Antibiotics for Acne: How Much Is Too Much?

Health experts warn that taking too many antibiotics can do more harm than good. Just look at the increase in antibiotic-resistant “superbugs.”

That’s why more dermatologists are trying to crack down on the long-term use of oral antibiotics for acne. Dermatologist Amy Kassouf, MD, says it’s not uncommon to see teens taking antibiotic pills for six months or longer.

“We need to stop that,” she says. “Today, the common belief is you shouldn’t take oral antibiotics for more than two or three months in a row.”

Why long-term antibiotics won’t cure acne

Antibiotics alone are not enough to treat acne. Acne is a complex condition involving four factors:

• Clogged pores. Hair follicles fill with oil, bacteria and dead skin cells. This is when whiteheads or blackheads form.
• Oil production. Usually during puberty, an increase in hormones causes glands to secrete more oil.
• Bacterial growth. Bacteria live on your skin all the time, but an increase in oil causes them to multiply.
• Inflammation. The increase in bacteria causes inflammation. Acne can go deeper into your skin and grow into bigger nodules and cysts.

“Antibiotics will help control bacterial growth,” says Dr. Kassouf. “But if we don’t address the other factors as well, we won’t treat acne successfully.”

Treatments that help eliminate acne

For the average kid or teen with acne, Dr. Kassouf recommends:

• 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 sulfa base. These can diminish bacteria and yeast in order to decrease inflammation and can be safely used with other topical products, as well as less irritating for sensitive skin.
• Topical retinoids. Creams with retinoids (made from vitamin A) can break up whiteheads and blackheads. These retinoids make dead skin cells less sticky so that they can clear out of the pores more easily and not only treat the active acne but help prevent it from coming back.
• Topical antibiotics. Apply them directly to the skin to control bacteria and inflammation. 

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

It’s critical to use topical antibiotics with benzoyl peroxide, she notes. Benzoyl peroxide kills bacteria in a different way than antibiotics. Using them together makes it less likely that bacteria will become antibiotic-resistant.

Oral antibiotics are for severe cases. However, applying antibiotics to the skin can cause fewer side effects than swallowing antibiotics that circulate through your body.

“In general, topical antibiotics can be used longer than oral antibiotics,” says Dr. Kassouf.

What if standard acne treatments don’t work?

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

• Isotretinoin. This oral retinoid can shrink the size of oil glands.
• Hormone therapy. Some women have acne due to excess androgen (male hormone). They may also have irregular periods and thinning hair. Low-dose estrogen and progesterone (birth control pills) may help.
• Low-glycemic diet. Some studies have found a link between acne and sugar intake. “Cutting back on sugar can help with other inflammatory skin diseases, too,” says Dr. Kassouf. “Start by avoiding sugary drinks.”

Don’t wait to treat acne

You may think of acne as a teenage problem, but it’s not uncommon for acne to appear around age 9. The earlier it comes, the earlier it may go. However, those who start puberty later may have acne into their 20s.

“Acne usually subsides on its own, but treatment is important if your child is bothered by his or her appearance,” says Dr. Kassouf. “It’s also important if you’re concerned about long-term effects. Severe acne can leave scars and cause skin discoloration.”