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Alternatives to Antibiotics When Treating Acne

Many people are familiar with antibiotics. They’re used to treat infections, acne, and other inflammatory skin diseases. Nonmedical uses of antibiotics are seen in agriculture and water systems, as well as in domestic products such as soaps.[1] With the widespread use of antibiotics, one has to wonder—what are the ramifications?

 

Potential Consequences of Antibiotic Use

There is a growing understanding that antibiotics must be used with caution. With the rapid emergence of antibiotic-resistant strains of bacteria, the ultimate concern is that the drugs that we currently have will no longer be able to fight off infections.

Another major concern of antibiotic use is the depletion of the healthy bacteria that commonly live in and on the human body, known as the human microbiota. These good bacteria function to prevent the growth of more dangerous bacteria that can cause disease—thus, depletion and alteration of these with antibiotics could lead to impairment in immunity and certain infections. Many studies have been conducted to evaluate the effects of antibiotics on the gut microbiome, and further research is necessary to continue to understand all the complex interactions and possible implications.

 

Effects of Antibiotics on the Skin Microbiota

Antibiotics are a mainstay treatment of many dermatologic skin diseases, especially in the treatment of acne. However, the downside is that treatment with antibiotics kills bacteria, including healthy bacteria, leading to an imbalance in the normal skin microbiota. Many dermatological diseases are now suspected to be associated with a disruption in the skin microbiota, including:

  • Acne
  • Psoriasis
  • Atopic dermatitis (eczema)
  • Rosacea[2]

The story with acne and bacteria

It has been known that skin bacteria, most notably Cutibacterium acnes (previously known as Propionibacterium acnes), is involved in the acne disease process. A causal relationship has always been suspected but is difficult to totally blame C. acnes since it is also found on the skin of people without acne.

In fact, a recent study found that there was a greater abundance of C. acnes on healthy skin, suggesting that it might even play a protective role in acne. They postulated that C. acnes produces an antimicrobial substance that provides benefits to the skin and suggested that the development of acne is due to an imbalance of the normal skin bacteria, rather than the presence of “bad” bacteria.[3] Another study even went a step further to suggest that it might be that people with acne have the wrong type of C. acnes bacteria.[4] 

So it seems that while bacteria may have a role in acne, it is not a simple story. While antibiotics may be an option, there is clearly more to the story of how bacteria may affect acne. Also, dermatologists use antibiotics in acne because it has anti-inflammatory actions apart from the antibiotic effects.

 

Alternative Treatments for Acne

There are several approaches that are taken by dermatologists to reduce antibiotic exposure (Table 1).

Table 1. Alternatives to antibiotics in acne

Alternative Approach

Reason

Low Dose of Antibiotic

Reduces Inflammation

Use benzoyl peroxide

Reduce bacterial resistance

Hormonal therapies

Block hormone activity

Isotretinoin (Accutane)

Can permanently improve acne

Lower dose of antibiotic

One way to minimize the effects on the microbiome is by using lower doses of antibiotics. At lower doses, antibiotics work to treat skin conditions based on their anti-inflammatory activity, not their antibiotic activity. These lower doses are considered, “sub-antimicrobial” doses. To reduce antibiotic resistance, it is important that doctors reserve oral antibiotics only for the correct patients who can benefit from them the most, and limit the duration of time that they are used. 

Combine with benzoyl peroxide

For topical antibiotics, combining them with topical benzoyl peroxide (which kills bacteria by a different mechanism) can help reduce the risk of antibiotic resistance.

Hormonal therapies

Hormonal therapies such as oral contraceptives and spironolactone can also be used to treat acne in women, which can minimize the need for antibiotics in people who have hormonally-mediated acne.[5] Weight loss and stress reduction may also help reduce acne.

Isotretinoin (previously known as Accutane)

Isotretinoin is a vitamin A derivative that is commonly used to treat moderate to severe acne. It is thought to work mainly by reducing sebum (oil) production and keratinocyte (skin cell) production and maturation. A 2017 study found that isotretinoin reduced the number of the acne-associated bacteria C. acnes in moderate to severe acne—even the ones resistant to antibiotic treatment. They demonstrated that this reduction was only present on the patients’ cheek, and not in the nose or toe web, indicating that isotretinoin could have different effects on the skin microbiome, depending on the location.[6]

As we learn more about the human microbiome, we can begin to understand how it can be altered with treatment or disease. To this day, we are still learning about the effects of antibiotic treatment, and the role that it plays in skin health.

