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  • Presentation

Update on Antibiotics for Acne and Rosacea

Description

The presentation provides an update on the use of antibiotics in the treatment of acne and rosacea, focusing on the guidelines from the American Academy of Dermatology (AAD). It emphasizes the preference for combination therapies that include topical antibiotics (like Clindamycin) used alongside benzoyl peroxide and retinoids to mitigate antibiotic resistance. Systemic antibiotics, particularly doxycycline, are recommended for moderate to severe acne. A significant finding is the effectiveness of a triple combination therapy in reducing inflammatory lesions, showing a marked improvement over dual therapies. The speaker highlights that the treatment outcomes are generally favorable across different demographics, although females may respond slightly better. Quality of life improvements linked to the therapies are also noted. In addressing acne exacerbated by Janus kinase (JAK) inhibitors, the speaker advocates for topical options over oral antibiotics as first-line therapy. The importance of antibiotic stewardship is underscored, promoting the use of narrow-spectrum antibiotics such as Ceracycline, which has a reduced risk of gut microbiome dysbiosis. The discussion also includes the anti-inflammatory properties of tetracyclines and their implications in various conditions, including rosacea. Finally, misconceptions regarding antibiotic interactions with oral contraceptives are clarified, asserting that tetracyclines do not affect their efficacy.

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Conclusions

  • Topical antibiotics should not be used as monotherapy due to the risk of antibiotic resistance.
  • Combination therapy involving benzoyl peroxide and topical retinoids alongside antibiotics is recommended for effective acne treatment.
  • Doxycycline is preferred over azithromycin for systemic treatment of acne.
  • The triple combination topical therapy of Clindamycin, Benzoyl Peroxide, and Adapalene has shown superior efficacy compared to dual therapies.
  • Quality of life improves significantly with the use of effective topical acne treatments.
  • Both adult women and men benefit from the triple combination topical therapy, but it appears more effective in women.
  • Narrow-spectrum antibiotics should be prioritized to mitigate antibiotic resistance and protect gut microbiota.
  • Ceracycline, a narrow-spectrum antibiotic, shows effectiveness in treating acne while minimizing gut microbiome disruption.
  • Clindamycin has potent anti-inflammatory properties and remains effective against acne due to its mechanism of action.
  • The latest acne treatment guidelines emphasize multimodal therapies combining different mechanisms of action for optimal results.
  • Christopher G. Bunick, MD, PhD, Yale School of Medicine, 2024 Update to AAD Acne Guidelines
  • Del Rosso IQ, Schmidt NF. A review of the anti inflammatory properties of clindamycin in the treatment of acne vulgaris. Cutis. Jan 2010;85(1):15-24.
  • Armillei MK, Lomakin IB, Del Rosso JQ, Grada A, Bunick CG. Scientific Rationale and Clinical Basis for Clindamycin Use in the Treatment of Dermatologic Disease. Antibiotics (Basel). 2024 Mar 17;13(3):270.
  • Stein Gold L, et al. Efficacy and Safety of a Fixed-Dose Clindamycin Phosphate 1.2%, Benzoyl Peroxide 3.1%, and Adapalene 0.15% Gel for Moderate-to-Severe Acne: A Randomized Phase II Study of the First Triple-Combination Drug. Am J Clin Dermatol. 2022 Jan;23(1):93-104.
  • Grada A, Armstrong A, Bunick C, Salem R, Feldman S. Trends in Oral Antibiotic Use for Acne Treatment: A Retrospective, Population-Based Study in the United States, 2014 to 2016. J Drugs Dermatol. 2023 Mar 1;22(3):265-270.
  • Jungsoo Chang, Michael R. Nock, Jeffrey M. Cohen, Christopher G. Bunick. Healthcare Utilization of Acne Among Adults in the United States.