From the Guidelines
Infection in acne is typically a downstream effect rather than the primary cause of acne, as it begins with excess sebum production and abnormal shedding of skin cells that clog pores, creating an environment where bacteria can proliferate. This understanding is supported by the most recent guidelines of care for the management of acne vulgaris, which recommend a multimodal therapy approach combining multiple mechanisms of action, including topical retinoids, benzoyl peroxide, and topical antibiotics 1. The use of antibiotics like doxycycline (100mg twice daily) is recommended for acne treatment based on moderate certainty evidence from several studies, which have shown that doxycycline can help manage acne by reducing bacterial populations and inflammation 2. However, it is also important to note that antibiotic resistance is a growing problem, and the use of oral antibiotics is associated with disruption of the normal flora, bacterial resistance among other organisms, and increased rates of upper respiratory infection and pharyngitis 3.
Some key points to consider in the management of acne include:
- The use of topical retinoids, such as tretinoin (0.025-0.1% cream applied nightly), to address excess sebum production
- The use of hormonal therapies, such as spironolactone (25-100mg daily for women), to address hormonal imbalances
- The use of salicylic acid or benzoyl peroxide products to reduce pore blockage
- The use of emerging topical therapies, such as nitric-oxide releasing particles, which have shown promise in reducing inflammation and preventing C. acnes induced inflammation 4
- The importance of limiting the use of systemic antibiotics when possible to reduce the development of antibiotic resistance and other antibiotic-associated complications, as recommended by the guidelines of care for the management of acne vulgaris 1.
Overall, a comprehensive approach to acne treatment that addresses multiple factors, including excess sebum production, hormonal imbalances, and pore blockage, is more effective for long-term management than relying solely on antibiotics. The most effective treatment approach will depend on the individual patient's needs and circumstances, and may involve a combination of topical and systemic therapies.
From the Research
Infection in Acne
- Infection in acne is a complex process involving the bacterium Cutibacterium acnes (formerly known as Propionibacterium acnes) 5, 6, 7.
- The role of infection in acne is multifaceted, with C. acnes contributing to the development of inflammation and comedones 5, 7.
- Topical and systemic antibacterial agents are commonly used to treat acne, with the goal of reducing C. acnes populations and minimizing inflammation 8, 9, 6, 7.
Downstream Effect of Infection
- The evidence suggests that infection in acne is not solely a downstream effect, but rather an integral part of the disease process 5, 6, 7.
- C. acnes plays a crucial role in the development of acne lesions, and its presence is necessary for the formation of inflammatory lesions 5, 7.
- However, the development of antibiotic resistance in C. acnes is a growing concern, highlighting the need for combination therapies that include non-antibiotic agents like benzoyl peroxide 6, 7.
Treatment Strategies
- Combination therapies, such as topical retinoids and benzoyl peroxide, or oral antibiotics and topical retinoids, are often used to treat acne 8, 9, 5.
- The use of fixed combinations of antibiotics and benzoyl peroxide may help reduce the risk of antibiotic resistance and improve treatment outcomes 6.
- The selection of a treatment strategy should be tailored to the individual patient, taking into account the severity and type of acne, as well as the patient's skin characteristics and medical history 8, 9, 5, 7.