LAS VEGAS – Acne patients treated with oral antibiotics don’t necessarily need to stay on them for more than 3 months, according to Dr. Joshua Zeichner.
"Even if you are initially treating them with an oral antibiotic for severe acne, you can maintain them after about 12 weeks just on a topical therapy like tazarotene, explained Dr. Zeichner, director of cosmetic and clinical research in the dermatology department at Mt. Sinai Medical Center in New York. "You don’t necessarily need to keep your patients on oral antibiotics for long periods of time."
Dr. Joshua Zeichner
To prevent resistance and other problems, "try to limit use to about 3 months, and think about maintenance using just a topical therapy," he said at the Las Vegas Dermatology seminar, sponsored by the Skin Disease Education Foundation.
Several studies prove the point. In one, 189 patients with severe acne received 0.1% tazarotene gel each evening and 100 mg minocycline twice daily for 12 weeks. The 110 (58%) with at least a 75% global improvement were then assigned to 12 weeks of maintenance with tazarotene gel, minocycline, or tazarotene plus minocycline.
Keeping the antibiotic onboard past 12 weeks made no difference. All three groups – including the tazarotene-only group – did equally well. At week 24, more than 80% of the patients had at least a 50% global improvement from baseline, and 50% had at least a 75% improvement (Arch. Dermatol. 2006;142:605-12).
In his own practice, Dr. Zeichner said he often puts patients on oral antibiotics with topical therapies while they wait a month for their oral isotretinoin prescriptions to come through. "There are a lot of cases where patients don’t even end up going on isotretinoin because they are doing well," he said.
The approach also offers an alternative for severe acne patients who, for whatever reason, can’t take isotretinoin.
Another combination that’s been shown to work is minocycline extended release (Solodyn) about 1 mg/kg daily, daily clindamycin phosphate 1.2%/tretinoin 0.025% gel, and benzoil peroxide 6% foaming cloths. There’s an excellent chance isotretinoin candidates will no longer be candidates after 12 weeks of treatment, Dr. Zeichner said.
Some patients will need to stay on oral antibiotics a bit longer than 3 months. Even so, "try to get them off the antibiotic as early as possible. If they flare up again, [you can always] give them another course," he said.
Although the antibiotic may be stopped, Dr. Zeichner cautioned, it’s important to continue topical treatment to keep acne from coming back.
"I’d much rather see women on hormonal-type therapies than on oral antibiotics. I feel it gets a little more to the root of the issue," he noted.
Dr. Zeichner is a consultant, an investigator, or an advisory board member for several pharmaceutical companies, including Allergan, Beiersdorf, Galderma, Medicis, and Valeant. The SDEF and this publication are owned by Frontline Medical Communications.