, yet perhaps the least understood, is the use of antibiotics. In this guide, we explore how antibiotic acne treatments work, which are the best antibiotics for the job and how to access these in the UK. We also discuss the risks, the limitations and the alternatives to antibiotics.
Which Types of Acne Can Antibiotics Treat?
This condition generally occurs when pores become clogged with excess oil and dead skin cells. In some cases, this leads to bacterial overgrowth and inflammation. Hormonal changes often drive it, and certain medical conditions like polycystic ovary syndrome (PCOS), 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 that there are actually a number of different types of acne. This plays a part in which treatments are best. At the most basic level, you can group acne by whether it is inflammatory or not. This depends on the type of lesions present. Non-inflammatory acne is limited to comedones (blackheads and whiteheads), whilst inflammatory acne contains everything else (papules, pustules, cysts and nodules).
Antibiotics have long been a first-line treatment for acne in the UK. They are particularly effective for treating inflammatory acne types. They work by reducing inflammation and targeting the bacteria responsible for acne. However, they are less effective against non-inflammatory forms like blackheads and whiteheads, or more severe lesions like cysts and nodules.
How Do Acne Antibiotic Treatments Work?
Antibiotics tackle acne in two key ways. They reduce inflammation, and they also curb the growth of Cutibacterium acnes (C. acnes, formerly known as Propionibacterium acnes) bacteria. Both these processes are significant in inflammatory acne. Antibiotics work by entering the sebaceous (oil) glands of the skin and lowering the number and activity of C. acnes. This in turn suppresses inflammation. Overall, the effect is to reduce the severity of acne breakouts.
It’s important to note that antibiotics will not work for all types of acne. Nor will they help with what acne can leave behind, like hyperpigmentation or scars. They are more effective for inflammatory types of acne than for blackheads and whiteheads. Antibiotics can help reduce the redness and swelling of more severe forms like nodules and cysts. However, their effects are more impressive on moderate lesions such as papules and pustules. It’s also worth knowing that antibiotics for acne should be part of a broader treatment plan. This normally includes other acne medicines, over-the-counter skincare and lifestyle changes. These work together to address the many sides of acne and provide long-lasting results. It also ensures there is an exit plan and maintenance, since antibiotics are not suitable for long-term use.
The Types of Antibiotics Used for Acne Treatment
Doctors widely prescribe both oral and topical antibiotics for acne. The type your doctor gives you depends on your acne type, its severity and the latest guidelines. In the UK, acne treatment with antibiotics follows specific guidelines, which 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. They are effective for mild to moderate acne, and they target surface bacteria and reduce inflammation. In the UK, clindamycin and erythromycin are two of the most commonly prescribed topical antibiotics for acne. They both have strong anti-inflammatory action. They are often found in combination treatments such as with benzoyl peroxide or retinoids (for example tretinoin or adapalene). This boosts their effect and reduces antibiotic resistance. They are 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 through the body to fight bacteria and inflammation. In the UK, the most common oral antibiotics prescribed for acne are tetracyclines, macrolides and trimethoprim. Tetracyclines (for example doxycycline, lymecycline and minocycline) are the first-line oral antibiotics for acne in the UK. This is because they are effective at reducing inflammation and bacterial activity. They are not suitable for children under 12 or pregnant women. Macrolides (for example erythromycin and azithromycin) are an alternative when tetracyclines are unsuitable, such as in younger patients or during pregnancy. Whilst far less common, trimethoprim is usually set aside as an alternative for patients who cannot tolerate other antibiotics.
| Topical antibiotics | Oral antibiotics | |
|---|---|---|
| Examples | clindamycin, erythromycin | doxycycline, lymecycline, minocycline |
| Best for | mild to moderate acne | moderate to severe or widespread acne |
| How they work | target surface bacteria and inflammation | work through the body to fight bacteria and inflammation |
| Time to work | 4 to 6 weeks | 6 to 8 weeks |
| Typical course | always paired with benzoyl peroxide or a retinoid | 3 to 6 months, never as the only treatment |
When to Consider Antibiotics
Antibiotics are often used for moderate to severe acne, especially when there is a risk of scarring or psychological impact. Throughout the world, you will need to see a healthcare professional who will decide whether antibiotics are appropriate. Which type of professional this is will depend on each individual country’s regulations. In the UK, general practitioners (GPs) usually prescribe antibiotics as a first-line treatment before referral to a dermatologist. However, they may refer to a dermatologist straight away if the acne is very severe.
