Antibiotics are the first-line treatment for moderate to severe acne. And most acne patients walk out from dermatologist’s office with a prescription for course of oral antibiotics. Doctors prescribe and we take them assuming they are safe and without much thought to the consequences. While antibiotics are generally safe, there’s now good reason to believe they may make you more prone to future acne breakouts.
In this post I’m going to call into question the use of oral antibiotics in treating acne. For two reasons. They don’t really work, and they carry long-term consequences that may harm your skin.
Do antibiotics really work for acne?
Obviously antibiotics work short-term. Nobody doubts that. The real question is what happens after you finish the treatment. Acne forums are filled with posts complaining how acne came back with vengeance after the treatment stopped.
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Read moreAnecdotal evidence is horribly unreliable, so I wanted to see what studies say on this. I looked for studies on recurrence or relapse rates after oral antibiotic therapy. Given how often they are used I was quite shocked that this was the best I could find:
In a study of women over the age of 25 with persistent AV [acne vulgaris], approximately 82 percent failed therapy with multiple courses of antibiotics and 32 percent had relapsed after treatment with one or more courses of oral isotretinoin.
I couldn’t find any studies on recurrence rates of acne after oral antibiotic therapy. Pretty much all studies just say that patients improved so and so many percentages after so and so many weeks. But nobody seems have bothered to follow up and see what happens after the antibiotic treatment. Because what’s the point if acne comes back a few weeks later?
The one study that even touched this showed massive failure rate (82%) after multiple courses of antibiotics.
So if we ask do antibiotics really work for acne? I don’t know about you, but my answer is flat no. Clear skin for a few weeks is nice, but I want a long-term solution. And that antibiotics ain’t.
Antibiotics make your more prone to acne?
Not only are antibiotics a short-term fix, but they can actually cause long-term harm to your skin. This happens because antibiotics kill the beneficial, or probiotic, bacteria from your gut.
The digestive system is colonized by billions and billions of bacteria. The number of bacteria in the gut is estimated to be 10 times larger than the number of cells in your body. These bacteria are often called as gut microflora or microbiota.
As humans we live in a mutually beneficial relationship with the bacteria in the gut. The so-called probiotic bacteria for example assist in digestion of food and creation of certain nutrients. And with every new study the importance of gut microflora in health is becoming more and more evident.
The biggest problem with oral antibiotics is that they cause long-term disturbances in gut microflora. Most antibiotics prescribed for acne are not precision weapons. They indiscriminately kill both harmful and probiotic bacteria.
Exactly what kind of damage they do to gut bacteria varies from person to person. Each of has unique bacterial makeup in the gut. And some strains of bacteria are more resistant to antibiotics than other strains. But what’s clear is that most antibiotics cause at least some damage to the beneficial bacteria in the gut. And the damage is more likely to be extensive than minor – because most probiotic bacteria can’t resist antibiotics.
The damage also depends on the length of the treatment. Common antibiotic treatments for acne run from several weeks to several months. Sometimes patients are also kept on maintenance dose for years.
Suppressing probiotic bacteria opens the door for harmful (pathogenic) bacteria and yeast (such as Candida) to grow in the gut. Harmful bacteria cause damage to the gut wall and lead leaky gut syndrome, and this allows toxins, bacteria and other inflammatory substances to leak into the blood. In the gut-skin axis post I explained in detail how this can lead to acne.
Candida albicans in another invader that takes advantage of the opportunity created by antibiotics. Candida can cause further gut damage and cause sensitivity reactions that show up on the skin.
Long-term effect
The gut microflora is resilient. Without any disturbances (such as antibiotics, chemotherapy or excessive stress) the microflora remains fairly stable. Even after you wipe it out with antibiotics it does try to return to pre-treatment balance. But this can take long time. One study found disturbances even 2 years after a 7-day clindamycin treatment. Another study showed disturbances 4 years after the treatment.
Antibiotic treatment also increases the levels of antibiotic-resistant bacteria in the gut. So it’s possible that the gut microflora never really recovers after long-term antibiotic use. I don’t mean to sound alarmist saying this, and we really don’t know whether minor disturbances have any real health effects.
The point I’m making is that taking antibiotics you set yourself up for getting more acne in the future. At the moment we can’t say how long this effect persists. It may pass in a few weeks or it may linger in some form for years.
The larger message here is not to take antibiotics unless absolutely necessary. If you need them to clear an infection, then by all means take them. But I don’t see any point in taking oral antibiotics for acne. They are a short-term help with potential long-term harm.
