From Angela Palmer,
Your Guide to Acne.
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About.com Health's Disease and Condition content is reviewed by Kate Grossman, MD

If over-the-counter treatments like benzoyl peroxide and salicylic acid aren't improving acne, your doctor may suggest topical antibiotics.

Clindamycin and erythromycin are the most commonly prescribed antibiotics for topical acne treatment. Tetracycline is used less often. Topical antibiotics come in a variety of forms, including lotions, gels, pads (pledgets) and toner-like solutions.

In addition, topical antibiotics can be found in medications containing other acne treatments such as benzoyl peroxide or Retin A (tretinoin).

How They Work

Just like oral antibiotics, topical antibiotics inhibit the growth of bacteria. A chief cause of acne is the proliferation of the acne-causing bacteria Propionibacteria acnes (P. acnes). 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 reduces the amount of P. acnes, and helping to control acne. Because P. acnes create inflammation, topical antibiotics work best for inflamed acne, rather than non-inflamed blemishes or blackheads.

Common Usage Directions

Most topical antibiotics are applied once or twice per day. Before application, the skin should be cleansed and thoroughly dried. The medication is then applied over all areas prone to acne breakouts.

Possible Side Effects

Most people can use topical antibiotics without difficulty. Side effects, when they do occur, aren't usually too bothersome. The most common side effects are:

• Burning or stinging when medication is applied
• Dryness, flakiness, or peeling of the skin
• Mild skin irritation
• Yellowing of the skin (tetracycline only)

Very rarely, topical antibiotics cause more serious side effects such as:

• Stomach pain
• Vomiting and/or severe diarrhea
• Rash
• Unexplained bleeding or bruising

Tips for Using Topical Antibiotics

• Tell your doctor about all medications you are using, including topical treatments and over-the-counter acne products. Also, let your doctor know if you are pregnant.
• To reduce the chance of burning or stinging, wait at least 30 minutes after cleansing and/or shaving before applying your medication.
• Using astringents, aftershave, alpha hydroxy acids or other exfoliating products can increase the chance of developing uncomfortable dryness and irritation.
• Let your doctor know right away if you experience any side effects.

• Find a Dermatologist

_Sources:

"Clindamycin." Medline Plus. 1 Apr 2003. U.S. Library of Medicine & National Institutes of Health. 31 Dec 2007.

"Erythromycin and Benzoyl Peroxide Topical." Medline Plus. 1 Oct 2003. U.S. Library of Medicine & National Institutes of Health. 31 Dec 2007.

"Prescription Medications for Treating Acne." 2007. Acne Net. American Academy of Dermatology. 31 Dec 2007.