Antibiotics for Acne: Types, Side Effects & Controversies

If you’re prone to acne outbreaks, there are many treatment options available to help clear up blemishes.

The problem is, having so many options can be overwhelming.

For people suffering with moderate to severe acne that has not improved with topical treatments, a doctor or dermatologist may prescribe oral antibiotics that which can kill bacteria, reduce inflammation, and even balance hormone levels.

But if you receive a prescription, it’s important to understand how  those antibiotics work, potential side effects, and more.

What is Acne?

Acne is a skin condition that occurs when pores become clogged with excess oil, bacteria, and dead skin cells, resulting in breakouts of visible blemishes on or underneath the surface of the skin.

Acne blemishes most commonly appear on the face, forehead, chest, upper back, and shoulders and can range from small, red bumps (pimples) to large cyst-like lumps.

No matter the size or type, all acne blemishes begin with a blocked pore.

Pores—small openings in our skin—are either oil pores or sweat pores.

• Oil pores: These openings are at the base of hair follicles, which contain  sebaceous glands (oil glands). These pores not only allow hair to grow out of the follicle, but they also allow dead skin cells, natural bacteria, and the sebum (oil) our bodies produce to come to the surface. This process is important for moisturizing and protecting our skin.

• Sweat pores: The pores that allow sweat to escape from our bodies are much smaller than oil pores, and can’t be seen with the naked eye. Sweat pores are not responsible for acne.

Acne occurs within oil pores when our bodies produce too much sebum, or when the opening of the pores becomes otherwise blocked.

When the body starts making too much sebum, the excess oil causes dead skin cells to stick together and build up inside the pore rather than rising to the surface where they can be shed.

If the pore closes with oil and skin cells trapped inside, it will produce a whitehead.

If the pore remains open to the air, the dead skin cells trapped inside will darken, producing a blackhead.

Natural bacteria that live on our skin may also get trapped in a clogged pore.

Once inside the pore, these bacteria can multiply faster than usual and fill the pore, causing it to become inflamed.

If the blocked hair follicle becomes inflamed or infected due to bacteria, it will produce a pimple—a swollen red bump with a white or yellow center.

If the inflammation develops deep inside the hair follicle, it will produce a lump (cyst or nodule) beneath the surface of the skin.

Types of Antibiotics for Acne

The goal of acne treatment is to help heal blemishes, stop new blemishes from forming, and prevent scarring.

Antibiotics are specifically prescribed to help slow or stop the growth of bacteria that clogs the pores and reduce inflammation.

Tetracyclines

Oral tetracyclines are the most widely prescribed class of antibiotics for acne.

They work by slowing down the growth of bacteria and act as an anti-inflammatory.

Tetracyclines are commonly used to treat moderate to severe acne.

Minocycline

Minocycline (Dynacin) is a tetracycline antibiotic commonly used to treat skin conditions like acne. As described above, it works to prevent bacteria growth and inflammation. Although similar to doxycycline, several studies suggest that minocycline patients had fewer relapses in symptoms and a longer remission period. 

Doxycycline

Similar to minocycline, doxycycline (Vibramycin) is a tetracycline antibiotic used to treat acne by stopping bacterial growth and inflammation.

It is believed to cause fewer side effects than minocycline.

Septra/Bactrim and Macrolides

Septra or Bactrim (Sulfamethoxazole/Trimethoprim) and Zithromax (Azithromycin), a macrolide, have sometimes been used to treat moderate to severe inflammatory acne.

However, allergic reactions (sulfa allergy) are fairly common with sulfonamides, and significant resistance has been seen with both of these categories of antibiotics.

Topical Medications 

Most acne medications are topical treatments that you apply to the affected areas of your skin.

Some are designed to kill bacteria in the pores, while others reduce oil production.

The most common topicals are available over-the-counter and contain benzoyl peroxide or salicylic acid.

It’s recommended to use topical treatments continuously for 4-8 weeks to determine whether your acne is improving before considering changing to a different treatment.

If over-the-counter medications aren’t working, you may want to make an appointment with a dermatologist who may prescribe a stronger topical antibiotic.

Prescription topicals may contain a retinoid, antibiotic, or prescription-strength benzoyl peroxide.

Side Effects

As with many medicines, tetracycline antibiotics can cause side effects.

The most common include: 

• Nausea
• Vomiting
• Diarrhea
• Headache
• Fatigue
• Dizziness
• Itching
• Photosensitivity
• Tooth discoloration
• Reduced bone development in children

Minocycline has been associated with rare instances of liver failure and hepatitis.

Patients with known hepatic impairment should avoid minocycline or be monitored closely while taking.

Doxycycline has been associated with the rare but serious adverse event of Stevens-Johnson syndrome (SJS).

SJS may present with small purple or red spots, blisters, skin peeling, and/or rash.

It is a very serious condition that requires immediate medical attention.

Antibiotic Resistance 

Sometimes the bacteria that cause acne can develop the ability to defeat the drugs designed to kill them—this is called antibiotic resistance.

In recent years, reports of antibiotic resistance to common acne treatments have increased.

To limit resistance, it is recommended that benzoyl peroxide should always be added when long-term oral antibiotic use is deemed necessary.

It’s also recommended that this course of treatment last no longer than three months. 

When to See a Doctor 

If you have inflammatory acne that hasn’t responded to other treatments, talk with your doctor about whether an antibiotic might be an option for you.

If you are currently taking an antibiotic to treat acne and experience any severe or unusual side effects, you should stop taking the medication and contact your doctor immediately. 

How K Health Can Help

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