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Topical Antibiotics


What are some examples of topical antibiotics for acne?


The most common topical antibiotic used in dermatology today for the treatment of acne is clindamycin. Clindamycin directly targets the p. acnes bacteria that is usually implicated as the cause of inflammatory cystic acne. Clindamycin is frequently combined with benzoyl peroxide in what is called “combination medicines.” Erythromycin is another topical antibiotic that is used to treat acne. Dapsone is an antimicrobial medication that is used similarly to a topical antibiotic.


Are topical antibiotics just as good as oral antibiotics for acne?


Depending on the severity of your acne, your dermatologist may decide to give you a topical antibiotic, an oral antibiotic or both. Topical antibiotics are sufficient for the treatment of acne in many patients. However, some patients need an oral antibiotic in order to treat their acne. Both topical and oral antibiotics are often combined with other medications in order to get optimal results. Benzoyl peroxide is commonly combined with Clindamycin (in medications such as Duac, Benzaclin and Acanya) and these formulations have been clinically shown to be superior to either ingredient on its own. In recent years, Clindamycin has been combined with tretinoin (in medications such as Ziana and Veltin.) Oral antibiotics are often used in combination with topical medications such as retinoids, topical antibiotics and benzoyl peroxide.


Can you do in-office procedures to treat acne if you are using a topical antibiotic?


Yes, topical antibiotics are safe to be using while undergoing in-office procedures for the treatment of acne. Most acne treatments work best when used in combination.


Do topical antibiotics use in acne treatments cause dry skin?


Topical antibiotics may be slightly drying, but are considered to be among the most tolerable of the topical acne medications. Certain formulations are less drying than others; for example, Clindamycin lotion is much less drying than Clindamycin solution. Your dermatologist or acne specialist will instruct you on how to use your topical antibiotics in order to avoid irritation and dryness.


Are topical antibiotics available over-the-counter?


Topical antibiotics are only available by prescription. An acne specialist at the Clear Clinic can determine if topical antibiotics are appropriate for you.


Oral Antibiotics


Is acne caused by bacteria?

There are many factors that contribute to the development of acne. The development of acne begins with the formation of a microcomedone due to abnormal regulation of the cells within the pore. The microcomedone does not allow dead skin cells and sebum to escape from the pore. This becomes a perfect environment for the Propionbacterium acnes (p. acnes) bacteria, which create inflammation and ultimately lead to inflammatory acne lesions.


How are antibiotics used to treat acne?


Antibiotics are commonly used in the treatment of inflammatory acne. They can be used topically in the treatment of mild to moderate inflammatory acne or taken by mouth for the treatment of moderate to severe inflammatory acne. Antibiotics work in a few different ways to reduce acne. The main mechanism that antibiotics use to treat inflammatory acne is to decrease the amount of p. acnes bacteria around the pore. Antibiotics also work by reducing the concentration of free fatty acids in the sebum; free fatty acids promote inflammation and may cause comedones (whiteheads and blackheads.)


What are the most effective antibiotics for the treatment of acne?


The tetracyclines are the most commonly prescribed antibiotics for the treatment of inflammatory acne. These include the second generation tetracyclines, doxycycline and minocycline. Doxycycline and minocycline are derived from the more traditional Tetracycline and tend to be better tolerated and more effective than the older medications. All tetracyclines, including doxycycline and minocycline work by interfering with protein synthesis, exerting a bacteriostatic effect on p. acnes bacteria. Examples of doxycycline and minocycline are the brand names Doryx and Solodyn.


Macrolide antibiotics, such as azithromycin, have also shown to be effective against the p. acnes bacteria. They work by inhibiting protein synthesis to have a bacteriostatic effect; they bind to a different portion of the bacterial ribosome than the tetracyclines. Trimethoprim/Sulfamethoxazole (Bactrim) is sometimes used to treat inflammatory acne that does not respond to other antibiotic treatments.


Are oral antibiotics alone sufficient for the treatment of acne?


Oral antibiotics are almost never a proper treatment for acne. Especially cystic acne is an abscess, surgical infection and not just cellulitis, a medical infection. Oral antibiotics are rarely used as monotherapy (the only treatment used.) Topical antibiotics, Salicylic acid, benzoyl peroxide, retinoids and combination of other topicals are often using in conjunction with oral antibiotics for best results. In-office treatments at Boston Acne Specialists, such as medical extractions along with the Isolaz and various exfoliating chemical peels are commonly performed while oral antibiotics are rarely prescribed. These treatments can reduce the acne lesion count more quickly than oral antibiotics and topical medications alone.


What are the side effects of oral antibiotics?

All oral antibiotics have unique side effects; your Boston acne specialist can review the potential side effects for the oral antibiotic that you are taking. Side effects that are potentially seen with most antibiotics used for acne are gastrointestinal upset (“stomachache”) and vaginal yeast infection. Dr. Ishoo believes that the most effective treatment of a localized infection such as acne or tooth abscess, is localized, hands-on treatment and not systemic chemotherapy with oral antibiotics, birth control hormones or Accutane. These systemic treatments will lead to more medical side effects than is reasonable to tolerate for acne. Acne is a complicated disease and the solution is not as simple as trail and error prescription of antibiotics. It requires intensive, hands-on combination or comprehensive treatment to reestablish skin's ability to regulate itself. There are nosher cuts. It is tried and true methods that have the best chance, not magic!

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