Dr Johanna Ward on why antibiotics belong to yesterday’s acne treatment methods
"Since the late 1970’s we have observed a huge increase in antibiotic resistance that has become a major concern for the medical & dermatology world."
Guest blog contributed by Dr Johanna Ward, award-winning cosmetic Doctor, GP, dermatologist - Vitalize Skin and Wellness Clinic, United Kingdom
"A growing number of infections are becoming harder to treat such as tuberculosis, blood poisoning, pneumonia, gonorrhoea and food poisoning because the bacteria that cause them are becoming resistant to antibiotics.
The World Health Organization (WHO) cites antibiotic resistance as ‘one of the biggest threats to global health’ and warns us that ‘we are heading for a post-antibiotic era in which common infections and minor injuries can once again kill’.
What about acne treatment?
For many years antibiotic therapy has been an important part of acne treatment in either topical or oral form. But nowadays we deal with such endemic levels of resistance that we have had to reduce our reliance on antibiotics and explore novel and new ways of treating acne.
Antibiotics have been used in acne to help reduce bacterial infection, reduce inflammation and to reduce sebum (oil) production. In mild cases they are used topically and for moderate to severe cases they are used orally or systemically.
The recommendation nowadays is to minimize use of antibiotics in acne as much as possible. If we do need to use topical antibiotics then we generally combine them with something called benzoyl peroxide to reduce antibiotic resistance. (Benzoyl peroxide is a topical acne treatment that works like an antiseptic and kills the surface bacteria). Topical medication like Duac combine clindamycin (an antibiotic and benozyl peroxide).
If oral antibiotics are needed for treating moderate to severe acne then we normally use them only for short term therapy and ideally for less than three months. They aren’t ever first line treatments. By that I mean we try other topical treatments first and non-antibiotic treatments to avoid over reliance on antibiotics.
Those of us in General Practice agree with the WHO endeavor to try to rapidly reduce our global overuse of antibiotics now so that we can quickly try to reverse the impending problem of resistance and the development of so called ‘Super Bugs’. Common antibiotics still prescribed for acne belong to the tetracycline family and include Lymecycline, Minocycline and Doxycycline. These typically still have some effect on acne but we are seeing that reduce over time hence our need to explore new treatments and therapies.
A great alternative?
A great alternative option for the treatment of acne is the use of light. Blue light has been clinically evidenced to reduce the bacteria Propionibacterium Acnes that sits in oil glands in acne and causes inflammation.
Phototherapy is the use of light as a treatment and is remarkably effective for treating acne, especially acne caused by inflammation or bacteria.
Blue light utilizes a wavelength of 415-495 nm making it one of the shortest and highest energy wavelengths. This wavelength has well evidenced antimicrobial effect on the skin with lots of data now existing in favor of blue light and the treatment of acne.
Even better is the fact that light treatment comes with very few side effects when compared to more standard treatments for acne such as antibiotics, retinoids and benzoyl peroxide.
Typically, blue light treatments are performed several times a week in a dermatology office or in the patient's own home with a home light device.
An expert’s recommendations
Blue light doesn’t damage or harm the skin like ultraviolet does but we still need to be mindful of protecting the skin when using this kind of therapy. Short exposures under the guidance of a professional is the safest way to proceed.
I use the DermaLUX LED system in my office and recommend that my patients use the LUSTRE device at home. The key with light therapy is little and often. I like my patients to use their home devices daily and to commit to a 6–8-week program to get the best results."