The type of antibiotics your healthcare provider prescribes also depends on your country’s regulations and availability. In the UK, the National Institute for Health and Care Excellence (NICE) and the British Association of Dermatologists provide guidelines for acne antibiotics. These cover which to use and when to prescribe them. This ensures a standardised level of care across the country. The UK and other countries also put strict rules in place 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 the prescriber.
How Long Do They Take to Work & What’s the Treatment Duration?
With antibiotics, both the time to see results and the length of treatment vary from person to person. This depends on the cause and severity of your acne, as well as your own body’s response to the medication. Other treatments, your diet and lifestyle and 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 through the body, may take slightly longer to show effects, often around 6 to 8 weeks. This delay is because the medication needs time to build up in the body and start affecting the skin.
How long you will need antibiotic treatment for acne also varies. However, for most people, the duration is usually 3 to 6 months. There is a balance between stopping too early or going on for too long. If you are lucky enough to see improvement quickly, your doctor may still continue the treatment a little longer. This reduces the risk of the acne returning as soon as you stop. However, your doctor is unlikely to want to continue beyond 6 months, even if you have not seen results. This is because the risk of antibiotic resistance increases over time. That can make your acne even harder to treat in future.
Potential Side Effects & Risks
Although antibiotics are generally a safe treatment for acne, they do have potential side effects. You should carefully consider these, and discuss them with your doctor before starting. Common side effects include stomach upset, dizziness and increased sensitivity to sunlight. There is also the possibility of an allergic reaction, and the serious risk of antibiotic resistance.
To reduce the chance of adverse events, your healthcare provider will take a careful approach. They will only prescribe these for you if they think it is 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 or add other treatments, such as topical Retinoids or benzoyl peroxide.
Long-term Management
Doctors heavily discourage the long-term use of antibiotics for acne. This is because of concerns about antibiotic resistance and the risk of serious side effects, including heart and liver disease. The aim is to use antibiotics for the shortest time needed to get results, whilst avoiding under-treatment or recurrence. After that, you will need to maintain these results with safer acne treatments.
Luckily, a number of treatments 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 help. Doctors use these either alongside the antibiotics or if the treatment did not work. Lifestyle changes also play a crucial role in long-term acne management. This includes a skin-friendly diet and reducing stress, both of which can worsen acne.
Alternatives to Antibiotics
Although antibiotics can be an effective treatment for acne, they will not work for everyone. They are also not a risk-free treatment, given the risks of antibiotic resistance and potential side effects. One important point is that antibiotics will not treat post-inflammatory hyperpigmentation or acne scars. Here are some safe and effective medical treatments for acne:
- 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 fade hyperpigmentation and treat acne scars. As a bonus, they also help treat skin ageing.
- Hormonal treatments: oral contraceptives or anti-androgens can help acne caused by a hormonal imbalance, such as menopausal or teen acne.
- Light and laser therapies: LED devices and laser treatments can reduce oil production and kill bacteria, which may improve breakouts and overall skin appearance.
- Chemical peels: 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.
- Isotretinoin: for severe or persistent acne that has not responded to antibiotics and other treatments, your doctor may consider oral isotretinoin. It is very effective but requires close monitoring, because of 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 are struggling with acne, have a thorough consultation with a dermatologist or other doctor experienced in treating it. They will advise you on whether antibiotics are appropriate for you, and which ones would suit your needs. They will also discuss alternative treatments and whether any of these would help you. Remember that patience and persistence are key. Whatever the treatment, the journey to clear skin is a long one, often strewn with trial and error. In addition, the best long-term approach is usually a combination of effective treatments, targeted skincare and lifestyle changes.
At City Skin Clinic, we are passionate about personalised skincare. Our doctors offer safe and effective custom treatments using ingredients like tretinoin, clindamycin, azelaic acid and spironolactone where appropriate, through our online clinic. Our doctors treat acne, hyperpigmentation, melasma, rosacea and skin ageing through bespoke compounded treatments designed around you. To start your personalised plan, book a virtual video consultation or use our online consultation form. The journey towards great skin starts here.
This article is intended for general informational purposes only and is not a substitute for medical advice, diagnosis or treatment. Always consult a qualified medical provider for any health concerns or questions you might have.
