American Journal of Clinical Dermatology

, Volume 5, Issue 2, pp 79–84

Topical Antibacterial Treatments for Acne Vulgaris

Comparative Review and Guide to Selection
Therapy in Practice

Abstract

Topical antibacterial agents are an essential part of the armamentarium for treating acne vulgaris. They are indicated for mild-to-moderate acne, and are a useful alternative for patients who cannot take systemic antibacterials. Topical antibacterials such as clindamycin, erythromycin, and tetracycline are bacteriostatic for Propionibacterium acnes, and have also been demonstrated to have anti-inflammatory activities through inhibition of lipase production by P. acnes, as well as inhibition of leukocyte chemotaxis. Benzoyl peroxide is a non-antibiotic antibacterial agent that is bactericidal against P. acnes and has the distinct advantage that thus far, no resistance has been detected against it. Combined agents such as erythromycin/zinc, erythromycin/tretinoin, erythromycin/isotretinoin, erythromycin/benzoyl peroxide, and clindamycin/benzoyl peroxide are increasingly being used and have been proven to be effective. They generally demonstrate good overall tolerability and are useful in reducing the development of antibacterial resistance in P. acnes. The selection of a topical antibacterial agent should be tailored for specific patients by choosing an agent that matches the patient’s skin characteristics and acne type. Topical antibacterial agents should generally not be used for extended periods beyond 3 months, and topical antibacterials should ideally not be combined with systemic antibacterial therapy for acne; in particular, the use of topical and systemic antibacterials is to be avoided as far as possible.

