Acne Treatment with Topical Antibiotics

Dr. Thomas P. Habif, MD discusses Acne Treatment with Topical Antibiotics. See more at http://www.dermnet.com PLEASE RATE AND COMMENT!!!
Pathogenesis of inflammation



P. acnes is found in low numbers on normal skin and is probably not

infectious. The bacteria may be the primary factor in the production of

inflammatory acne. The mixture of abnormally desquamated cells and

excessive amounts of sebum in the microcomedo provides a lipid rich

environment for bacteria to thrive. They

produce neutrophil chemotactic

factors and stimulate neutrophils to release lysosomal enzymes. These

proinflammatory mediators attack the microcomedo follicular wall and

contribute to the formation of inflammatory lesions. Acne improves

when the P. acnes numbers are reduced. P. acnes is sensitive to many

antibiotics. The problem is to deliver

antibiotics into the lipid-rich

environment of the sebaceous follicles where the organism is

proliferating. Topical and oral antibiotics are used alone or in

combination with

topical retinoids. Retinoids disrupt the microcomedo.



Benzoyl peroxide

Benzoyl peroxide is an effective non-specific antimicrobial agent. It

penetrates sebum and suppresses the

growth of P. acnes more effectively than topical clindamycin and erythromycin. It has only a weak effect on inflammation and little comedolytic activity. It does not stimulate

bacterial resistance like erythromycin and clindamycin. Product formulations include gels, creams, lotions, cleansers and bar soaps. It is available in available in 2.5, 4, 5,

6, 8, 9 and 10 percent

formulations. Sulfoxyl strong and Sulfoxyl regular are 10 and 5

percent formulations of benzoyl peroxide that contain sulfur. They are

antibacterial and

keratolytic and can be very effective for patients

with pustular acne and oily skin.



PB causes concentration-dependent irritation, erythema and dryness. It

has the potential to

cause allergic contact dermatitis. Suspect this

side effect when patients complain of the acute onset of erythema and

itching at a higher intensity that would be expected from

just

irritation from the base. Benzoyl peroxide can bleach clothing.



Benzoyl peroxide/clindamycin

Benzoyl peroxide is available as a 5 percent gel in combination with

erythromycin called Benzamycin. There are two benzoyl peroxide

clindamycin combination products. Benzaclin is available in a jar.

Duac is available in a tube. These

combination products result in

greater reductions in inflammatory lesions and comedones at 16 weeks when compared to monotherapy with clindamycin. BP helps to reduce the

emergence to resistant variants of P. acnes.



Clindamycin

Clindamycin is effective as monotheryapy for short periods of

treatment. Products include solution, lotions, gels and

pledgets. It

can be especially effective when used as combination therapy with

retinoids such as tretinoin, tazarotene, and adapalene. If use for

longer than 3 months is

required than switch to a combination benzoyl

peroxide/clindamycin product to avoid the problems of bacterial

resistance to clindamycin.



Sodium sulfacetamide and sulfur

These

combination products have been available for many years. They

have antimicrobial activity and are keratolytic. They inhibit comedogenesis by normalizing desquamation of the

follicular epithelium. They may cause irritation. Recently may gel, cream and cleanser formulations have become available. Klaron lotion is pure

sulfacetamide and is less

irritating.



Azelaic acid

Topical Azelaic acid has been available in Europe for years. It reduce

P. acnes to about the same degree as topical clindamycin. It has mild

comedolytic

and antiinflammatory activity. It also suppresses

post-inflammatory hyperpigmentation that is a problem in patients with

a dark complexion.

Category:

Education

Tags:

• Acne
• Treatment
• with
• Topical
• Antibiotics
• Cure

[TAS34232]

Nicely done video. FYI, you can order a few of the mentioned products online at RxPalace DOT com with no prescription required. Fully licensed, US Pharmacy, in business over 11 years.

[marcuspharmacien]

Well done Dr. Habif! Very informative. Thank you.

[therapeutics23]

@723965 i don't think azelaic can be used on darker complextions because it has a bleaching effect. did this therapy that you described here work for you? and how old are you and what is ure severity of acne? i'm trying to figure out a routine for my own skin, i'm tired of going to the dermatologist

[usachick1015]

I have a quick question I used benzaclin before and it worked wonders only problem is when I stopped all my acne came back, I have a new doctor and am now using clindamycin phosphate gel 1% nowadays I get whiteheads on my cheek a little less than A moderate amount, and I have little bumps on my forehead, before the benzaclin worked great on my forehead since it was the only place with acne but now I have white heads would you recommend going back to benzaclin for the whitehead or not?