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Antibiotic Resistance in Acne: Mechanisms, Complications and Management

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Abstract

Antibiotic resistance in acne was first observed in the 1970s, and since the 1980s has become a major concern in dermatologic daily practice. The mechanisms for this type of resistance include biofilm formation that promotes virulence and the transmission of resistant bacterial strains. Genetic mutations with modification of ribosomal RNA, alteration in efflux pumps, and enzymatic inactivation are able to create resistance to tetracyclines and macrolides. The state of art in acne treatment is no longer to use antimicrobials as monotherapy. There should be a time limit for its use plus the employment of non-antibiotic maintenance. Earlier initiation of oral isotretinoin therapy should be considered in patients with insufficient response to antimicrobials, severe acne, or a history of repeated antimicrobial use. A better understanding of acne pathogenesis, the subtypes of Propionibacterium (also known as Cutibacterium) acnes, homeostasis of the skin microbiota, and the mechanisms of antibiotic resistance would be useful in the selection of narrow-spectrum or species-specific antimicrobials, as well as the non-antimicrobial, anti-inflammatory treatment of acne. A number of novel treatments awaiting clinical proof may include the use of bacteriophages, natural or synthetic antimicrobial peptides, probiotics, and biofilm-targeting agents, as well as the reassessment of phototherapy.

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Authors and Affiliations

  1. Department of Dermatology and Venereology, Istanbul Medeniyet University, School of Medicine, Goztepe Training and Research Hospital, Istanbul, Turkey

    Melek Aslan Kayiran & Ayse Serap Karadag

  2. Department of Dermatology, Hamad Medical Corporation, Rumailah Hospital, Doha, Qatar

    Safaa Al-Khuzaei

  3. Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany

    WenChieh Chen

  4. Department of Dermatology, Pingtung Hospital, Ministry of Health and Welfare, Pingtung, Taiwan

    WenChieh Chen

  5. Dermatology and Cutaneous Biology, Jefferson Center for International Dermatology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA

    Lawrence Charles Parish

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  1. Melek Aslan Kayiran
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WenChieh Chen, Melek Aslan Kayiran, Ayse Serap Karadag, Safaa Al-Khuzaei, and Lawrence Charles Parish declare no conflicts of interest.

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Aslan Kayiran, M., Karadag, A.S., Al-Khuzaei, S. et al. Antibiotic Resistance in Acne: Mechanisms, Complications and Management. Am J Clin Dermatol 21, 813–819 (2020). https://doi.org/10.1007/s40257-020-00556-6

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