Can antibiotics replace skincare to treat acne?


Can antibiotics replace skincare to treat acne?

By Professor Des Fernandes and Dr Ernst Eiselen

How do you deal with clients who say that they would rather treat acne with antibiotics than follow your prescribed routine of diet, skin care and supplements? It’s always easier to pop a pill than to change your lifestyle – cheaper too. 

According to Professor Des Fernandes:

“The important thing is that antibiotics only treat a symptom, they don’t treat the basic problems leading up to sebaceous gland dysfunction. That’s why antibiotics should always be seen only as a reprieve to control infection while the strategic measures taken to normalise the sebaceous gland get to work.

I have seen many people ignore my advice and I believe, in the beginning, when I was using Vitamin A creams rather than oils on acne, the acne did get worse in many cases and that no doubt disillusioned people. The oils, I now know, are far better for controlling acne. The fact is acne sufferers need the normalising effect of Vitamin A and anything they do that clears up the acne, if it does not include Vitamin A, will only see the problem return. 

Dr Ernst Eiselen has a similar take on the problem:

The only molecule that can help acne resolve to clear skin is Vitamin A

Just as the correct diet is the most important factor for the treatment of diabetes, so the use of vitamin A forms the basis of treatment for all types of acne. Sine qua non, requisite - essential. 

If one leaves out the vitamin A, any other treatment can only treat symptoms and may provide very temporary relief or clearance of acne lesions. This is why one of the most potent systemic treatments, if not the most potent is a molecule called isotretinoin, which in fact, is an acid form of vitamin A.

Acne is usually best treated by the combination of different treatments rather than a single treatment type. Antibiotic by mouth may have an important role to reduce inflammation and help the topical vitamin A treatments to work more quickly or more effectively.

No one should reasonably expect a good long-term result without using sufficient vitamin A, either topically in less serious cases, or topically and systemically in more serious cases. It is important to note that acne is a condition which results because of over-sensitivity to some of the male gender hormones which are, of course, present in both males and females. It is thus important to regard skin that has cleared up from acne, not as being cured, but as being in remission.

Once acne that has been successfully treated, it may return at times when there are changes in the levels of hormones. Acne in remission often returns for instance during pregnancy, and menopause in women, and when men are treated for a lack of testosterone by supplementing this hormone. Many women experience “breakouts” with the hormone changes that go with every menstrual cycle.

Maintaining the remission of Acne is best done by using highly active topical products. In someone with a history of acne this should be a permanent habit of care.”  

A summary of the advice above would be ­– get the acne under control, but do not neglect home care and treatments. Without Vitamin A the acne will return, and you cannot live on antibiotics.

Cardiff University

Online research @ Cardiff University completed a study on the effects of long-term antibiotic use on acne. This is a summary of their recommendations:

Topical antibiotics used to treat mild-to-moderate acne should be limited in duration or avoided. Ideally, BPO combined with a topical retinoid should be used instead of a topical antibiotic to stop their use in acne and minimise the impact of resistance. Topical antibiotics should not be used as monotherapy. Topical and oral antibiotics should never be used concurrently. Oral antibiotics still have a role in the treatment of moderate-to-severe acne, but only in combination with a topical retinoid, BPO, or a fixed-dose topical retinoid and BPO combination, and ideally for no longer than 3 months. To limit antibiotic resistance, BPO should always be added when long-term oral antibiotic use is necessary. Acne improvement can be maintained with topical retinoids or a topical retinoid and BPO combination.

You can download the rest of the study here or email and request a copy.

Ref: Walsh, Timothy R., Efthimiou, John and Dréno, Brigitte 2016. Systematic review of antibiotic resistance in acne: an increasing topical and oral threat. The Lancet Infectious Diseases 16 (3) , e23- e33. 10.1016/S1473-3099(15)00527-7 file