5 Reasons You Shouldn’t Take Antibiotics for Acne

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.

The result?

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.

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13 thoughts on “5 Reasons You Shouldn’t Take Antibiotics for Acne

  1. That being said, I’m taking antibiotics right now for a gut dysbiosis and SIBO (Which is the same thing I suppose) And I’ve been taking probiotics too. Thank god I haven’t experienced any antibiotic associated diarrhea. Which is nice actually. I know it may cause long term damage but if you monitor your gut feeling and take measurements to mitigate the damage. Then I’m sure it’ll be worth it in the end, probably not for Acne treatment but for infections and dysbiosis and sibo.

    Even though it’s not the reason I’m taking antibiotics now, my skin is pretty decent actually on this anyway. 😛 After a laser treatment it’s starting to look good again!

    • I do agree that antibiotics can be useful for treating SIBO and other gut issues, and in that way can be indirectly helpful in acne. That kind of usage was not the point of this article.

  2. Seppo, do you know anything about the usage of saltwater on the face for acne? Parents came up to me today to tell me about how this works and anecdotal information from the friend of a friend of a friend of a friend tried this and it worked. I’ve tried enough things over the years to the point where I want studies now for supposed “methods” that miraculously cure acne. My parents are not scientifically oriented or critical thinkers so I’m thinking this is just one of their pseudo-science recommendations that will just waste my time and end up disappointment again. Thanks.

  3. Seppo,

    I had to take antibiotics recently for a large boil. Boy did my stomach suffer as a consequence. I have no doubt the antibiotics caused the upset. Antibiotics should be a last resort, not the first port of call, using it for serious infections. Recent report on the BBC said that by 2050 deaths relating to antibiotic resistance will be the number one killer. Let’s not forget cattle also get fed antibiotics as routine practice.

    Michael

    • Fully agree with you, Michael. I don’t understand why dermatologists prescribe antibiotics like they are candy. They must know acne comes back the moment antibiotics are stopped and they must know that antibiotic resistance is one of the most serious health issues we face.

  4. Hi Seppo,
    I never knew the importance of taking probiotics after finishing an antibiotic treatment until reading this. I took Oracea which is doxycycline for a couple of months. Do you think that Renew Life Ultimate Flora is a good probiotic to take? It says it’s gluten, soy, and dairy free, which i need. I’m always hesitant to take supplements for the fear that i’ll have a negative reaction to something in it.

    • Thanks for your comment, Genny. It’s hard to comment on probiotic supplements. Mainly because how good they are vary from person to person. For example, any time I’ve taken probiotics they have caused constipation and made my acne worse, but at the same time there are studies that show probiotics reduce acne in other people. You can’t really think of probiotics in isolation. You also have to consider the environment you are putting them into, in this case the existing microflora in the gut. And that’s why different people will react differently to supplements.

      The short story is that you have to try and see what happens. If you react badly you might also consider taking some herbal anti-bacterials. That’s actually what I’m doing now. Trying to rebalance the bacteria in my gut with herbal anti-bacterials and then trying probiotics again after that. So far it seems to be working ok, but it’s too early to tell yet.

  5. I have two sons in college with cystic acne. They are gluten free and mostly dairy free and this diet does help, but they will always have big break out during finals and always have some acne that never goes away and that scars. I also observed that when they get gluten contamination they break out as well. My older son went to a Harvard-educated acne specialist and he didn’t recommend accutane because of prior depression, gut problems,( they have DNA for celiac) They have a cousin who has crohn’s disease who had been on accutane and not sure that had any influence on his decision. So the doctor put him on doxycyline mo and he is breaking out more after 10 days on it. Should he stop and taper off? I notice that low carb, GF,CF and low stress living helps the most. But when they do have a break out it’s horrible and leaves scars. My son does not tolerate medications well. The anit-depressants always gave him side effects or allergies. He’s very sensitive. What should they do? Thank you for your dedication to acne by the way!!

  6. Love this site, I have learned a lot – you write extraordinarily well and have a wonderful way of keeping things in perspective. Just a note on antibiotics: It seems to me that your article here focuses on the antimicrobial properties of antibiotics and associated side-effects (and perhaps that is because so do most dermatologists) but I have started hearing a lot of buzz about the anti-inflammatory properties of antibiotics, which some dermatologists are convinced is a main mechanism of action against acne.

    In particular, I recently heard about subantimicrobial-dose antibiotic use – i.e. using doses of antibiotics that are too low to exhibit antimicrobial properties or trigger microbial resistance, but are more effective than placebo probably due to the independent anti-inflammatory properties of antibiotics:

    https://archderm.jamanetwork.com/article.aspx?articleid=479281

    I wonder if the antimicrobial effects of antibiotics are a red herring when thinking about acne – we know P. acnes bacteria is involved in acne and we know that antibiotics are antibacterial (it’s in the name), so we abide by Occam’s razor and say that must be why they work. But we may be missing part or even most of the story because antibiotics also have independent anti-inflammatory action. I haven’t looked much into the actual anti-inflammatory mechanisms of action of antibiotics to see if they fit in with the scientific story you laid out in the book; nor have I looked closely at the efficacy of subantimicrobial-doses versus normal antibiotic use. But it seems likely from the studies that there is at least some anti-inflammatory benefit to antibiotics that plays a role. And when used this way, you likely would not see the side-effects you talk about here.

    • You raise some good points. I’ve also read about the potential anti-inflammatory effects of antibiotics. It’s an interesting story but at the moment it’s just speculation. I don’t think anyone has compared the effectiveness of full vs. sub-antimicrobial doses.

  7. Any dose of antibiotics effects the gut flora. My derm had me on the lowest dose of doxy for 4 months, saying it would just be “anti imflammitory….” No. I ended up with candida. Fixed it with probiotics, anti fungals, biofilm disrupters. It wasn’t fun. Don’t take antibiotics, even the lowest doses have big impacts on the gut.

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