Topical Antibiotics for Acne

Since acne is, in part, caused by bacteria, topical antibiotics (meaning, those that get applied to the skin) are one way to treat acne. Topical antibiotics are typically used for mild to moderately severe inflammatory acne.

Medications like clindamycin and erythromycin are most commonly used for this purpose. Topical tetracycline is another option, but it's prescribed less often because it is known to cause skin discoloration. These come in a variety of forms, including lotions, gels, pads, and toner-like solutions.

This article covers how topical antibiotics work for acne and the possible side effects of using them. It also includes some best practices for using topical antibiotics as part of your skin care routine.

Types of Topical Antibiotics for Acne

The most commonly used topical antibiotics for treating acne are erythromycin and clindamycin. They are available in solutions, lotions, gels, and saturated pads.

Clindamycin 1% solution or gel is considered the preferred treatment of the two antibiotics, in part because the risk of bacterial resistance is slightly higher with erythromycin.

Many healthcare providers avoid prescribing erythromycin all together and may only prescribe clindamycin when absolutely necessary.

Using an Additional Acne Treatment Helps Topical Antibiotics Work Better

While both erythromycin and clindamycin are effective for treating acne, they aren't usually prescribed by themselves due to the increasing risk of bacterial resistance.

Some healthcare providers also believe that topical antibiotics are becoming less effective precisely because of bacterial resistance.

Instead, combining a topical antibiotic with a second acne treatment like benzoyl peroxide is considered the safest and most effective treatment plan.

While antibiotics reduce bacteria and inflammation, they do nothing to reduce pore blockages or stop microcomedones (the tiny beginnings of a pimple under the skin) from forming.

Pairing topical antibiotics with another acne medication ensures you're treating all causes of acne, not just bacteria, so your treatment regimen will be much more effective.

Other acne medications that may be paired with topical antibiotics include:

• Benzoyl peroxide is a likely choice. It works well with topical antibiotics and can help reduce the likelihood of developing antibiotic-resistant bacteria.
• Topical retinoids are another option that works well with topical antibiotics. These rapidly exfoliate your skin, reducing the formation of comedones (blocked pores). 
• Spironolactone or birth control pills aren't as commonly used, but they can be helpful in certain cases where hormonal fluctuations are contributing to acne breakouts. These can only be used by teen girls or adult women.

Combination Prescription Acne Medications

There are some acne treatments available that combine topical antibiotics with another acne treatment in one medication.

Combination acne medications like these aren't necessarily any more effective than using the medications separately. The benefit is they streamline your acne treatment routine. A drawback, though, is that they can be pricey compared to some other acne medications.

Some of the available combination medications are:

• Acanya, Onexton (clindamycin and benzoyl peroxide)
• Benzamycin (erythromycin and benzoyl peroxide)
• Cabtreo (clindamycin phosphate, adapalene, and benzoyl peroxide)
• Ziana (clindamycin and tretinoin)

Cabtreo (clindamycin phosphate, adapalene, and benzoyl peroxide) is the first-ever triple-combination topical gel approved by the Food and Drug Administration (FDA) for treating acne in people ages 12 and older.

Depending on your skin, one of these might be a good fit for you. Again, your dermatologist will help create the best treatment plan.

How Topical Antibiotics Are Used

Antibiotics—oral and topical—inhibit the growth of bacteria. Propionibacteria acnes, or P. acnes, is a chief cause of acne.

This bacterium is an ordinary resident of the skin. But in those with acne, the P. acnes population grows out of control. These bacteria irritate the skin's follicles, creating inflamed papules and pustules.

Applying a topical antibiotic directly to your skin reduces the amount of the bacteria, which in turn helps control acne. Topical antibiotics also reduce inflammation, so they work best for inflamed breakouts rather than non-inflamed blemishes or blackheads.

Application

Topical antibiotic acne treatments can sometimes cause mild skin irritation in the form of dryness and flakiness, especially when used with benzoyl peroxide or retinoids.

To help prevent this, your dermatologist may recommend using a moisturizer that contains anti-inflammatory ingredients, such as:

• Aloe vera
• Witch hazel
• Bisabolol
• Chamomile
• Coconut oil
• Cucumber extract
• Green tea extract
• St. John's wort

Always start your skincare regimen by cleaning your face, ideally with a cleanser that contains benzoyl peroxide. Next, dry your face with a clean towel, then apply your topical antibiotic acne medicine. Your moisturizer should be applied last, after you have applied your acne medicines.

Possible Side Effects

Serious side effects from topical antibiotics are very rare. Most people can use topical antibiotics without difficulty, but some people may experience some mild side effects.

Possible side effects depend on the type of medication you're using. Sometimes, the medication can burn or sting slightly when it's applied. Other side effects may include:

• Dryness
• Flakiness
• Minor skin peeling
• Mild skin irritation

Although uncommon, there have also been some reports of contact dermatitis linked to the use of topical antibiotics. That risk may be higher if you have sensitive skin, a history of allergic reactions to skin treatments, or have used topical antibiotics repeatedly.

When Are Topical Antibiotics Considered?

When considering whether a topical antibiotic is a suitable acne treatment for you, your healthcare provider will consider the location and severity of your acne, your age, and any treatment preferences you may have.

Generally, topical antibiotics are only considered for moderate to severe acne when other treatments fail to achieve the desired results. If your healthcare provider believes a topical antibiotic is necessary, they may prescribe it in combination with another acne treatment like benzoyl peroxide.

Contraindications

Topical clindamycin and erythromycin should not be prescribed to people who have previously had an allergic reaction to an antibiotic or a history of antibiotic sensitivity.

Topical antibiotics should also be used with caution in people who have a history of antibiotic-associated colitis, Crohn's disease, or regional enteritis, in which the small intestine is irritated or inflamed.

Some research also shows that antibiotic use may be associated with an increased risk of inflammatory bowel disease.

Clindamycin and erythromycin should not be prescribed to people who are pregnant or who could become pregnant, as the antibiotics have been linked to birth defects in clinical trials.

Furthermore, both antibiotics are known to pass into breastmilk, and should not be used by people who are breastfeeding.

Summary

Topical antibiotics like erythromycin and clindamycin are effective acne treatments that work best when paired with a second topical treatment like benzoyl peroxide or retinoids. Pairing them with another topical treatment also reduces the risk of bacterial resistance.

If you are prescribed a topical antibiotic for your acne, it's important to use it for the full course of treatment, even if your acne starts to get better after a few days. Side effects like skin dryness and flakiness are uncommon and generally mild.