References

  1. 1.
    Shalita AR, Lee WL. Inflammatory acne. Dermatol Clin 1983; 1: 361–4Google Scholar
  2. 2.
    Puhvel SM, Sakamato M. The chemoattractant properties of comedonal components. J Invest Dermatol 1978; 71: 324–9PubMedCrossRefGoogle Scholar
  3. 3.
    Webster GF, McGinley KJ, Leyden JJ. Inhibition of lipase production in propionibacterium acnes by sub-minimal-inhibitory concentrations of tetracycline and erythromycin. Br J Dermatol 1981; 104: 453–7PubMedCrossRefGoogle Scholar
  4. 4.
    Elewski BE, Sam M, Gammon WR. In vivo suppression of neutrophil chemotaxis by systemically and topically administered tetracycline. J Am Acad Dermatol 1983; 8: 807–12PubMedCrossRefGoogle Scholar
  5. 5.
    Eady EA, Cove JH, Joanes DN, et al. Topical antibiotics for the treatment of acne vulgaris: a critical evaluation of literature on their clinical benefit and comparative efficacy. J Dermatolog Treat 1990; 1: 215–26CrossRefGoogle Scholar
  6. 6.
    Wechsler HL, Kirk J, Slone J. Acne treated with a topical tetracycline preparation: results of a one-year multi-group study. Int J Dermatol 1978; 17: 237–42PubMedCrossRefGoogle Scholar
  7. 7.
    Toyoda M, Morohashi M. An overview of topical antibiotics for acne treatment. Dermatology 1998; 196: 130–4PubMedCrossRefGoogle Scholar
  8. 8.
    Burke B, Eady EA, Cunliffe WJ. Benzoyl peroxide versus topical erythromycin in the treatment of acne vulgaris. Br J Dermatol 1983; 108: 199–204PubMedCrossRefGoogle Scholar
  9. 9.
    Swinyer LJ, Baker MD, Swinyer TA, et al. A comparative study of benzoyl peroxide and clindamycin phosphate for treating acne vulgaris. Br J Dermatol 1988; 119: 615–22PubMedCrossRefGoogle Scholar
  10. 10.
    Habbema L, Koopmans B, Menke HE, et al. A 4% erythromycin and zinc combination (Zineryt) versus 2% erythromycin (Eryderm) in acne vulgaris: a randomized, double-blind comparative study. Br J Dermatol 1989; 121: 497–502PubMedCrossRefGoogle Scholar
  11. 11.
    Dreno B, Trossaert M, Boiteau HL, et al. Zinc salts effects on granulocyte zinc concentration and chemotaxis in acne patients. Acta Derm Venereol 1992; 72 (4): 250–2PubMedGoogle Scholar
  12. 12.
    Strauss JS, Stranieri AM. Acne treatment with topical erythromycin and zinc: effect on Propionibacterium acnes and free fatty acid composition. J Am Acad Dermatol 1984; 11: 86–9PubMedCrossRefGoogle Scholar
  13. 13.
    Mills OH, Kligman AM. Treatment of acne vulgaris with topically applied erythromycin and tretinoin. Acta Derm Venereol (Stockh) 1978; 58: 555–7Google Scholar
  14. 14.
    Brisaert M, Gabriels M, Plaizier-Vercammen J. Investigation of the chemical stability of an erythromycin-tretinoin lotion by the use of an optimization system. Int J Pharm 2000; 197: 153–60PubMedCrossRefGoogle Scholar
  15. 15.
    Korting HC, Braun-Falco O. Efficacy and tolerability of combined topical treatment of acne vulgaris with tretinoin and erythromycin in general practice. Drugs Exp Clin Res 1989; 15: 447–51PubMedGoogle Scholar
  16. 16.
    Marazzi P, Boorman GC, Donald AE, et al. Clinical evaluation of double strength Isotrexin™ versus Benzamycin® in the topical treatment of mild to moderate acne vulgaris. J Dermatolog Treat 2002; 13: 111–7PubMedCrossRefGoogle Scholar
  17. 17.
    Dermik Laboratories. Prescribing information as of December 2002 (a): Benzamycin® topical gel. Berwyn (PA): Aventis Pharmaceuticals, 2002Google Scholar
  18. 18.
    Basak PY, Gultekin F, Kiline I, et al. The effect of benzoyl peroxide and benzoyl peroxide/erythromycin combination on the antioxidative defence system in papulopustular acne. Eur J Dermatol 2002; 12 (1): 53–7PubMedGoogle Scholar
  19. 19.
    Eady EA, Bojar RA, Jones CE, et al. The effects of acne treatment with a combination of benzoyl peroxide and erythromycin on skin carriage of erythromycin-resistant propionibacteria. Br J Dermatol 1996; 134: 107–13PubMedCrossRefGoogle Scholar
  20. 20.
    Gans EH, Kligman AM. Comparative efficacy of clindamycin and benzoyl peroxide for in vivo suppression of propionibacterium acnes. J Dermatolog Treat 2002; 13: 107–10PubMedCrossRefGoogle Scholar
  21. 21.
    Warner GT, Plosker GL. Clindamycin/benzoyl peroxide gel: a review of its use in the management of acne. Am J Clin Dermatol 2002; 3 (5): 349–60PubMedCrossRefGoogle Scholar
  22. 22.
    Crawford WW, Crawford IP, Stoughton RB, et al. Laboratory induction and clinical occurrence of combined clindamycin and erythromycin resistance in corynebacterium acnes. J Invest Dermatol 1979; 72: 187–90PubMedCrossRefGoogle Scholar
  23. 23.
    Bojar RA, Eady EA, Jones CE, et al. Inhibition of erythromycin resistant propionibacteria on the skin of acne patients by topical erythromycin with and without zinc. Br J Dermatol 1994; 130 (3): 329–36PubMedCrossRefGoogle Scholar
  24. 24.
    Eady EA, Cove JH, Holland KT, et al. Erythromycin resistant propionibacteria in antibiotic treated patients: association with therapeutic failures. Br J Dermatol 1989; 121: 51–7PubMedCrossRefGoogle Scholar
  25. 25.
    Eady EA, Ross JI, Cove JH. Macrolide-lincosamide-streptogramin B (MLS) resistance in cutaneous propionibacteria: definition of phenotypes. J Antimicrob Chemother 1989; 23: 493–502PubMedCrossRefGoogle Scholar
  26. 26.
    Eady EA, Farmery MR, Ross JI, et al. Effects of erythromycin and benzoyl peroxide alone and in combination against antibiotic-sensitive and resistant skin bacteria from acne patients. Br J Dermatol 1994; 131: 331–6PubMedCrossRefGoogle Scholar
  27. 27.
    Rothman KF, Pochi PE. Use of oral and topical agents for acne in pregnancy. J Am Acad Dermatol 1988; 19: 431–2PubMedCrossRefGoogle Scholar
  28. 28.
    Parry MF, Rha CK. Pseudomembranous colitis caused by topical clindamycin phosphate. Arch Dermatol 1986; 122: 583–4PubMedCrossRefGoogle Scholar
  29. 29.
    Tan HH. Antibacterial therapy for acne: a guide to selection and use of systemic agents. Am J Clin Dermatol 2003; 4 (5): 307–14PubMedCrossRefGoogle Scholar
  30. 30.
    Gollnick H, Cunliffe W, Berson D, et al. Management of acne: a report from a Global Alliance to Improve Outcomes in Acne. J Am Acad Dermatol 2003 Jul; 49 (1 Suppl.): S1-S37CrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2004

Authors and Affiliations

  1. 1.National Skin CentreSingapore

Personalised recommendations