What is your opinion on antibiotic use for acne?

holisticallyminded · Nov 10, 2010

Hmmm....This is quite the interesting thread and I'm quite surprised by the overwhelming support for ABO.

I had cystic acne years ago, starting in my early teens. I was prescribed tetracycline and Retin-A for years. When I finally stopped taking the ABO, I was constantly ill with every bug that came my way. It never actually totally cleared my acne and I was prescribed Accutane. I was actually part of the first 10 year trial and knew nothing about the drug. It wasn't until I worked in oncology that I realized it was actually a chemo drug with the odd SE of drying sebaceous glands. I wouldn't take it if my life depended on it now, though it certainly did keep me fairly clear for years (liver storage, of course).

I have since then had subcision and YAG for scarring with some success, I've used every topical you could ever think of. The only thing that I would really recommend is a topical retinol, with its strength based on how sensitive one's skin is to such a thing. I do use Skin Medica retinol at this time, and it works very well for me. I also greatly recommend trying to steer clear of so much dimethicone in skincare/makeup products and to find a more natural skin care line that works well for you. I like Arcona.

Systemic antibiotics really shouldn't be a first line defense for acne. It is NOT infection. It is bacteria caused by sebum production coupled with skin that doesn't exfoliate well. It took me many years to understand this. Exfoliation is absolutely the key. Salicylic acid is often not a strong enough exfoliant for some and doesn't work well. It certainly does nothing for me. Minor cases might see more sucess with this product.

I also suggest really looking at EFAs. Sebum production is hormonal and EFAs certainly help to regulate this. Larger doses are what you are wanting. Fish, flax, EPO, etc. Make sure you're getting enough vit D. 4000 units is about right. And if you can afford it or if your insurance covers it, look into a good cosmetic dermatologist AND a naturopath. This is unfortunately a lifelong issue for some of us. We just have maladapted skin. And it's hard. If anybody lives in the Seattle area, I've got some great recommendations.

NancyPie · Nov 11, 2010

Is there a way to edit messages? I would like to clarify that as far as I know she's never been OFF antibiotics in the time that I've known her. If I can edit messages I'll add this to my other comment & delete this one.

allnurses Guide · Nov 11, 2010

I will rx topicals like Retin-A and abx gels first, before going to oral abx. If I think someone needs to be on the orals long term, I then refer them to derm (but good luck getting an appt. in less than 6 months!). Unfortunately, many insurance companies won't pay for the topicals if the patient is over 18, but will pay for the oral abx. Like many other posters have said, I don't believe acne is a simple cosmetic problem. It can be painful, and can destroy the self esteem of the person suffering from it. It needs to be taken as seriously as any other medical condition.

Home Health Columnist / Guide · Nov 11, 2010

professional articles:

aafp:

topical therapy for acne - january 15, 2000 - american academy of ...

medscape:

teenagers and acne: treatment of acne

antibiotic resistance of propionibacterium acnes in acne: oral ...

mayoclinic:

acne: treatments and drugs - mayoclinic.com

SaraStrong · Nov 12, 2010

At the risk of sounding too harsh, I think the use of antibiotics such as BROAD spectrum tetracycline is extremely irresponsible. We all took microbiology, and all know the risks of the overprescription of antiobiotic meds. Physicians know this too, and have the responsibility to be as modest as they can be in prescribing them. Granted, I have never suffered from severe acne, and so don't know what it means to some people who have. But we need to keep in mind that although the risks of overprescribing antibiotics seem abstract and out of sight, they are real.

jekisslpn · Nov 13, 2010

I am getting extremely disappointed with responses to posts on this site.

We are nurses, not doctors! Granted we are required to double check medication orders prior to administration, and may be able to give input to med modification, but to reject, on a wholesale basis, treatment for a disease that a Licensed Physician has recommended is bordering on exceeeding your scope of practice.

If you want to determine what treatment a patient should receive then go to med school and become a Doctor. Follow this link to find out what a major problem acne is. http://news.yahoo.com/s/ap/20101112/ap_on_he_me/eu_britain_acne_suicide;_ylt=ApfP_HR4CEWNb4RyDetvkX.s0NUE;_ylu=X3oDMTNyODhxcjRoBGFzc2V0A2FwLzIwMTAxMTEyL2V1X2JyaXRhaW5fYWNuZV9zdWljaWRlBGNjb2RlA21vc3Rwb3B1bGFyBGNwb3MDOQRwb3MDNgRwdANob21lX2Nva2UEc2VjA3luX2hlYWRsaW5lX2xpc3QEc2xrA3N0dWR5bWFqb3JhYw--

lilaclover · Nov 13, 2010

At the risk of sounding too harsh, I think the use of antibiotics such as BROAD spectrum tetracycline is extremely irresponsible. We all took microbiology, and all know the risks of the overprescription of antiobiotic meds. Physicians know this too, and have the responsibility to be as modest as they can be in prescribing them. Granted, I have never suffered from severe acne, and so don't know what it means to some people who have. But we need to keep in mind that although the risks of overprescribing antibiotics seem abstract and out of sight, they are real.

