Let’s be real: acne can be a gigantic pain to deal with. With various causes, many different acne types and even more treatment options available, it can be difficult to know exactly how to minimise breakouts and treat acne scars.
Although skincare alone can be hugely effective when it comes to treating acne for some — especially bespoke formulations — sometimes those with more severe acne need antibacterials to help. Topical and oral antibacterials for acne can be really beneficial.
It can seem like a daunting prospect to get your acne under control, but we’re here to help you on your journey. Here's everything you need to know when it comes to using antibacterials for acne treatment.
What causes acne?
Acne (or acne vulgaris as it’s medically known) is the most common skin condition with 85% of Australians experiencing it at some point in their life [1].
Although acne is most common in people aged 12-24, adult acne is not uncommon. A study from 2013 suggests that it impacts 64% of those aged 20-29 and 43% of those aged 30–39 years [2].
Generally speaking, acne is typically more common in men than women [3].
Breakouts occur when the tiny hair follicles on your skin get blocked with oil and dead skin. The sebaceous glands, which are attached to these follicles, produce something called sebum, an oily secretion.
Sometimes, these glands can overproduce oil, in turn, causing the follicle openings to become clogged and as a result, whiteheads can occur.
A whitehead is known as a closed comedone. An open comedone is a blackhead, which presents with its dark colour due to reacting with oxygen in the air.
If these closed comedones are contaminated with bacteria on the skin, it can lead to pustules, papules, cysts or nodules — but we’ll dive into those more later.
So, when exactly does a breakout become acne? Though there is no universal guide to acne to determine when a formation of spots is classed as acne, a continued formation of these pimples is often determined as being acne.
It’s also important to note that acne can occur on the body as well as on the face, often presenting together. Common areas include the back, chest and shoulders as these have lots of sebaceous follicles.
Types of acne?
To make things a little confusing, not all acne is the same. In fact, there are 6 types of acne. And many of them need to be treated slightly differently.
Milder types of acne include:
Whiteheads
Whiteheads are closed comedones that, as the name suggests, are white in colour with a pin-sized head. The skin around these whiteheads appears either red or purple-hued in colour.
Blackheads
Blackheads are open comedones and are dark in colour due to a reaction with oxygen in the air; often this is confused as being dirt.
Both of these types of spots are known as non-inflammatory spots.
Moderate types of acne include:
Papules
Unlike whiteheads, papules don’t have a pin-head centre to them but are rather more rounded and bumpy. In lighter skin tones, they appear red and in darker skin tones, they appear purple, brown or grey in colour.
A papule may be painful to touch, including the skin surrounding the area.
Pustules
Pustules occur when the papules (we know they sound similar, stay with us!) form pus.
They appear slightly bigger, possibly more inflamed and have visible pus filling them; often referred to as “coming to a head”. Just like papules, pustules can be painful to touch.
Both papules and pustules can be clustered together and can be at various stages in their formation.
Severe types of acne include:
Nodules
Nodules are large, hard and inflamed bumps deeper within the skin without a whitehead.
Nodules occur due to bacteria trapped within the skin and tend to require medical treatment. It’s a painful type of acne and can lead to scarring.
Cysts
Cysts are similar to nodules, except they contain pus so are slightly less hard to touch. Many will go away on their own, but similarly to nodules, if they become infected, cysts require medical attention. If unresolved and left, they are very painful and can form scarring.
All of the above four spots are known as inflammatory, as they have been infected with bacteria on the surface of the skin.
Milia
Now, you might think that milia is a seventh type of acne but it’s not — although, it is often mistaken for acne.
Milia (also known as milk spots) are under the skin formations caused by a protein (or keratin) build-up. They typically present near the eyes and are not red or inflamed; often forming due to heavy creams.
It’s not considered acne because they do not develop in a pore. The removal treatment for this has to be done by a trained professional so acne treatments aren’t going to work for you here.
Which antibacterials are used for acne?
For moderate and severe acne, your doctor or dermatologist may suggest an antibacterial, which is often available in topical creams and oral tablets.
Oral antibacterials are a short-term treatment for getting breakouts under control, used in combination with an expert-led skincare routine, including ingredients like topical benzoyl peroxide, azelaic acid and retinoids and acids like salicylic acid.
Your doctor will guide you on which is most suitable for your individual circumstances.
What are the benefits of using antibacterials for acne?
Oral antibacterials work by helping to reduce the acne-causing bacteria (C. acnes) on the skin. Reducing C. acnes reduces inflammatory lesions, which, in turn, should reduce breakouts [4].