* This Website is for general skin beauty, wellness, and health information only. This Website is not to be used as a substitute for medical advice, diagnosis or treatment of any health condition or problem. The information provided on this Website should never be used to disregard, delay, or refuse treatment or advice from a physician or a qualified health provider.

References

  1. Meek RW, Vyas H, Piddock LJ. Nonmedical Uses of Antibiotics: Time to Restrict Their Use? PLoS Biol.2015;13(10):e1002266; PMID: 26444324 Link to research.
  2. Gallo RL, Nakatsuji T. Microbial symbiosis with the innate immune defense system of the skin. J Invest Dermatol.2011;131(10):1974-1980; PMID: 21697881 Link to research.
  3. Barnard E, Shi B, Kang D, et al. The balance of metagenomic elements shapes the skin microbiome in acne and health. Sci Rep.2016;6:39491; PMID: 28000755 Link to research.
  4. Fitz-Gibbon S, Tomida S, Chiu BH, et al. Propionibacterium acnes strain populations in the human skin microbiome associated with acne. J Invest Dermatol.2013;133(9):2152-2160; PMID: 23337890 Link to research.
  5. Barros B, Thiboutot D. Hormonal therapies for acne. Clin Dermatol.2017;35(2):168-172; PMID: 28274354 Link to research.
  6. Ryan-Kewley AE, Williams DR, Hepburn N, et al. Non-antibiotic Isotretinoin Treatment Differentially Controls Propionibacterium acnes on Skin of Acne Patients. Front Microbiol.2017;8:1381; PMID: 28790988 Link to research.
MakeupMicrobiomeTCMDiagnosis and DetailsReproductive HealthDevicesSkin MicrobiomePsoriasisFoodVitamins and SupplementsNaturopathy BasicsHerbal ExtractsAyurvedaSun CareClimateMineralsWestern BasicsStress Effects on SkinIngredientsHairAnti-AgingRosaceaPerspectivesPregnancyGut MicrobiomeVitamin DDietProduct InfoNutritionHealthy AgingWesternProbiotics and PrebioticsExerciseHolistic TherapiesFitnessMental HealthOTC ProductsInfectionsAcneBeautyNailsYogaOmega-3 Rich FoodsEnvironmentMindfulnessAyurveda BasicsSexual HealthSunscreenAlopeciaBeauty SmartsAtopic DermatitisMassageIngredient ScienceMedicationsProceduresStressNatural ProductsNaturopathyCosmetics and ProceduresAntioxidantsHerbs and BotanicalsNatural IngredientsStress ReductionSun SmartsAcupunctureSkin FoodsAntioxidant FoodsBiopsyWater QualityVitaminsVirusesFinding Personal HarmonyIntegrative ApproachMushrooms and FungiSkin Barrier ProtectionEye CareAestheticsBiological TreatmentBody CareChemistryClaysCosmeticsEpigeneticsSkin DiscolorationSkin BasicsAntioxidants for SkinChemical Effects on the SkinVaginal HealthAsian Skin CareBody OilCancerVitamin AThe Microbiome in EczemaSkin Type ProfileSkin Care for MenSkin CancerSuperfoodsSkin in PregnancyFood SensitivityGlycemic IndexHair Loss CausesSexually Transmitted DiseaseSkin Affects PsychologyAlternatives to AntibioticsAutoimmuneAyurvedic Medical ApproachesBasal Cell CarcinomaBiologicsBleach BathsBody ContouringVitiligoVegan Skin CareQuality of LifeHarmful Effects of UV LightAyurvedic DoshasAyurvedic PractitionersBlue Light EffectsBotulinum ToxinWrinklesComplementary and Alternative MedicineUV LightUltraviolet Light Based TreatmentEffects of AgingEssential OilsFiber IntakeSkin BlistersDiagnosisHair HealthActive LifestyleApps and ToolsVitamin CSquamous Cell Skin CancerSkin DetoxSkin Aging and Fine LinesTeaFoods