Good to see there is at least one other person out there who feels like I do about this .

lilaclover · Nov 13, 2010

I am getting extremely disappointed with responses to posts on this site.
We are nurses, not doctors! Granted we are required to double check medication orders prior to administration, and may be able to give input to med modification, but to reject, on a wholesale basis, treatment for a disease that a Licensed Physician has recommended is bordering on exceeeding your scope of practice.
If you want to determine what treatment a patient should receive then go to med school and become a Doctor. Follow this link to find out what a major problem acne is. http://news.yahoo.com/s/ap/20101112/ap_on_he_me/eu_britain_acne_suicide;_ylt=ApfP_HR4CEWNb4RyDetvkX.s0NUE;_ylu=X3oDMTNyODhxcjRoBGFzc2V0A2FwLzIwMTAxMTEyL2V1X2JyaXRhaW5fYWNuZV9zdWljaWRlBGNjb2RlA21vc3Rwb3B1bGFyBGNwb3MDOQRwb3MDNgRwdANob21lX2Nva2UEc2VjA3luX2hlYWRsaW5lX2xpc3QEc2xrA3N0dWR5bWFqb3JhYw--

This is just a discussion. Yes we are nurses, but that doesn't mean we can't have a discussion about the issue. By no means am I going around pushing my opinion about this onto my pt's that have been prescribed an antibiotic by their physician.

But that doesn't mean I can't or shouldn't have an opinion of my own that I can freely discuss amongst other healthcare professionals.

allnurses Guide · Nov 13, 2010

I am getting extremely disappointed with responses to posts on this site.
We are nurses, not doctors! Granted we are required to double check medication orders prior to administration, and may be able to give input to med modification, but to reject, on a wholesale basis, treatment for a disease that a Licensed Physician has recommended is bordering on exceeeding your scope of practice.
If you want to determine what treatment a patient should receive then go to med school and become a Doctor. Follow this link to find out what a major problem acne is. http://news.yahoo.com/s/ap/20101112/ap_on_he_me/eu_britain_acne_suicide;_ylt=ApfP_HR4CEWNb4RyDetvkX.s0NUE;_ylu=X3oDMTNyODhxcjRoBGFzc2V0A2FwLzIwMTAxMTEyL2V1X2JyaXRhaW5fYWNuZV9zdWljaWRlBGNjb2RlA21vc3Rwb3B1bGFyBGNwb3MDOQRwb3MDNgRwdANob21lX2Nva2UEc2VjA3luX2hlYWRsaW5lX2xpc3QEc2xrA3N0dWR5bWFqb3JhYw--

With all due respect, you don't have to be a doctor to prescribe. As an NP, I do it daily. I also highly value the opinions and views of others on this website-RN, LPN, NP, etc. There's a bazillion years of experience here that I respect, even if I disagree with some statements. The title of the original post contains the word "opinion", and that's exactly what everyone has been giving here. Nothing more, nothing less. Please don't perpetuate the notion that nurses aren't allowed to question doctors or other prescribers, even if it's just on a discussion board. I'd hazard a guess that many lives have been saved because nurses questioned things.

SaraStrong · Nov 13, 2010

This is really a public health issue, not an issue about who's scope of practice it's in to say which drugs are appropriate for which health problems. The harm that prescribing an antibiotic for acne could cause an individual - maybe that's the MD's territory. The harm it could cause the community and population generally - that IS my concern and it should be everyone's concern.

OgopogoLPN, LPN, RN · Nov 13, 2010

I know of a derm who would push Accutane for EVERY ACNE PATIENT. Every age, gender, type of acne. It could be the most mild case of forehead comedonal acne in a 14 year old girl---Accutane. A moderate case of pustular acne in a 17 year old boy---Accutane. A mild to moderate case of acne vulgaris in a 21 year old woman---Accutane. All as a very first method. Pushed it very hard to patient/their parents.

Yes, a negative pregnancy test was required to get a refill, but still. This derm had so many people on Accutane. This derm would have his MA give the patient/their parents info on Accutane before the doctor even came in the room if they were there for an acne consult :eek:

Then I knew of another derm who often used long term ABX along with topical creams/gels and this derm had a great success rate with her patients.