Concurrent use of oral and topical antibiotics should be avoided and should not

Concurrent use of oral and topical antibiotics should

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Concurrent use of oral and topical antibiotics should be avoided and should not be used as monotherapy. If acne relapses, use the same antibiotic if it was previously effective. It may also be helpful to use benzoyl peroxide for 5-7 days between antibiotic courses to reduce resistance in organisms on the skin. [ 2 ] Benzoyl peroxide products are also effective against C acnes (formerly P acnes ) , and bacterial resistance to benzoyl peroxide has not been reported. [ 41 ] Benzoyl peroxide products are available over the counter and by prescription in a variety of topical forms, including soaps, washes, lotions, creams, and gels. Benzoyl peroxide products may be used once or twice a day. These agents may occasionally cause a true allergic contact dermatitis . More often, an irritant contact dermatitis develops, especially if used with tretinoin or when accompanied by aggressive washing methods. [ 41 ] If intensive erythema and pruritus develop, a patch test with benzoyl peroxide is indicated to rule out allergic contact dermatitis. Systemic treatments Oral antibiotics Systemic antibiotics are a mainstay in the treatment of moderate-to- severe inflammatory acne vulgaris. [ 33 ] These agents have anti- inflammatory properties, and they are effective against C acnes (formerly P acnes ) . The tetracycline group of antibiotics is commonly prescribed for acne. The more lipophilic antibiotics, such as doxycycline and minocycline, are generally more effective than tetracycline. [ 33 ] Sarecycline is a new first-in-class tetracycline-derived antibiotic indicated for adults and children aged 9 years and older with non- nodular moderate-to-severe acne vulgaris. Compared with currently available tetracyclines, it has a narrow spectrum of activity, including less activity against enteric gram-negative bacteria, and it also elicits anti-inflammatory effects. Clinical trials showed efficacy compared with placebo to be statistically significant. Onset of efficacy, observed by improvement of inflammatory lesions, was evident at the first follow-up visit (ie, 3 weeks). [ 42 ] Greater efficacy may also be due to less C acnes (formerly P acnes ) resistance to minocycline. However, C acnes (formerly P acnes ) resistance is becoming more common with all classes of antibiotics currently used to treat acne vulgaris. [ 43 ] C acnes (formerly P acnes ) resistance to erythromycin has greatly reduced its usefulness in the treatment of acne. [ 33 ] Subantimicrobial therapy or concurrent treatment with topical benzoyl peroxide may reduce the emergence of resistant strains. [ 44 ] Comparing subantimicrobial 40-mg doxycycline, 100-mg doxycycline, and placebo, Moore et al found a comparable percentage of patients clear of acne between at the 40-mg and 100-mg doses, both significantly higher than placebo. [ 45 ] Additionally, less drug-related adverse events were found with the 40-mg subantimicrobial dosing. Enteric-coated, delayed- release formulations of doxycycline can further reduce gastrointestinal adverse effects.
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  • Fall '20
  • V,b,n,
  • acne

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