for Skin CareEffects of DairySkingredientsHair and NailsAccess To CareAlcoholAvocadoBaby Skin CareBacteria and ParasitesBathingEnvironmental Effects on SkinFacial MasksSkin of ColorSkin Gut ConnectionSkin DNA ChangesLifestyle Tips for AcneCleansersAutoimmune Skin DiseaseBalneotherapyBathBeneficial Effects of GroomingBiological AgentsClothingCuppingSystemic Medications for PsoraisisNatural Oils for the SkinHealthy Sun HabitsSkin CareHidradenitis SuppurativaBiological MedicationsBotoxChakras and the SkinSweating More Than UsualFastingUsing SunscreenPhytochemicalsAllergiesBotulinum Toxin for CosmeticsAntibiotic UseBathing with Dry SkinBlistering DiseaseCastorYoga For Skin HealthYellow NailsTraditional Chinese Medicine ApproachesThe Benefits of PetsSportsSkin Signs of Internal DiseaseSensitive SkinExfoliatorsNon-Surgical Cosmetic ProceduresActinic KeratosesAgingBehavioral HealthChemotherapyChinese Medicine BasicsWound HealingCircadian RhythmUsing Steroids SafelyThe Power of SleepTanningSpironolactoneSkin LighteningShavingWellnessSun ProtectionKeratosis PilarisSkin IrritationFemale Sexual HealthAntibiotic Use for More Than InfectionsBacterial BiofilmsBarber ShopsBodyWeight LossWartsDry ScalpFat ReductionMelanoma Skin CancerOxidative StressSugar Effects on SkinBleachBotulinum Toxin for Medical PurposesCalciumWorld Influences on Skin CareCosmetic ProceduresThe Skin We're InSunburnMind Skin ConnectionHealthy FoodsAlternative Approaches for EczemaHealthy HygieneMoisturizersChoosing A SunscreenNatural Skin CareCosmetic CornerAyurvedic ApproachesBeta GlucanBiomedicineCelluliteChemicals Used in Skin ProductsDry SkinTechnology for Your SkinExercise and Physical ActivityEyelash CareSkin TipsSafety of IngredientsDiet Effects on SkinAntiperspirantAromatherapyBacteria, Fungi and ParasitesDrug ReactionsSkin BiopsyScar TreatmentsEczemaSupplementsMale Sexual HealthBasal Cell Skin CancerBeneficial Effects of OatsWoundFacialsSkin ProcedureResearch SpotlightProduct LabelsHair GrowthOily SkinHome DevicesNail SalonsChinese MedicineInfo on Product LabelsIntegrative MedicineNutraceuticalsNaturopathic MedicineGreen TeaOmega-3OpinionNaturopathic ApproachesGenetics of SkinAyurvedic MedicineNicotinamideNail BeautyHealthy BathingRetinoidsSafe SexRadiation TherapyLights and LasersSexualityPower of Social MediaIsotretinoin AccutaneIntense Pulsed LightHyperhidrosisHoney Health for SkinNiacinamideMedication TipsLifestylepH of the SkinPollution Effects on SkinMelasmaMediterranean DietHerbal CareLaser TreatmentsMeditationHair ReductionInsects and ParasitesNanoparticlesItchingNail CareMedications That Suppress the Immune SystemHow to Read Product LabelsCosmeceuticalsInjectablesInfections of the SkinSkinPaleo DietFit Living is Healthy SkinHealthy Living is Healthy SkinMind and BodyLifestyle Tips for EczemaHomeopathyHair CareNail HealthHormone Effects on the SkinChemicalsMore Than Skin DeepGrainsModern MedicineDermatologistHow Stuff WorksBack to BasicsHair OilsSoap AlternativesSkin Physics SpotlightHair SupplementsFoods for Hair HealthHair LossPlant Based DietMedicineIntegrative Approach to SkinCOVID-19Eye and Oral CareFacial CareEye MicrobiomeNonmelanoma Skin CancerViruses and BacteriaMedicine BasicsHealthy DrinksGut HealthDry ShampoosStress and MindfulnessEstheticians