Acne and antibiotics - could you become a victim of 'super acne'?

Are you fed up of being warned that the whole world is heading for doom if we don't stop prescribing antibiotics? Do you think the threat of every small graze being potentially deadly is overplayed? Well, how about bringing it closer to home?

Acne affects 90% of teenagers, and three in 10 of us get acne bad enough that it causes scarring without treatment. What's more, for many people acne doesn't ever become a distant nightmare. Although it's most common between the ages of 12 and 25, it can start at any time - and without treatment, some people never get rid of it. It's much more than a cosmetic condition - it can have a huge effect on confidence and self-esteem. I've had patients who have given up on their dreams of a career in teaching or hotel management because they can't live with the sideways looks and the muttering about them being dirty.

Small sebaceous glands in your skin produce sebum, an oily substance to keep the skin moisturised. Overactive sebaceous glands, along with blocked pores, leave pockets of sebum trapped beneath the skin, providing a perfect feeding ground for a germ called Propionibacterium acnes (P.acnes). This in turn can lead to inflammation, pustules and cysts.

Antibiotics - both in tablet and topical (cream/lotion) form ­- are among the commonest treatments for acne. Interestingly, while acne-affected skin can harbour a lot of P. acnes, antibiotics work largely by reducing inflammation rather than killing off germs (1).

But new research has led to warnings that prolonged antibiotic treatment for acne could lead to patients developing 'super acne', untreatable with antibiotics. It's the length of time antibiotics are used for acne that causes particular concern. For instance, for acne and rosacea doctors are told to advise patients that they'll need to use their antibiotic treatment (whether in tablet or cream/lotion form) for at least eight to 12 weeks before they can really expect to see a difference.

Warnings have been coming out about the risk of antibiotic resistance for all sorts of skin conditions for some time. That's partly because dermatologists use antibiotics for a bigger proportion of the conditions they treat than other specialists. But it's also because they use them for much longer, giving time for resistance to build up. The fact that antibiotics don't work in acne by killing bacteria doesn't mean the bacteria can't take advantage. If a drug-resistant germ is born, it won't have competition for food if other bacteria have been killed off - so it can thrive and multiply at a rate of knots.

Some of my patients really benefit from antibiotics. If they do, they're loath to stop them for fear or their acne returning. Others throw in the towel if they don't see an improvement in a couple of weeks. Still others get some benefit, and keep on asking for antibiotics in the hope that they'll cause a further improvement. Official guidance suggests a specialist referral if acne hasn't improved after three months of treatment. But you may find your GP is reluctant to refer - my practice, along with most in the country, has strict targets for reducing referrals to dermatologists.

There are other treatments than antibiotics available for acne. GPs have been using them more in recent years in a bid to do our bit to cut antibiotic resistance. But other treatment causes side effects, including dry, red skin, so antibiotics are likely to be a popular option among patients for years to come. However, you may find after this latest warning, that your GP will want to review your medication. Stopping antibiotics every few months gives a chance to see if your acne has improved on its own. You may be able to stop using antibiotic tablets, but carry on with topical treatment to keep the improvement going. Or combining different antibiotics (a tablet with a cream) may cut the chance of resistance developing.

Acne is miserable and nobody wants to see you suffer needlessly. But your doctor may just be trying to save you from much more facial horror to come.


1) NHS Scotland/Scottish Medicines Consortium/Scottish Antimicrobial Prescribing Group, November 2015. Long term antibiotic use for acne, rosacea and other dermatology conditions.

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Egton Medical Information Systems Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.