Like everything, these aren’t guaranteed to work. There are various factors that will impact the efficacy, many being beyond your control. But for a lot of people, oral antibacterials work well to reduce acne.
Do topical antibacterials work for acne?
You can also be prescribed topical antibacterials to help with acne, which helps keep inflammatory acne under control. Topical treatments work similarly to oral antibacterials and help to reduce the C. acnes bacteria on the surface of the skin and thus, calming inflammation and breakouts.
Due to antibiotic resistance, these topical creams may be used in conjunction with other treatments like benzoyl peroxide and retinoids (vitamin A derivative) to speed up treatment and results to reduce the length of the antibiotic course [6]. Benzoyl peroxide also has properties known to kill C. acnes.
How do oral antibacterials help with acne?
As previously mentioned, antibacterials work by reducing the C. acnes bacteria, as well as staphylococcus epidermidis, which newer studies are showing may disrupt the skin’s microbiome and contribute to acne-causing bacteria [7].
Killing this bacteria reduces a build-up of clogged follicles, leading to fewer pimples and fewer infections on existing breakouts.
Many of these also have anti-inflammatory properties meaning the acne is less angry and sore! It can provide relief to those experiencing deep, nodular and cystic acne.
Who can use antibacterials for acne?
Typically, acne has to be moderate to severe before using antibacterials as a treatment. This is because there are plenty of other treatments that can help with mild to moderate acne that have fewer side effects.
With the direction of your doctor, you can take antibiotics for acne from as young as your teenage years. Pilot's acne treatment is an ideal place to start if you’re looking for help with your acne.
Our Aussie practitioners can also create personalised topical cream formulas that treat acne without antibiotics as the first port of call. Simply complete an online consultation and our practitioners will be able to prescribe a treatment plan based on your skin needs.
How long do acne antibiotics take to work?
As with most skin treatments, it can take a while to see results, this is due to cell turnover in the skin. With acne antibiotics, it can take up to 6 weeks to start seeing improvements.
Depending on your individual circumstances and how well you’re responding to treatment, your course of antibiotics can last anywhere from 4-6 weeks.
Using antibiotics with other treatments can improve its efficacy and mean that you don’t need to be on them as long, which is something you’ll discuss with your doctor or dermatologist prescribing the treatment.
What are the limitations of acne antibiotics?
Aside from resistance and side effects (which we’ll touch on soon), acne antibiotics can’t be used alone due to other varying factors that contribute to acne and breakouts.
These include clogged pores, inflammation and increased oil production. Antibiotics can help with bacterial influences on breakouts but don’t address the other factors.
For this reason, there are limitations to antibiotics. This is why establishing a good skincare routine and looking into other contributing factors (including possible underlying health conditions) is imperative when treatment of acne with antibiotics.
Side effects of antibiotics for acne
Unfortunately, there are a few side effects caused by antibiotics used for acne. The most serious side effect is antibiotic resistance. Long-term use of antibiotics may cause antibiotic resistance; a growing concern in the Western world [4].
That’s why it’s vital to follow instructions from your doctor or dermatologist closely. This not only ensures antibiotic resistance isn’t a concern, but also that you’re getting the most effective treatment possible.
Side effects of oral antibiotics
Antibiotics increase sun sensitivity. This means you’re more likely to burn and it is likely to aggravate acne. Your skin could feel itchy, dry and inflamed.
You may also notice pigmentation changes such as dark marks. The easiest and most effective way to prevent this is staying in the shade, wearing UV-protecting clothing and applying daily sun protection according to the instructions on the back of the product.
You may also experience other side effects, including gastrointestinal disturbance such as nausea, vomiting and diarrhoea, as well as dizziness and headaches [8][4]. But, like every medication, people react differently. If you have any worries, call your doctor or visit the emergency room if it’s urgent.
Side effects from topical antibiotics
Topical antibiotics can cause things like dryness and irritation while your skin gets used to the ingredients. If this is the case, you might be advised to introduce the cream or gel into your routine slowly, and build up the frequency.
You may also experience contact dermatitis if you’re allergic to the topical antibiotic, your doctor will be able to instruct you on what to do if this is the case.
Topical and oral antibiotics should not be used at the same time.
TL;DR Antibiotics alone aren’t enough to get rid of acne and they aren’t a long-term fix due to the potential risk of antibiotic resistance. However, they can be a great treatment option for people with moderate to severe acne when used in conjunction with a good skincare routine to help manage their breakouts.
Photo credit: Getty Images
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