Journal
JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY
Volume 80, Issue 2, Pages 538-549Publisher
MOSBY-ELSEVIER
DOI: 10.1016/j.jaad.2018.09.055
Keywords
acne; antibiotics; antibiotic stewardship; diet; evidence-based medicine; guidelines; isotretinoin; laser; spironolactone
Categories
Funding
- National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health [T32-AR-007465]
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Acne is one of the most common diseases worldwide and affects; 50 million individuals in the United States. Oral antibiotics are the most common systemic agent prescribed for the treatment of acne. However, their use might be associated with a variety of adverse outcomes including bacterial resistance and disruption of the microbiome. As a result, multiple treatment guidelines call for limiting the use of oral antibiotics in the treatment of acne, although actual prescribing often does not follow these guidelines. In this review, the rationale for concerns regarding the use of oral antibiotics for the management of acne is reviewed. In addition, we will discuss our approach to complying with the intent of the guidelines, with a focus on novel topical agents, dietary modification, laser and light-based modalities, and systemic medications, such as spironolactone, combined oral contraceptives, and oral isotretinoin.
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