For years dermatologists have shuffled most acne patients out the door with a prescription for antibiotics. While there’s no question that antibiotics can reduce acne, there are quite a few reasons to avoid oral antibiotics in favor of other treatments.
1. Antibiotics Don’t Treat the Underlying Cause
It is easy to make bacteria out to be the “bad guy,” but bacteria itself doesn’t cause acne. So when you take antibiotics for acne, you are actually treating part of the symptom, rather than the root of the problem.
Originally, scientists thought that acne was due to the bacterial infection of pores and hair follicles. One study, however, found that P. acnes is not actually present when acne lesions first begin to form. Though this bacteria may contribute to inflammation in acne, the root cause may lie elsewhere.
As mentioned in another article on this blog, a variety of factors, such as stress, diet, environment, and genetics, often work together. Some or all of these can lead to blocked pores, pimples, inflammation, and acne. Without going into too much technical detail, the root cause can be traced to damage in one of the skin’s fatty acids. Damage to this fatty acid results in the overproduction of a protein that “glues” together dead skin cells, which, in turn, creates blocked pores.
And blocked pores, of course, are where pimples begin. Are antibiotics even treating the problem? Perhaps not.
2. Antibiotics Just Don’t Work That Well for Acne
If the root cause isn’t bacteria, this may be one reason that antibiotics have such a spectacularly high failure rate when it comes to acne treatment.
In fact, a dermatological study performed in the UK revealed that 82% of the study patients failed multiple courses of antibiotic treatments. Almost a third of patients who used isotreninoin (Accutane) relapsed after treatment. Perhaps due to their low success rate, doctors often prescribe several antibiotics, one after another.
In fact, over the past 4 decades, P. acnes has become more and more resistant to standard antibiotic treatments. A paper published by The Medical Journal of Australia claimed that acne’s resistance to antibiotics increased from 20% in 1978 to 62% in 1996.
And since traditional acne antibiotics just don’t work as well as they used to, different types of antibiotics are being used to treat acne.
3. They Make Bacteria Stronger
In other words, the more that antibiotics are used to treat bacterial infections and diseases, the more that bacteria evolves and becomes resistant to the drugs. The generic term for this is “antibiotic resistance,” and it isn’t limited to P. acnes.
“Antibiotic resistance has been called one of the world’s most pressing public health problems,” according to the CDC.
Treating drug-resistant infections can become difficult or even impossible, which is particularly problematic for potentially life-threatening infections. MRSA, for instance, is an infection common in hospital settings. This infection can cause deadly illnesses such as pneumonia, meningitis, and more. Over-prescribing antibiotics for acne could help these deadly bacteria develop resistance to antibiotics.
Combined with the fact that the developments of systemic antibacterial drugs is on the decline, antibiotic resistance will only get worse over time. The less that these drugs are used, the more effective they will be.
4. They Can Cause Serious Side Effects or Even Long-Term Harm
Antibiotics can have serious side effects, including some that may never go away.
Many types of bacteria live inside the intestines and gut, but use of antibiotics can harm some types of bacteria and while allowing others to proliferate. In worst case scenarios, dangerous bacteria can grow in number and cause health issues with the colon, such as acute peritonitis, toxic megacolon, and colonic perforation. Research has also shown that gut problems are far more common among acne patients than those with clear skin, and that gut problems likely contribute to acne. While I’m sure there are many reasons why gut problems are more common among acne patients, frequent use of antibiotics is surely one of them.
Even a one-week course of clindamycin – a type of antibiotic – can create antibiotic resistance that lasts for up to two years. Now consider the fact that most antibiotic courses prescribed for acne patients are long-term. Many treatments last for six months or more.
Given these side effects, some of which may be permanent, is it really worth the risk?
5. There are Better Treatments than Antibiotics
If there were no better treatments available, then antibiotics for acne may be worth considering as a first line of treatment. But quite a few other options have shown promise and have even been recognized by researchers.
Acne sufferers, for instance, have been shown to be low in zinc. One study performed by Turkish scientists showed a clear correlation between acne severity and low blood levels of zinc. In one study, one group of acne patients was given minocycline (oral antibiotic) and another group was given a zinc supplement. The study showed that the group who received the zinc supplement reduced acne almost as much as the group that was given the antibiotic.
Zinc supplements are affordable, available over the counter and almost no side-effects (some people get mild nausea from them). If this is something you’d like to try, this is the supplement I recommend for people with acne.
But Zinc is just one option. Taking steps to make minor corrections to your diet often helps. Studies show that people with moderate acne, the same group of people who usually get a prescription for antibiotics, may benefit from antioxidant supplements. Furthermore, benzoyl peroxide and topical antioxidants are viable alternatives for most people.
Regardless of the severity of one’s acne, there are other science-based alternatives that can help. And given the fact that antibacterial drugs can increase antibiotic resistance, cause health problems, and don’t even work most of the time, there is plenty of reason to consider other treatments besides antibiotics.