Washington DC [USA], Apr 25 : As people become more aware of the overuse of antibiotics, doctors are turning to antibiotics alternatives to heal acne, a study has revealed.
The findings, published in the journal Dermatologic Clinics, surveyed studies on acute and long-term acne treatments over the past decade to identify trends.
"People are more conscious about the global health concern posed by the overuse of antibiotics and that acne is an inflammatory, not infectious, condition. Overuse of antibiotics can also promote the growth of resistant bacteria, which can make treating acne more challenging," said Hilary Baldwin, a researcher.
Prolonged use of antibiotics can affect the microbiome (trillions of bacteria, viruses and fungi that inhabit our bodies) in areas other than the skin, resulting in diseases.
The report noted that people who use topical and oral antibiotics were three times as likely to show an increase of bacteria in the back of their throat and tonsils compared with non-users.
Long-term use of antibiotics in acne treatment is also associated with an increase in upper respiratory infections and skin bacteria and was shown to affect a user's blood-sugar level.
However, doctors are increasingly exploring combinations of therapies instead of antibiotics for long-term treatment. Baldwin said there is renewed interest in the antibacterial medication benzoyl peroxide that often is used in combination with topical retinoids, which are medicines derived from vitamin A. One benefit is that benzoyl peroxide, which kills the acne-causing bacteria, helps the skin shed more effectively, reduces clogged pores and does not promote resistant acne-inducing bacteria strains.
Although acne is common in teens, it can continue into adulthood, affecting mainly women. The report noted that about 50 per cent of women in their 20s, one-third in their 30s and one-quarter in their 40s suffer from the condition.
The oral medication spironolactone is particularly effective in women. Although this medication, which is typically prescribed for high blood pressure, heart failure and swelling, is not FDA-approved for acne treatment, it is commonly used for disorders related to androgens, a group of sex steroid hormones.
Since hormone imbalance can trigger acne, doctors are looking to hormonal therapies, which target androgens in the development of acne and have been shown to be effective, safe and require little continual monitoring.
The researchers said laser and light therapies and regulating diet also show promise as non-antibiotic alternatives, but more research is needed.
"Our patients often ask about the role diet plays in acne development, but that remains unclear. However, there is some evidence that casein and whey in dairy may promote clogged pores and low levels of omega-3 polyunsaturated fatty acids in foods such as fish contribute to inflammation that can lead to acne," said Baldwin.
In severe acne, early intervention with the retinoid isotretinoin is effective without antibiotics. "This oral medication is unique among acne therapies in that it has the potential to not just treat acne but to eradicate it. It is 80 per cent effective if a complete course is taken. Studies also have disproven internet theories that the medication increases the risk of depression, ulcerative colitis and Crohn's disease," said co-author Justin Marson.
However, the researchers noted, antibiotics remain highly effective for moderate to severe cases of inflammatory acne and are approved by the FDA as a supplement to other treatments such as benzoyl peroxide or a topical retinoid.
"Numerous studies have shown that these combinations are fast, effective and help reduce the development of resistant strains of bacteria that causes acne, but the Centers for Disease Control and Prevention recommends that antibiotics be used for a maximum of six months," Baldwin said.