Antibiotics are one of the keystone discoveries of modern medicine, and their significance can’t be understated. In dermatology, many acne treatments rely in no small part on prolonged use of antibiotics. We tackle and debate the problem of antibiotic resistance in the context of acne care and maintenance.
Is the use of antibiotics a serious concern in dermatology?
While antibiotics are certainly necessary for medical practice, the problem of antibiotic resistance and the threat of resistant bacteria is real. Dermatologists are less likely to prescribe systemic antibiotics to their patients compared to specialists that treat systemic illnesses. However, the concern with the overuse of antibiotics is certainly something that all doctors need to keep in mind, and antibiotic resistance is a problem that affects a wide spectrum of conditions.
In dermatology, the most common use of antibiotics is in treating acne and rosacea. Antibiotics reduce redness and inflammation. Commonly prescribed antibiotics include tetracycline, doxycycline, minocycline, and clindamycin. For more severe cases, oral antibiotics may also be used. One concern is that the antibiotics used to manage acne and rosacea are often used for a long time; it is not uncommon for patients to be prescribed antibiotics for longer than six months. The way that antibiotics are used to treat acne and rosacea is quite different from how they are used to treat infections.
Why are antibiotics used to treat acne and rosacea since they are not bacterial infections?
Dermatologists commonly prescribe antibiotics to manage acne and rosacea. In acne, the proliferation of P.acnes bacteria does lead to problems, but the condition itself is not an infection. Rosacea is also not an infection but a chronic disease. Acne is not a bacterial infection, but the proliferation of the P.acnes bacteria around the hair follicles is thought to contribute to inflammation and eventually lead to pimples. Antibiotics can help to reduce the amount of P.acnes bacteria in the hair follicle, and perhaps more importantly, have an anti-inflammatory effect on the treated area. It is often this latter effect that helps calm down acne flares.
Another common use of antibiotics is in the treatment of rosacea. For mild redness, antibiotics are usually applied in a topical cream form. Antibiotics can also be taken orally. The exact mechanism of how antibiotics work on rosacea symptoms is not known. It is thought that the anti-inflammatory properties of the antibiotics are the main reason that it helps reduce rosacea symptoms.
In what other contexts are antibiotics used for dermatology?
Antibiotics are powerful tools that are used in a variety of contexts. They are used to treat or manage the symptoms of many skin problems such as pityriasis rosea, Hailey-Hailey disease, and pityriasis lichenoid. Due to the relative rarity of these conditions compared to that of acne and rosacea, however, we suspect that they are less concerned about the overall effect on antibiotic resistance.
Do you feel that antibiotics should be phased out of dermatology?
Antibiotics are arguably the most significant discovery in medicine in improving patient quality of life and extending average life span. It plays a vital role in medicine and is extremely unlikely to be phased out any time soon. We need to be more judicial in how they are used and prescribed by doctors. The use of antibiotics may likely be reduced in favor of other acne or rosacea treatments, as there are plenty of alternatives. Patients may be prescribed antibiotics for a shorter period of time, alternating with other therapy. This topic is certainly a relevant and important one and is likely to be an ongoing discussion topic among dermatologists.