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Bacteriological resistance in acne: A call to action

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European Journal of Dermatology

Abstract

Acne is common in adolescence but is also increasingly seen in adulthood, with about 40% of adults being affected. Topical and systemic oral antibiotics have been used for more than 40 years in the treatment of acne lesions. In the 1970s, evidence of resistance to topical erythromycin and clindamycin was reported and, since then, antibiotic resistance in acne has been increasing worldwide. Antibiotic exposure can be significant in acne treatment because the patient population is large and there is a tendency for prolonged treatment regimens to be prescribed. The overuse of antibiotics is now considered a major public health problem. Action is therefore required to encourage judicial and appropriate use of antibiotics in acne management in line with available evidence-based guidelines. Alternatives to topical antibiotics for the treatment of acne should be considered. Topical antibiotics should no longer be used as monotherapy in acne treatment and use in combination regimens should be limited to a maximum of four weeks. Evidence from studies suggests that, as for topical antibiotics, oral antibiotics should not be used as monotherapy, but instead should be combined with a topical retinoid or benzoyl peroxide for a maximum of four months. Correct and appropriate use of antibiotics in the treatment of acne will help to preserve their utility in the face of increasing antibiotic resistance but greater awareness of the issues is required among prescribing physicians.

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References

  1. Gollnick HP, Finlay AY, Shear N. Global Alliance to Improve Outcomes in Acne. Can we define acne as a chronic disease? If so, how and when? Am J Clin Dermatol 2008; 9: 279–84.

    PubMed  Google Scholar 

  2. Dawson AL, Dellavalle RP. Acne vulgaris. BMJ 2013; 346: f2634.

    Article  PubMed  Google Scholar 

  3. Tan J, Bhate K. A global perspective on the epidemiology of acne. Br J Dermatol 2015; 172(Suppl 1): 3–12.

    Article  PubMed  Google Scholar 

  4. Dréno B. Recent epidemiological data on acne. Annales de Dermatologie 2010; 137(Spécial issue 5): 3–5.

    Article  Google Scholar 

  5. Ballanger F, Baudry P, NéGuyen JM, Khammari A, Dréno B. Heredity: a prognostic factor for acne. Dermatology 2006; 212: 145–9.

    Article  CAS  PubMed  Google Scholar 

  6. Beylot C, Auffret N, Poli F, et al. Propionibacterium acnes: an update on its role in the pathogenesis of acne. J Eur Acad Dermatol Venereol 2014; 28: 271–8.

    Article  CAS  PubMed  Google Scholar 

  7. Dreno B, Gollnick HPM, Kang S, et al. Understanding innate immunity and inflammation in acne: implications for management. J Eur Acad Dermatol Venereol 2015; 29(Suppl 4): 3–11.

    Article  PubMed  Google Scholar 

  8. Zouboulis CC, Eady A, Philpott M, et al. What is the pathogenesis of acne? Exp Dermatol 2005; 14: 143–52.

    Article  CAS  PubMed  Google Scholar 

  9. Drucker CR. Update on topical antibiotics in dermatology. Dermatol Ther 2012; 25: 6–11.

    Article  PubMed  Google Scholar 

  10. Garner SE, Eady A, Bennett C, et al. Minocycline for acne vulgaris: efficacy and safety. Cochrane Database Syst Rev 2012; 8: 1–228.

    Google Scholar 

  11. Goulden V. Guidelines for the management of acne vulgaris in adolescents. Pediatr Drugs 2003; 5: 301–13.

    Article  Google Scholar 

  12. Thiboutot D, Gollnick H, Bettoli V, et al. New insights into the management of acne: an update from the Global Alliance to Improve Outcomes in Acne group. J Am Acad Dermatol 2009; 60: S1–50.

    Article  PubMed  Google Scholar 

  13. Dreno B, Thiboutot D, Gollnick H, et al. Antibiotic stewardship in dermatology: limiting antibiotic use in acne. Eur J Dermatol 2014; 24: 330–4.

