Antibiotic Therapy For Acne Research Articles

Antibiotic therapy of acne and antibiotic resistance: State of the art

Acne is one of the most common dermatoses, with 117 million people diagnosed with the disease each year. Acne has a complex multifactorial genesis, including genetic predisposition and the influence of exposome factors. The direct mechanisms of the disease are associated with increased sensitivity of sebaceous glands to androgens, sebum hyperproduction, impaired keratinization at the mouth of hair follicles, and inflammation, in the induction of which Propionobacterium acnes is involved.
 The treatment of acne is complex, and one of its strategies is to regulate the number and activity of P. acnes through the use of antibacterial therapy. Antibacterial drugs have been used in the treatment of acne since the 1950s. They are included in a number of clinical guidelines and expert consensus documents for the treatment of the disease. However, the use of antibacterial drugs is limited by the formation of antibiotic resistance. Antibacterial drugs resistance in acne was first noted in the 1970s and was labeled as a global problem in the 2000s. The rapid increase in antibiotic resistance has prompted the development of strategies to prevent it and limit the use of antibacterial drugs in acne.
 This review presents information on the efficacy and place of antibacterial drugs in the treatment of acne, the epidemiology and mechanisms of antibiotic resistance, and strategies to overcome it. The authors consider and substantiate the effectiveness of a fixed combination of adapalene 0.1% and benzoyl peroxide 2.5%, based on the effect on the key links in the pathogenesis of acne, synergism of action and suppression of even antibiotic-resistant strains of P. acnes.

Comparative Effects of Bee Venom and Clindamycin on Propionibacterium acnes-induced Inflammatory Skin Disease in Mice

Acne is the most common skin disease, causing significant psychosocial problems for those afflicted. Currently, available agents for acne treatment have limited to use with antibiotics, which cause side effects or resistance. Bee venom (BV) has traditionally been used as a treatment for a wide variety of ailments such as inflammatory diseases. Despite its well documented antiinflammatory property, it has not been fully demonstrated regarding the influence of BV against inflammatory acne. This study evaluated the anti-inflammatory property of BV and clindamycin, which is well-known antibiotics against acne treatment. To induce inflammation in vivo using Propionibactierium acnes (P. acnes), 1×10 7 CFU of living P. acnes were intradermally injected into the ear of mice. BV (50, 100, 200 and 400μg/g) in gel and clindamycin (1%) was applied epicutaneously on the ear. Epicutaneous administration of BV or clindamycin decreased the number of infiltrated inflammatory cells and inflammatory cytokines in the ear, thereby relieving P. acnes-induced ear swelling and subsequent proinflammatory cytokine expression, especially at the dose of 200μg/g of BV. The anti-inflammatory effects of BV is relatively same or superior compared to those of clindamycin in P. acnes-induced inflammation in vivo. These results demonstrate that the potential of using BV as an alternative treatment to the antibiotic therapy of acne.

Understanding innate immunity and inflammation in acne: implications for management.

Acne has long been understood to have a complex physiological basis involving several main factors: hormonally-stimulated sebum production, abnormal keratinization of the pilosebaceous duct, and an inflammatory immune response to Propionibacterium acnes. Recent studies at the molecular and cellular level have begun clarifying how all of these factors interact, and the role of the innate immune system is better appreciated. Inflammation has been demonstrated in all acne lesions - the preclinical microcomedo, comedones, inflammatory lesions, 'post-inflammatory' erythema or hyperpigmentation, and scarring. Inflammation localized to the pilosebaceous unit can be considered the defining feature of acne and should be addressed via multiple therapeutic pathways. Clinicians tend to think oral antibiotics should be used to 'calm' inflammatory acne, but there is good evidence showing that topical retinoids also have anti-inflammatory properties as a class effect. For best therapeutic outcomes, most patients with acne should be treated first line with a topical retinoid plus an antimicrobial agent, as has been demonstrated in thousands of patients involved in clinical trials and recommended by the Global Alliance to Improve Outcomes in Acne for more than a decade. Moving away from reliance on antibiotic therapy for acne is particularly important in an era of worsening antimicrobial resistance and worldwide calls to reduce antibiotic use. Improved understanding about the role of P.acnes and the innate immune system in acne should help clinicians in designing efficacious treatment strategies.

Antibiotic susceptibility of Propionibacterium acnes isolated from acne vulgaris in Korea

Propionibacterium acnes plays an important role in the development of acne, and inflammatory lesions are improved by antibiotics. Long-term use of antibiotics may result in development of resistant strains and treatment failure. The aim of the present study was to investigate the isolation rate of P. acnes and to evaluate its antibiotic susceptibility to widely used antibiotics in acne in Korea. Among 46 patients, 31 P. acnes strains were cultured. Isolated P. acnes was measured for minimum inhibitory concentration (MIC) of tetracycline, doxycycline, minocycline, erythromycin and clindamycin using an Epsilometer test. Age, disease duration and previous history of antibiotic therapy for acne were compared in relation to the MIC. The mean MIC of tetracycline, minocyclines, doxycycline, clindamycin and erythromycin were all below the breakpoint of antibiotic resistance. The patients with acne vulgaris with disease duration of more than 2 years documented higher MIC values in doxycycline, erythromycin, and clindamycin than those of less than 2 years. The patients who were previously treated with topical or systemic antibiotics showed higher MIC in doxycycline. Antibiotic resistance of P. acnes is still low in Korea, but at this point, there is an increasing trend of MIC. Caution and acknowledgement of increased risk of antibiotic resistant P. acnes should be advised in acne antibiotic treatment to minimize and avoid the emergence of the resistant strain.

Systemic Antibiotics for Acne

Antibiotic therapy for acne is very common. Antibiotics are frequently used in acne, either systemically or topically. Systemic antibiotics are indicated as treatment of moderate and quite severe acne or if acne is considered as very serious by the patient for psychological or social reasons. Results are very often excellent, but failure is possible; in this case using another treatment, especially isotretinoin, is necessary. A few antibiotics are useful: tetracyclines (tetracycline, doxycycline, minocycline, lymecycline), erythromycin, co-trimoxazole and trimethoprim. Their side effects are reviewed. During pregnancy the best antibiotic is erythromycin. For the nursing mother it is generally said that tetracyclines are contraindicated but the risks if they exist are certainly slight. The mechanism of action of systemic antibiotics for acne is not perfectly clear as it is not only antimicrobial: they diminish chemotaxis of polymorphonuclear leukocytes, modify the complement pathways and inhibit the polymorphonuclear leukocyte chemotactic factor and the lipase production in Propionibacterium acnes.