Probiotics can mitigate the damage
Probiotic Drinks (Photo credit: Jepster)
If antibiotics cause disturbances in the gut flora, then taking probiotics should mitigate the damage. And that’s exactly what studies are showing.
One study showed a dramatic effect. The researchers treated 30 volunteers with clindamycin for 7 days. The subjects were divided into 3 groups: 2 different probiotic supplements and a placebo group. After 7 days the placebo group had no bifidobacteria (a strain of probiotic bacteria) left. The subjects receiving the probiotic supplements showed much smaller disturbances to the gut microflora and experienced fewer side-effects. Other studies have shown similar results using both probiotic supplements and yogurt.
Probiotics are also effective in preventing diarrhea that sometimes follows antibiotic therapy.
Conclusion and take-aways
Oral antibiotics are often prescribed for moderate to severe. For the following reasons I don’t think it’s very smart:
- Antibiotics are effective short-term treatments, but in majority of cases acne comes back with a vengeance.
- Antibiotics can cause long-term disturbances to the bacterial balance in the gut (gut microflora).
- Disturbances in the gut microflora allow harmful bacteria and Candida to colonize the digestive track. This increases inflammation and can lead to acne breakouts.
- Probiotics, either as supplements or fermented foods, mitigate the damage antibiotics cause and allow the gut microflora to recover faster.
Moral of the story: don’t take antibiotics unless you absolutely necessary. They are a flash in the pan that burns your fingers.
Toggle references
- Prevalence of facial acne in adults.
- Oral Spironolactone in Post-teenage Female Patients with Acne Vulgaris.
- At least it won’t hurt: the personal risks of antibiotic exposure (PDF)
- Long-term ecological impacts of antibiotic administration on the human intestinal microbiota.
- The effects of antibiotic use on gastrointestinal function.
- Impact of topical clindamycin and systemic tetracycline on the skin and colon microflora in patients with acne vulgaris.
- Impact of different antimicrobial agents on the colonisation resistance in the intestinal tract with special reference to doxycycline.
- Effect of Supplements with Bifidobacterium longum and Lactobacillus acidophilus on the Intestinal Microbiota during Administration of Clindamycin.
- Lactobacillus acidophilus, Bifidobacterium lactis and Lactobacillus F19 prevent antibiotic-associated ecological disturbances of Bacteroides fragilis in the intestine.
- Prescribing an Antibiotic? Do Not Forget the Probiotic.
- Probiotics for prevention of antibiotic-associated diarrhea.
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Thanks for the insight, all your articles are pretty neat and clear cut. I have a question, I was in acne antibiotics(TC) for moderate acne before 2 years and acne was completely gone. And I stopped the med and was almost eating a healthy diet (High Protein, Mod Carb/low Fat) diet. But I recently changed my diet to High Fat/Protein, Mod Carb diet and the acne seems to be back. I am really eating super clean foods and healthy (building muscle with weights). I include lots of fermented foods, vegetable juicing, etc. The high fats come from Raw dairy/yogurt/eggs/coconuts, so mainly Saturated Fats. And I think this seems to aggravate back my acne and its getting pretty worse daily and so I am stopping this diet right away and thinking to jump on antibiotics. Already I cut out diary/eggs/meat for a week now, but no improvement. So do you think my reason is correct?…also can I take probiotics along with antibiotis or should i have to take it after the course of antibiotics?/ i am also applying some topicals with Tree tea oil and taking saw palmetto do see if that helps with the DHT as I feel i have a lot of test fro my weight lighting!! Thanks
Senavis, happy to help
Generally speaking high-fat diets cause some insulin resistance. So if you eat a decent amount of carbohydrates also, that could cause some problems. I would get a blood glucose monitor and get your fasting and post-meal readings. That could give you some idea.
If you decide to go on antibiotics I would take probiotics at the same time. And keep eating fermented foods.
I wouldn’t jump to conclusions yet. Acne is quite complex and it’s easy to get mislead by quick conclusions without sufficient data. Check the articles in the gut-skin section also. I’ve heard quite a few stories of people whose acne got better after eating less vegetables, because the fiber irritated their gut. Not sure if that’s relevant in your case.
Hey thanks for the reply, I checked my blood glucose level last week, which is pretty solid (low numbers)…and this is after going back to the normal 50/30/20 diet without dairy/meat/eggs/nuts once I got some serious acne before 2 weeks.
