As acne becomes more severe,
the potential to scar and disfigure increases exponentially. Young adults
who suffer severe acne may also suffer social and psychological damage, especially
if the acne attacks are concentrated on the face. It is therefore imperative
to treat inflammatory acne immediately and properly. While there are various
systemic treatments available, oral antibiotics are recommended for moderate
to severe types of acne, as well as in the following cases:
- Topical treatment has little or no effect on the acne
- Acne covers large areas of skin, such as the chest, back,
and shoulders.
Tetracycline, and its second generation derivatives minocycline
and doxycycline, are among the most common oral antibiotics used
in systemic treatment. (Clinical experience and data available
to date show that minocycline and doxycycline are more effective
than tetracycline). Tetracycline is known to have anti-inflammatory
properties and suppresses the growth of Propionibacterium acne
and reduces the number of comedones. The effectiveness of the
drug is highly dependent on its ability to penetrate the pilosebaceous
follicles where the propionibacterium resides. Deeper penetration
means better effectivity of oral antibiotics.
The typical duration of oral antibiotic treatment lasts 4 to
6 months. The patient should be forewarned about any possible
drug intake that causes violent reaction on his system. It is
recommended for women that their acne antibiotics should be administered
along with hormonal treatments, especially where oral contraceptives
are part of the regimen. The claims that oral antibiotics reduces
the efficiency of oral contraceptives is a hearsay since the failure
rate of oral contraceptives, according to the literature, is the
same with or without antibiotics.
Tetracycline
Since tetracycline is generally safe and proven effective in
previously untreated case of severe acne, there is no need to
monitor healthy patients under this treatment. Scientific experiments
yield 60% rate of improvement done on random trials with inflammatory
acne. Tetracycline works better when taken with an empty stomach
as food intake impedes its absorption rate. It was noted that
failures of the treatment only occur whenever: patients do not
comply with rules set by the doctor; the treatment duration is
insufficient; there is evident development of folliculitis; when
there are high sebum secretion leading and higher bacteria resistance.
The three known side effects of tetracycline are gastrointestinal
problems, vaginal candidiasis, and photosensitivity with permanent
pigmentation on bone and teeth on some cases making it not being
recommended on pregnant women and children below 12 years of age
after general complaints of frequent abdominal pain is noted.
Minocycline
The most frequently prescribed oral antibiotic is Minocycline
because the response to its use in treatment protocols is quicker
and because it quickly penetrates the pilosebaceous hair follicles.
Unlike tetracycline, minocycline can be taken with meals as food
affects its absorption less. It is one of the most expensive drugs
on the market, which can be an issue in countries with public
state health care systems, as seen on the very minimal number
of support it has in being the first choice in oral antibiotic
treatment. Though minocycline is effective in moderate acne, its
effectivity relative to other treatments is still undetermined.
Furthermore, Minocycline causes headaches, vertigo, and hyperpigmentation
of the skin and some allergic reactions, and very rarely autoimmune
disorders like autoimmune hepatitis, hypersensitivity reactions
like hepatitis and pneumonitis. Certain cases are reported where
it causes death due to hepatoxicity and myocardial necrosis! Somehow,
gastrointestinal problems are much less compared to those caused
by tetracycline since minocycline is absorbed readily by the body.
Patients on minocycline should be checked every 3 to 4 months
for liver function and antinuclear factor in their blood.
Doxicycline
Like Minocycline, Doxicycline penetrates the pilosebaceous follicles
as well as minocycline and can be administered on an empty stomach.
Among the three drugs, doxicycline is most likely to cause dose
dependent photosensitivity reactions.
Low dose administration of doxicycline was found to be effective
and safe since the risks of developing side effects are as low
as the development of bacterial resistance. If further studies
confirm this benefit, it is likely that lower doses will become
standard.
Bacterial Resistance
The increasing bacterial resistance on antibiotic treatment of
acne has been noted as several studies. A main objective of acne
treatment research these days is to lower and impede bacterial
resistance. Compared to other antibiotics such as erythromycin,
resistance is less common with tetracycline and doxicycline and
rare with minocycline. Some strategies adopted for reducing resistance
with oral antibiotics are:
- minimizing use of antibiotics
- discontinuing oral antibiotics
when acne control is achieved
- prescribing the same oral antibiotic
for re-treatment
