Oral Antibiotics for Acne
First the Dull Stuff
Antibiotics are a class of drugs designed to kill bacteria – with me so far? Bacteria are the tiny, microscopic organisms that live just about everywhere on the planet, including in and on the surface of our bodies. Propionibacterium acnes (P. Acnes) is the particular bacterium that’s associated with acne breakouts and the one that acne antibiotics are designed to put down.
We could argue over how long antibiotics have been on the scene but generally speaking, antibiotics appeared in the 1930’s. By the 1950’s they were being used to treat a wide range of bacterial infections. They soon found their way into the acne treatment world when tetracycline began being prescribed for severe acne.
How Antibiotics Work
Antibiotics work in a pretty interesting way. They’re constructed to affect bacteria strains without affecting the human cells that surround them. And they don’t “kill” bacteria in a classical sense either, but rather inhibit or restrict the bacteria’s ability to perform some basic function or process. For instance, some antibiotics target the bacteria’s cellular wall, weaken it, and thus cause it to rupture (which prevents it from reproducing and ultimately kills the bacteria dead as a door nail).
Tetracycline works against P. acnes by stopping its ability to synthesize protein. Without enough protein, the rest of the bacteria’s metabolic processing breaks down and it too dies. When antibiotics for acne do their job, acne breakouts can stopped at their source.
The Most Used Acne Antibiotics
Doctors generally use four “go-to” oral antibiotics to treat acne.
Tetracycline
Widely used for decades now, it has the most name-recognition of any antibiotic used for acne treatment. It doesn’t treat the inflammation associated with some acne and shouldn’t be used by children or pregnant women. Also, it must be taken on an empty stomach or it’s totally ineffective.
Erythromycin
Commonly used as an alternative to tetracycline treatments as it also fights inflammation. This antibiotic can be used by pregnant women and should be taken with food to avoid nausea.
Minocycline
Used for the more severe cases of acne – the cystic/pustular types of breakouts. Minocycline can cause dizziness and other side-effects and should be should be taken on an empty stomach for best results.
Doxycycline
This antibiotic is used when other antibiotics are ineffective. It’s a broad-spectrum antibiotic that should be taken with food to avoid nausea.
Acne Oral Medication vs. “The Pill”
Okay, this section is just for the ladies – birth control pills can improve acne! Yes, it’s true; some female acne sufferers see marked improvement after taking prescribed oral contraceptives. In some cases, physicians will actually prescribe the contraceptives specifically as an acne medication too. But that typically only happens after a patient’s acne has not responded to other treatments.
The reason “The Pill” is effective in some cases is because it reduces the sebum (oil) that the skin’s sebaceous oil glands produce. Sebum combines with an excess of dead skin cells to form the tiny plugs that block hair follicles. These plugs in turn develop into the whiteheads, blackheads, and cysts we experience as acne. With less sebum around, less plugs form and breakouts can be reduced. But since these pills only work on the excessive oil side of the equation and don’t address the inflammation/bacterial infection side, they’re not effective for everyone. In fact some women see no improvement at all and for some, improvement takes several months. So generally speaking, even women taking “The Pill” need some form of additional acne treatment.
Side Effects of Acne Antibiotic Treatment
Oral antibiotics usually need somewhere between 6 to 8 weeks to show any real skin improvement and during that time they may produce side effects that are more unpleasant than the acne itself. For instance, some people experience mild to severe stomach upset when taking antibiotics. Others develop more severe digestive tract issues (e.g. diarrhea or vomiting). And women can experience an increase in the number and severity of yeast infections.
Using antibiotic therapy for acne can also produce allergic reactions because a certain percentage of the population is simply flat-out allergic to certain antibiotics. Those reactions include shortness of breath or the swelling of the tongue, lips, or face. They can even include a rash or hives which is particularly frustrating to an acne sufferer who only began the treatment in the first place to clear up their skin.
The problem with these side effects or allergic reactions is that there’s no real predicting ahead of time who will experience them. It’s only after beginning a course of antibiotics that these effects become apparent. So in that regard, taking antibiotics for acne is a bit of a crap shoot and it’s exactly why you need to be under medical supervision while doing so.
The Cost of Antibiotics
Antibiotics are not cheap – but then no medicine is nowadays. The out-of-pocket expense could easily run into the high 100’s of dollars as the normal treatment would be for several weeks to months. If you have insurance the cost could be considerably less but that would depend on your insurance plan, its deductible, and how it treats prescriptions.
So What’s the Bottom Line Here?
Antibiotic treatment for acne is not going to be the magic cure you hoped to find for your acne issues. When used all by themselves as treatment, antibiotics are only a little more effective than sugar pills (i.e. Placebos). You can read an extract from a study published by the Journal of the American Medical Association (JAMA) by clicking here that validates this position.
The reason for this limited effect could be that more and more bacterial strains are becoming more and more resistant to antibiotics. Another reason could be that antibiotics attack the bacterial side of the problem but do nothing to limit the excess oil production that’s one of the root causes of acne. In any case, a two-pronged attack is the most effective approach and using only antibiotics to treat acne probably isn’t enough.
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