I have some cysts along jaw line and temples..my forehead and cheeks are pretty clear but tends to get whiteheads.
may be for now I will try to stay away from Antibiotics and try with Saw Pal, Vit B5, and Topicals for another 3 weeks to see if it works. But it dont seem to get any better with my new changes, so do you know will this Saw+combo increases the breakouts at the beggining and then improves the skin ..??
Senavis,
I don’t think saw palmetto combo should ‘make it worse before it gets better’. From studies I’ve seen it takes a good 4 to 6 weeks for DHT blockers to start acting on the skin. For example one green tea study started showing decent results only after 4 weeks.
Are you using benzoyl peroxide or anything like that? If not, you might want to try them. For me BP really helped to got rid of the post-acne redness. It also nukes away the occasional, small pimple I used to get.
Do you think you can “catch” acne? I had perfect skin for my 28 years of life, no acne as a teen. Started dating a guy with bad acne and then now my face is covered with long-lasting bumps. They go away and them come back again. Sometimes painful. This is not normal and a crisis for me, I have been trying natural and antibiotics, topical….nothing is working?
Sorry about my late reply Sandra. Was travelling with my wife over the weekend and then got sick for a few days.
Nothing is impossible, but the general medical view is that acne is not contagious. We all have P. Acnes bacteria on the skin. And just by introducing the bacteria on the skin shouldn’t cause acne, as it’s actually triggered by inflammatory damage to sebum. Again, nothing is impossible, but I haven’t heard of “catching acne” before.
It’s hard for me to give you much advice with so little information. But I have plenty of info on this site. I’d recommend checking out the gut health section and the post about overview of how to cure acne. Those should give you the basics. If you have more specific questions, I’d be happy to guide you further.
This is mostly in relation to Sandra’s post.. Most general medical views are just that- general. They should never be taken as gospel. Many doctors will tell you antibiotics are good, probiotics are a waste of money, and any attempts to educate them further will make their eyes cross. It’s sad but true. Simply put, as medicine became more of a market it lost its basis in science. So now unless something can be proven profitable, it won’t often be researched, and certainly not conclusively. Acne treatment is big, big business.
My point being, I too ‘caught’ adult acne, at 24, and it has never totally receded. My general understanding is that every gut and skin is different, and therefore two people’s microorganisms may not get along. Indeed, one may be stronger than the other, especially if that person’s system is already weakened by stress, diet, etc. We all have p. acnes, strep, staph, etc… But there are different strains and strengths, so a person being ravaged may have a more vicious breed of bug, or simply be overrun to the point where your system is not prepared for the barrage.
All I know for sure is once you’ve got it, it’s a part of your life for good. But like candida or strep it just needs to be not fed and kept at lower levels. The only answers I’ve found is similar to Seppo’s advice. Eliminate refined sugar, dairy, and saturated fats while increasing EFAs and probiotics. Furthermore, consider reducing or eliminating simple starch and grain intake. Strengthening and balancing your system is the only long term hope there is.
My one thing with what I’ve read here is the fiber bit… I don’t think fiber is necessarily such an issue. Obviously, proper preparation/chewing and complete digestion is a big deal, but food sensitivities are a widespread problem. High amine, salicate, or glutamate foods can cause a lot of chaos for many people, as might nightshades. I’m bringing this up because all these things can contribute greatly to gut distress and further trouble, like immune issues, that may be reflected in the skin. So crucifying fiber, when it’s so necessary for digestive health, may not be wise.
All I’ve got. Great site.
P.S Whey protein is the devil, especially for girls. The devil I say.
Thanks for the thoughtful comment JH.
I would disagree little bit with your statement that unprofitable treatments are not studied. It’s true that pharma companies are unlikely to waste research dollars on something they see no profit potential in. But government grants also fund a lot of research. And those studies also look at less profitable angles. For example, NCAM has spent over a billion dollars funding research into complimentary and alternative medicine. Much of it simply poured down the drain studying highly implausible and dubious therapies, like homeopathy.
Of course the pharmaceutical industry has undue influence on doctors, academic journal and medical schools. I don’t think anybody denies that the system is broken to some degree. But I don’t think the situation is as bad as many alt-med sources make it out to be.
For those who ‘caught’ adult acne, I would recommend looking into hormonal abnormalities. One of the symptoms of excessive androgen levels is a sudden onset of acne.
It wasn’t my purpose to demonize fiber. It’s certainly not a problem for everybody. I just wanted to point out that some people with gut issues may have limited tolerance for fiber. I think this is useful to keep in mind because the advice almost always is to eat more fiber.