The simplest method of understanding how antibiotics work in association with acne, is to have a basic knowledge of the mechanisms involved. Acne usually starts around puberty and is the result of hormonal changes that occur at that time. The production of the male hormone androgen, which occurs in both males and females, stimulates the tiny pilosebaceous units in the skin (the structure consisting of hair, hair follicle, arrector pili muscle and sebaceous gland) to produce an excess of sebum and become blocked by an overgrowth of skin cells. There are millions of pilosebaceous units in the skin, predominantly on the face, back and chest - the areas most affected by acne. Sebum is a greasy substance, produced by the sebaceous glands, and is necessary to hydrate the skin. When the pilosebaceous unit starts to block (the structure consisting of hair, hair follicle, arrector pili muscles, and sebaceous gland), it becomes invaded by a germ called Proprionbacterium Acnes, more conveniently known as P Acnes.

The combination of blockage, excess sebum and infection by P Acnes, causes inflammation and the characteristic appearance of blackheads, red spots (papules) and small bumps on the skin (pustules).

For most people, mild to moderate acne can be treated by using over-the-counter treatments from a pharmacy. However, in severe cases your doctor may recommend a prescription treatment, using medicines that tend to be more effective in some patients, as they are stronger.

Antibiotics decrease the number of bacteria in and around pores. It also help reduce chemicals produced by white blood cells and the concentration of free fatty acids in the sebum which, in turn, reduces the inflammation.

Antibiotics, either oral or topical, can be successfully used in the treatment of acne.There are two types of antibiotics available: Oral (tablet or syrup format) and Topical (a cream or ointment applied to the skin). Oral medications can be used in combination with topical medications however both can be used alone. It is thought that doctors prefer to treat the infection first with oral medications that will not only treat the infection but will also have anti-inflammatory qualities too. More serious acne is often treated with a combination of antibiotics and topical treatments.

Oral antibiotics are usually only prescribed to adults

The most frequently used antibiotics are:

  • Erythronmycin - an anti-inflammatory that helps reduce redness and kills bacteria.
  • Tetracycline – significantly helps reduce lesions.
  • Minocycline – a form of tetracycline that fights bacteria.
  • Doxycycline – used for patients who don’t respond to Erythronmycin/Tetracycline or are unable to tolerate them.
  • Clindamycin – treats the bacteria.

Topical antibiotics are in the form of creams, gels and lotions that usually contain stronger doses of the active ingredients. Topical antibiotics can help reduce infection in or on the skin, and include medications which contain benzoyl peroxide, salicylic acid or sulphur as the main active ingredient.

When a stronger topical medication is required, Retinoid A may be prescribed. The cream has a drying effect on the skin, which helps clear up inflammation, redness, peeling and irritation. It is effective in the treatment of whiteheads and blackheads.

Other topical prescription medications include:

  • Azelaic acid reduces the growth of the keratin surface skin cells that can block pores. Azelaic acid helps to unblock the pores, allowing the sebum to escape which, in turn, reduces blackheads/whiteheads and spots. Azelaic acid also helps keep inflammation under control
  • Adapalene uses synthetic retinoids as the active ingredient, again, preventing the formation of blackheads and or whiteheads and reducing inflammation. It effectively clears pimples and unblocks pores.

You should always seek advice from your doctor with regards to the most effective form of antibiotic treatment for your symptoms.

Sources used in writing this article are available on request

Information contained in this Articles page has been written by talkhealth based on available medical evidence. Our evidence-based articles are certified by the Information Standard and our sources are available on request. The content is not, though, written by medical professionals and should never be considered a substitute for medical advice. You should always seek medical advice before changing your treatment routine. talkhealth does not endorse any specific products, brands, or treatments.

Information written by the talkhealth team

Last revised: 9 November 2017

Next review: 9 November 2020