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  • Writer's pictureDr. Leslie Baumann

Oral Antibiotics Should Be a Last Resort to Treat Your Acne Patients

Updated: Mar 25, 2020

Oral antibiotics are one of the most commonly prescribed medications for acne. However, they can contribute to antibiotic resistance and other potential health problems, such as inflammatory bowel disease and collagen vascular disease. There is some evidence that oral tetracycline class antibiotics could increase the risk of breast and colon cancers.

To reduce these risks, consider other therapies for acne, such as topical products, dietary interventions, and stress reduction. For more severe acne, alternatives to oral antibiotics include oral contraceptives, oral spironolactone, and isotretinoin.

How to Treat Acne without Antibiotics

Fortunately, there are a number of alternative treatments for all types of acne. Assess your patient’s skin type and severity of acne and prescribe the appropriate treatment combination.

Skincare regimen

The proper skincare regimen for acne-prone skin is a vital step in managing this condition. Many patients are surprised to learn that both oily and dry skin types can get acne, and skincare regimens should be customized to suit both needs. For example, alpha hydroxy acid and non-foaming cleansers are better for dry acne-prone skin, while oily types can better tolerate acne-fighting ingredients like benzoyl peroxide and salicylic acid. 

Topical retinoids are a good choice for both dry and oily skin, although sensitive skin types may need to begin using this treatment product slowly to minimize side effects like drying and flaking. 

Remind your patients that the acne cycle is eight weeks long, so they will need to stick with their prescribed skincare regimen for at least that long in order to see visible results.

Lifestyle factors

Diet and stress management are important factors to consider when managing acne. Studies have shown that dairy consumption increases insulin and insulin-like growth factor-1 (IGF-1), which have been linked to increased sebum production. Interestingly, low-fat and skim milks seem to enhance IGF-1 promotion, leading to an increased risk for acne compared to whole milk. Thus, patients with acne-prone skin should avoid milk – especially low-fat and skim – whenever possible. 

Sugar is also known to contribute to acne by causing low-grade chronic inflammation throughout the body. One study found that acne is largely nonexistent in parts of the world where the population eats low-glycemic-index diets. Stress has also been shown to affect inflammatory skin conditions like acne. Researchers believe that stress may cause the nervous system to release increased amounts of neuropeptides and neurotransmitters, leading to skin inflammation. Therefore, stress management practices like deep breathing, yoga, and aromatherapy may help to clear the skin. 

Oral contraceptives

When acne is caused by hormone imbalances, the prescription of oral contraceptives can be an effective treatment option. Hormone tests can be done to determine if a patient could be a good candidate for oral contraceptives to treat acne. In the case of hormonal conditions such as polycystic ovary syndrome and adrenal hyperplasia, acne is often a secondary condition. Proper use of oral contraceptives can effectively clear the skin and mitigate the health issues associated with these conditions. 

Oral spironolactone

Spironolactone is an androgen-blocking medication that can also treat hormonal acne. Originally used as a treatment for hypertension and congestive heart failure, oral spironolactone has been shown to decrease sebum production and therefore clear acne. It is often combined with oral contraceptives, but can also be used on its own. A topical form of 5% spironolactone is currently available in Europe but not yet in the United States. 


Commonly known as Accutane, isotretinoin is a vitamin A derivative and a safe and effective oral treatment for acne. This medication has been shown to reduce sebum production in the skin, decrease acne-causing bacteria, and lower inflammation. Due to a high risk of birth defects, all female patients on this medication must use two forms of birth control and absolutely cannot become pregnant. Isotretinoin also causes dry skin, so all patients on this medication should follow a skincare regimen specific to dry skin types. 

Light therapies

Light therapies have been indicated as effective treatments for acne. Blue and red light therapy work by killing acne-causing bacteria on the skin. However, studies have shown that exposure to blue light can prematurely age the skin, so this option is less attractive than other available acne treatments.

In Summary

Oral antibiotics should not be relied on as a go-to treatment for acne. Instead, use them as a last resort therapy for severe cases that do not respond to other treatment options. Review proper skincare regimens, dietary changes, and stress management techniques with patients to aid in the management of persistent acne. 

Visit to learn more about how to easily, accurately, and effectively assess your patients’ Baumann Skin Type using a validated questionnaire and prescribe customized regimens to clear acne-prone skin.

©2019 Metabeauty, Inc.


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