    PubMed  Google Scholar 

  14. Stern RS. Medication and medical service utilization for acne 1995-1998. J Am Acad Dermatol 2000; 43: 1042–8.

    Article  CAS  PubMed  Google Scholar 

  15. Humphrey S. Antibiotic resistance in acne treatment. Skin Therapy Lett 2012; 17: 1–3.

    CAS  PubMed  Google Scholar 

  16. Lee YH, Liu G, Thiboutot DM, Leslie DL, Kirby JS. A retrospective analysis of oral antibiotic therapy for the treatment of acne among adolescents: investigating practice gaps and potential cost-savings. J Am Acad Dermatol 2014; 71: 70–6.

    Article  PubMed  Google Scholar 

  17. Straight CE, Lee YH, Kirby JS. Duration of oral antibiotic therapy for the treatment of adult acne: a retrospective analysis investigating adherence to guideline recommendations and opportunities for costsavings. J Am Acad Dermatol 2015; 72: 822–7.

    Article  PubMed  Google Scholar 

  18. Sardana K, Garg VK. Antibiotic resistance in acne: is it time to look beyond antibiotics and Propionobacterium acnes? Int J Dermatol 2014; 53: 917–9.

    Article  PubMed  Google Scholar 

  19. Ross JI, Snelling AM, Eady EA, et al. Phenotypic and genotypic characterization of antibiotic-resistant Propionibacterium acnes isolated from acne patients attending dermatology clinics in Europe, the U.S.A., Japan and Australia. Br J Dermatol 2001; 144: 339–46.

    Article  CAS  PubMed  Google Scholar 

  20. Luk NM, Hui M, Lee HC, et al. Antibiotic-resistant Propionibacterium acnes among acne patients in a regional skin centre in Hong Kong. J Eur Acad Dermatol Venereol 2013; 27: 31–6.

    Article  PubMed  Google Scholar 

  21. Leyden JJ. Antibiotic resistant acne. Cutis 1976; 17: 593–6.

    CAS  PubMed  Google Scholar 

  22. Crawford WW, Crawford IP, Stoughton RB, Cornell RC. Laboratory induction and clinical occurrence of combined clindamycin and erythromycin resistance in Corynebacterium acnes. J Invest Dermatol 1979; 72: 187–90.

    Article  CAS  PubMed  Google Scholar 

  23. Leyden JJ, McGinley KJ, Cavalieri S, et al. Propionibacterium acnes resistance to antibiotics in acne patients. J Am Acad Dermatol 1983; 8: 41–5.

    Article  CAS  PubMed  Google Scholar 

  24. Cooper AJ. Systematic review of Propionibacterium acnes resistance to systemic antibiotics. Med J Aust 1998; 169: 259–61.

    CAS  PubMed  Google Scholar 

  25. Oprica C, Nord CE, ESCMID Study Group on Antimicrobial resistance in anaerobic bacteria. European surveillance study on the antibiotic susceptibility of Propionibacterium acnes. Clin Microbiol Infect 2005; 11: 204–13.

    Article  CAS  PubMed  Google Scholar 

  26. Tan HH, Goh CL, Yeo MG, Tan ML. Antibiotic sensitivity of Propionibacterium acnes isolates from patients with acne vulgaris in a tertiary dermatological referral centre in Singapore. Ann Acad Med Singapore 2001; 30: 22–5.

    CAS  PubMed  Google Scholar 

  27. Ramos-E-Silva M, Ramos-E-Silva S, Carneiro S. Acne in women. Br J Dermatol 2015; 172(Suppl 1): 20–6.

    Article  PubMed  Google Scholar 

  28. Mills O Jr., Thornsberry C, Cardin CW, et al. Bacterial resistance and therapeutic outcome following three months of topical acne therapy with 2% erythromycin gel versus its vehicle. Acta Derm Venereol 2002; 82: 260–5.

    Article  CAS  PubMed  Google Scholar 

  29. Levy RM, Huang EY, Roling D, et al. Effect of antibiotics on the oropharyngeal flora in patients with acne. Arch Dermatol 2003; 139: 467–71.

    Article  CAS  PubMed  Google Scholar 

  30. Margolis DJ, Bowe WP, Hoffstad O, Berlin JA. Antibiotic treatment of acne may be associated with upper respiratory tract infections. Arch Dermatol 2005; 141: 1132–6.

