Are antibiotics still relevant in acne? A review of the therapeutic conundrum

Antibiotics have constituted the mainstay of acne therapy despite acne being classified as an inflammatory disorder. The indiscriminate usage of antibiotics over the years has thus fueled the issue of antimicrobial resistance. Cutibacterium acnes (C. acnes) can acquire resistance due to chromosomal...

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Bibliographic Details
Published in:International journal of dermatology 2024-03, Vol.63 (3), p.306-310
Main Authors: Monteiro, Rochelle Cheryl, Fernandes, Merwyn
Format: Article
Language:English
Subjects:
Acne
Acne Vulgaris - drug therapy
Acne Vulgaris - microbiology
Aged
Anti-Bacterial Agents - therapeutic use
Antibiotics
Antimicrobial agents
Antimicrobial resistance
Biofilms
Effectiveness
Flora
Homeostasis
Humans
Inflammatory diseases
Isotretinoin - therapeutic use
Microbiomes
Phages
Probiotics
Propionibacterium acnes
Salicylic acid
Salicylic Acid - therapeutic use
Skin
Soft tissues
Succinic acid
Therapy
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Summary:Antibiotics have constituted the mainstay of acne therapy despite acne being classified as an inflammatory disorder. The indiscriminate usage of antibiotics over the years has thus fueled the issue of antimicrobial resistance. Cutibacterium acnes (C. acnes) can acquire resistance due to chromosomal mutation or genetic acquisition. C. acnes can transfer resistance to other resident flora, complicating the management of skin and soft tissue infections. It can also transfer resistant strains to other body sites and to immunocompromised and elderly patients thus putting them at risk of serious infections. Recent studies have highlighted the physiologic role of C. acnes in maintaining the normal homeostasis of the skin microbiome. The role of Malassezia in causation of acne has piqued interest in recent times. The efficacy of antibiotics in acne is attributed to their para-antibiotic, anti-inflammatory action rather than antimicrobial action. Thus, usage of low-dose antibiotics and alternatives to antibiotics has been advocated. Some alternative therapies showing efficacy in acne are probiotics, oral zinc, precision therapy using succinic acid, bacteriophages, and anti-biofilm therapy like myrtacin, topical azelaic acid, and salicylic acid. Using isotretinoin in early stages of acne can reduce the incidence of scarring and alleviate the need for antibiotics. Thus, a gradual shift from antibiotics to alternative therapies in acne is the need of the hour.
ISSN:0011-9059
1365-4632
DOI:10.1111/ijd.16854