Question: The mainstay of acne treatment is either long term oral antibiotics especially tetracyclines and/or topical antibiotic combination treatments. Do you feel this is still appropriate? Though effective patients are more concerned about long term antibiotic use-as am I!

Cliodna McNulty answered on 17 Nov 2015:

Many cases of acne can be treated without antibiotics:
If there are no inflammatory lesions; pustules, nodules or cysts, there is no need for antibiotics, either oral or topical
•The first line treatment of this type of acne is a topical retinoid (e.g. adapalene) or benzoyl peroxide. These can be used in combination
•If contraception is required, then Dianette could be considered, but once the acne is under good control, it should be stopped after 3-4 cycles because of the increased risk of deep vein thrombosis

In more severe acne with inflamed lesions; cysts and nodules, as well as blackheads. Systemic therapy should be considered especially if the area affected is extensive and involves the trunk. If it involved only the face, topical therapy could be prescribed as first line. For example, clindamycin in combination with benzoyl peroxide
•Suitable treatment regimens for acne on the back/ shoulders, in extensive disease or where there is a substantial risk of scarring or pigment change include: •Systemic tetracycline, doxycycline or lymecycline with benzoyl peroxide (to reduce resistance rates).
•Systemic tetracycline, doxycycline or lymecycline with adapalene +/- benzoyl peroxide
•Systemic tetracycline, doxycycline or lymecycline with azelaic acid (this may be a less effective combination)

•Antibiotics should be continued for 3-6 months, with consideration of topical adapalene afterwards as maintenance therapy

The RCGP now has a really excellent free on-line course on skin infection which includes acne available through the TARGET website! At http://www.RCGP.org.uk/TARGETantibiotics/