    Article  CAS  PubMed  Google Scholar 

  31. Jahns AC, Lundskog B, Ganceviciene R, et al. An increased incidence of Propionibacterium acnes biofilms in acne vulgaris: a casecontrol study. Br J Dermatol 2012; 167: 50–8.

    Article  CAS  PubMed  Google Scholar 

  32. Aubin GG, Portillo ME, Trampuz A, Corvec S. Propionibacterium acnes, an emerging pathogen: from acne to implant-infections, from phylotype to resistance. Med Mal Infect 2014; 44: 241–50.

    Article  CAS  PubMed  Google Scholar 

  33. Nusbaum AG, Kirsner RS, Charles CA. Biofilms in dermatology. Skin Therapy Lett 2012; 17: 1–5.

    CAS  PubMed  Google Scholar 

  34. Eady EA, Cove JH, Holland KT, et al. Erythromycin resistant propionibacteria in antibiotic treated acne patients: association with therapeutic failure. Br J Dermatol 1989; 121: 51–7.

    Article  CAS  PubMed  Google Scholar 

  35. Eady EA, Gloor M, Leyden JJ. Propionibacterium acnes resistance: a worldwide problem. Dermatology 2003; 206: 54–6.

    Article  CAS  PubMed  Google Scholar 

  36. Ozolins M, Eady EA, Avery AJ, et al. Comparison of five antimicrobial regimens for treatment of mild to moderate inflammatory facial acne vulgaris in the community: randomised controlled trial. Lancet 2004; 364: 2188–95.

    Article  CAS  PubMed  Google Scholar 

  37. Simonart T, Dramaix M. Treatment of acne with topical antibiotics: lessons from clinical studies. Br J Dermatol 2005; 153: 395–403.

    Article  CAS  PubMed  Google Scholar 

  38. Koreck A, Pivarcsi A, Dobozy A, Kemény L. The role of innate immunity in the pathogenesis of acne. Dermatology 2003; 206: 96–105.

    Article  CAS  PubMed  Google Scholar 

  39. Nast A, Dréno B, Bettoli V, et al. European evidence-based (S3) guidelines for the treatment of acne. J Eur Acad Dermatol Venereol 2012; 26(Suppl 1): 1–29.

    Article  PubMed  Google Scholar 

  40. Thiboutot D, Dreno B, Gollnick H, et al. for the Global Alliance to Improve Outcomes in Acne. A call to limit antibiotic use in acne. J Drugs Dermatol 2013; 12: 1331–2.

    PubMed  Google Scholar 

  41. Dutil M. Benzoyl peroxide: enhancing antibiotic efficacy in acne management. Skin Therapy Letter 2010; 15: 5–7.

    PubMed  Google Scholar 

  42. Wolf JE. Maintenance therapy for acne vulgaris: the fine balance between efficacy, cutaneous tolerability, and adherence. Skinmed 2004; 3: 23–6.

    Article  PubMed  Google Scholar 

  43. Bowe W, Kober M. Therapeutic update: acne. J Drugs Dermatol 2014; 13: 235–8.

    PubMed  Google Scholar 

  44. Bowe WP. Antibiotic resistance and acne: where we stand and what the future holds. J Drugs Dermatol 2014; 13: S66–70.

    PubMed  Google Scholar 

  45. Valente Duarte de Sousa IC. Novel pharmacological approaches for the treatment of acne vulgaris. Expert Opin Investig Drugs 2014; 23: 1389–410.

    Article  CAS  PubMed  Google Scholar 

  46. Saurat JH. Strategic targets in acne: the comedone switch in question. Dermatology 2015; 231: 105–11.

    Article  PubMed  Google Scholar 

Download references

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  1. CHU Nantes, Place Alexis Ricordeau, 44093, Cedex 01, France

    Brigitte Dréno

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  1. Brigitte Dréno
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Correspondence to Brigitte Dréno.

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Dréno, B. Bacteriological resistance in acne: A call to action. Eur J Dermatol 26, 127–132 (2016). https://doi.org/10.1684/ejd.2015.2685

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