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[General antibiotic therapy in acne]
1Clinique dermatologique Centre hospitalier universitaire Hôtel-Dieu, 44093 Nantes. bdreno@wanadoo.fr
Abstract:
The primary indication for systemic antibiotics is acute therapy for moderate-to-severe inflammatory acne. The preferred agents include tetracyclines and derivatives; macrolides, co-trimoxazole, and trimethoprim may represent acceptable alternatives. Antibiotics act mainly on inflammatory lesions (papules and pustules) and are only slightly comedolytic. Oral antibiotics reduce the number of Propionibacterium acnes. In addition, they have an anti-inflammatory activity. The side effects associated with oral antibiotics for acne depend on the drug; however, severe side effects are not common. Resistant strains of Propionibacterium acnes to antibiotics are increasing. Thus, general guidelines are useful when utilizing oral antibiotic therapy in acne.
Insights
Systemic antibiotics are key for moderate-to-severe inflammatory acne, targeting inflammatory lesions and Propionibacterium acnes. Guidelines are essential due to increasing antibiotic resistance.
Area of Science:
- Dermatology
- Microbiology
- Pharmacology
Context:
- Moderate-to-severe inflammatory acne requires systemic treatment.
- Antibiotic therapy is a primary treatment modality for inflammatory acne.
- Propionibacterium acnes plays a role in acne pathogenesis.
Purpose:
- To outline the role and considerations of systemic antibiotic therapy in managing acne vulgaris.
- To review preferred antibiotic agents, mechanisms of action, and potential alternatives.
- To highlight the emergence of antibiotic resistance and the need for treatment guidelines.
Summary:
- Systemic antibiotics, primarily tetracyclines, are indicated for moderate-to-severe inflammatory acne, targeting inflammatory lesions and reducing Propionibacterium acnes.
- Antibiotics offer anti-inflammatory effects and are effective against papules and pustules, with macrolides, co-trimoxazole, and trimethoprim as alternatives.
- While severe side effects are uncommon, increasing antibiotic resistance necessitates careful patient selection and adherence to general guidelines for oral antibiotic use in acne.
Impact:
- Informs clinical practice regarding appropriate systemic antibiotic selection and usage for acne.
- Highlights the growing challenge of antibiotic resistance in Propionibacterium acnes, emphasizing the need for judicious antibiotic stewardship.
- Underscores the importance of established guidelines to optimize therapeutic outcomes and minimize the development of resistance in acne management.