Topical and systemic acne therapy: use of antibacterial drugs

The demand for antibacterial drugs is explained by the fact that antibacterial drugs, both when applied topically and systemically, lead to a decrease in the colonization of P. acnes, as well as nonspecific pathogenic flora (streptococci, staphylococci, E. coli, etc.). The drugs reduce the population of P. acnes by 90% or more, reducing the proportion of free fatty acids in surface lipids by 50%. In addition, they are able to significantly reduce the inflammatory process during acne. It has been shown that tetracycline antibiotics inhibit bacterial lipases, have immunosuppressive and anti-inflammatory effects, in particular, reducing the secretion of cytokines, reducing the activity of metalloproteinases and directly inhibiting lymphocyte mitosis.

In recent years, there have been reports of a specific effect of systemic antibiotic therapy (macrolides and tetracyclines) on sebocyte activity and the level of unsaturated fatty acids (in particular, linolenic and linoleic) in sebum, as a result of which follicular detritus is liquefied and its release to the skin surface is improved. Successful treatment reduces the population of P. acnes, but leads to the eradication of this microorganism. The widespread use of antibiotics has led to the development of resistance and ineffectiveness of antibiotic therapy, only some of them can be recommended for the treatment of acne.

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