The use of antimicrobial peptides against P. acnes is under investigation as a treatment for acne to overcoming antibiotic resistance. In 2007, the first genome sequencing of a P. acnes bacteriophage (PA6) was reported. The authors proposed applying this research toward development of bacteriophage therapy as an acne treatment in order to overcome the problems associated with long-term antibiotic therapy such as bacterial resistance. Oral and topical probiotics are also being evaluated as treatments for acne. Probiotics have been hypothesized to have therapeutic effects for those affected by acne due to their ability to decrease skin inflammation and improve skin moisture by increasing the skin's ceramide content. As of 2014, studies examining the effects of probiotics on acne in humans were limited.
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In women, acne can be improved with the use of any combined birth control pill. These medications contain an estrogen and a progestin. They work by decreasing the production of androgen hormones by the ovaries and by decreasing the free and hence biologically active fractions of androgens, resulting in lowered skin production of sebum and consequently reduced acne severity. Although oral estrogens can decrease IGF-1 levels in some situations and this might be expected to additionally contribute to improvement in acne symptoms, combined birth control pills appear to have no effect on IGF-1 levels in fertile women. However, cyproterone acetate-containing birth control pills have been reported to decrease total and free IGF-1 levels. Combinations containing third- or fourth-generation progestins including desogestrel, dienogest, drospirenone, or norgestimate, as well as birth control pills containing cyproterone acetate or chlormadinone acetate, are preferred for women with acne due to their stronger antiandrogenic effects. Studies have shown a 40 to 70% reduction in acne lesions with combined birth control pills. A 2014 review found that antibiotics by mouth appear to be somewhat more effective than birth control pills at decreasing the number of inflammatory acne lesions at three months. However, the two therapies are approximately equal in efficacy at six months for decreasing the number of inflammatory, non-inflammatory, and total acne lesions. The authors of the analysis suggested that birth control pills may be a preferred first-line acne treatment, over oral antibiotics, in certain women due to similar efficacy at six months and a lack of associated antibiotic resistance.
Benzoyl peroxide is an antibacterial ingredient, and it’s very effective at killing the P. acnes bacteria that causes breakouts. But benzoyl isn’t without its downsides. The leave-on creams and cleansing treatments can dry out sensitive skin types and bleach clothing if you aren’t careful. Board-certified dermatologist Eric Meinhardt, M.D., previously told SELF that it's best to stick to formulations that have no more than 2 percent of benzoyl peroxide listed on the active ingredients chart; stronger concentrations are harder on your skin without being any tougher on bacteria.
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According to Dr. Bailey, it’s not enough to have a facial cleanser designed for acne-prone skin. Half the battle is properly washing your face. Here’s what she recommends: “First, wet your face with warm water, then lather your cleanser over all of your facial skin. Depending on your skin type, you can use your fingers, an exfoliating cloth or a sonic skin-cleansing brush system. Rinse well with warm water to remove the lather entirely. Some of the important acne cleanser ingredients will stay behind, but the cleanser’s foaming agents, as well as built-up oil, dead cells, products and bacteria, will be rinsed off of your skin.”
Glycolic acid is another chemical exfoliant that dissolves the structural lipids that hold dead skin cells and bind them to the surface. But aside from this, studies have also shown that glycolic acid effectively encourages and stimulates the production of collagen and elastin, restoring damaged skin faster and reducing signs of environmental damage with continuous use.
The idea behind using antibiotics for acne is that they can help reduce the number of p. acnes on the skin and relieve an acute case of severe acne. After the person stops taking the antibiotics, the hope is that the reduced numbers of p. acnes will prevent the pimples or cysts from getting out of hand again. However, in reality, most people simply end up taking the antibiotics much longer than they should, and the acne almost always comes back. That’s because, according to The Lancet: Infectious Diseases, over 50 percent of p. acnes strains are resistant to antibiotics7. If your doctor tries to prescribe you antibiotics for your acne, we recommend asking about other courses of action.
The Daily Skin Clearing Treatment is an all-over 2.5 percent benzoyl peroxide cream that also touts calming bisabolol and allantoin to alleviate the dryness and irritation that can crop up mid-treatment. Anyone frustrated with oil-slick skin will also love this part of the regimen — it creates a satin mattifying effect, instantly transforming shininess into a glow.
^ Jump up to: a b GBD 2015 Disease and Injury Incidence and Prevalence, Collaborators. (8 October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. PMC 5055577. PMID 27733282.
Globally, acne affects approximately 650 million people, or about 9.4% of the population, as of 2010. It affects nearly 90% of people in Western societies during their teenage years, but can occur before adolescence and may persist into adulthood. While acne that first develops between the ages of 21 and 25 is uncommon, it affects 54% of women and 40% of men older than 25 years of age, and has a lifetime prevalence of 85%. About 20% of those affected have moderate or severe cases. It is slightly more common in females than males (9.8% versus 9.0%). In those over 40 years old, 1% of males and 5% of females still have problems.
For adult women, spironolactone is preferred over oral antibiotics since women with adult acne will likely have this condition at least until menopause, and starting and stopping an oral antibiotic over many years could potentially contribute to drug resistance and decreased microbial response. Spironolactone is completely safe to use on an ongoing basis once the correct dose is determined by the treating physician. It is advisable to check a potassium level at the 150mg dosing.
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