Antibiotics for Acne: How Much Is Too Much?

We all have bacteria living on our skin. But if you have acne, that bacteria can sometimes cause inflammation or flare-ups, which can make your skin issues even worse.

But can antibiotics help?

While antibiotics can sometimes kill off harmful bacteria and help with some moderate-to-severe forms of acne, they should be used for short periods unless otherwise prescribed by your healthcare provider.

Dermatologist Jonathan Braue, MD, explains how antibiotics can help and which circumstances typically call for their use.

What type of acne can antibiotics help?

Antibiotics are most beneficial for moderate-to-severe deep, inflammatory acne. Antibiotics with this type of acne can help reduce inflammation when other treatments have trouble working. They can also help stop the growth of Propionibacterium acnes bacteria on your skin, which helps reduce the severity of flare-ups.

Inflammatory acne runs much deeper than other types of acne and includes:

• Pimples
• Pustules
• Nodules
• Cysts

“An increase in bacteria causes inflammation, which can make acne go deeper into your skin and grow into bigger nodules and cysts,” explains Dr. Braue. “That’s when it becomes more difficult to treat.”

Oral vs. topical antibiotics

If your provider determines that it’s time to try antibiotics, there are two possible ways to go about it:

• Topical antibiotics (like erythromycin) come in gels, lotions and wipes. You apply them directly to the affected area of your skin to help manage bacterial growth and inflammation.
• Oral antibiotics (like doxycycline) come in pill or liquid form. They have more widespread effects that can affect your entire body, so they’re typically reserved for more severe cases of inflammatory acne.

Side effects and drawbacks of taking antibiotics for acne

The longer you take antibiotics, the higher the chance that bacteria can become resistant to them. When this happens, bacterial infections become harder to treat.

“Today, the common belief is you shouldn’t take oral antibiotics for more than two or three months in a row,” clarifies Dr. Braue. “In general, topical antibiotics can be used longer.”

Plus, treating acne with antibiotics alone is like pulling weeds without taking care of the soil. It might help with appearances for a little while, but it won’t always address what’s happening below the surface.

That’s because acne is a complex condition with many root causes. It will continue to resurface unless you address underlying causes, like:

• Inflammation
• Clogged pores
• Hormonal imbalances
• An overproduction of sebum (skin oils)

“If you use antibiotics as prescribed, they’ll help control bacterial growth,” says Dr. Braue. “But if we don’t address the other factors as well, we won’t always treat acne successfully.”

Alternative treatments for acne

In most cases, especially for teens, Dr. Braue recommends the following over-the-counter and prescribed alternatives to antibiotics:

• Skin washes with benzoyl peroxide or salicylic acid: Benzoyl peroxide kills bacteria on the skin and helps remove oil and dead skin cells. Salicylic acid helps unclog pores.
• Skin washes with a sodium sulfacetamide base: These can diminish bacteria and yeast, decreasing inflammation. They can be less irritating for sensitive skin and can be safely used with other topical products.
• Topical retinoids: Creams with retinoids (made from vitamin A) can break up whiteheads and blackheads. These retinoids make dead skin cells less sticky so they can clear out of the pores more easily. They not only treat active acne, but they can also help prevent it from coming back.

“Usually, we start with skin washes and add topical retinoids next,” explains Dr. Braue. “We only add a topical antibiotic if the first two treatments aren’t enough.”

If you are prescribed a topical antibiotic for acne, it’s best used alongside benzoyl peroxide, says Dr. Braue. Benzoyl peroxide kills bacteria differently from antibiotics, so using them together makes it less likely that bacteria will become antibiotic-resistant.

For severe acne that doesn’t respond to standard treatment, there are other options, too:

• Isotretinoin is an oral retinoid that can shrink the size of oil glands.
• Hormone therapy can be helpful for women who have acne because of excess androgen (male hormone). Low-dose birth control pills may help. Dr. Braue often recommends options that use both estrogen and progesterone.
• A low glycemic index diet can help reduce inflammation associated with acne and other skin conditions. Start by limiting sugary drinks and how much sugar you consume.

“Treating acne is important if you’re bothered by its appearance or you’re concerned about long-term effects, like scars or skin discoloration,” advocates Dr. Braue. “But antibiotics are usually never the only solution we turn to when we’re treating acne.”