Does treatment of acne with Retin A and tetracycline cause adverse effects?

Journal of Family Practice, April, 2004 by Barbara F. Kelly, Martha Burroughs

* CLINICAL COMMENTARY

Use a judicious approach to topical agents and systemic antibiotics

We should use a judicious approach with appropriate use of topical agents to treat acne. In those cases where acne is not responding, systemic antibiotics can be quite effective and very well tolerated. Regarding antimicrobial resistance of P acnes, we should avoid changing antibiotics unnecessarily, and taper to the lowest effective dose once the acne is well controlled. I think the dictum to avoid treating with systemic antibiotics for longer than 6 months is not widely followed. Often, much longer courses of treatment are necessary. For an individual patient, the risk of developing resistant P acnes is often preferable to the alternatives of inadequate acne control or systemic isotretinoin. Periodic attempts should be made to discontinue antibiotics when acne is well controlled, with resumption of the same antibiotic if one continues to be needed.

Marsha Mertens, MD, Mercy Family Medicine Residency, St. Louis, Mo

TABLE 1

Side effects of tetracycline and topical tretinoin

Tetracycline                                 Side-effect rates

Vaginal candidiasis (8)                             12%
Gastrointestinal complaints (8) *                    4%
Gram-negative folliculitis (9)                       4%

Topical tretinoin (10)               Maximal observed side-effect rates
Peeling                                             50%
Burning                                             49%
Erythema                                            49%
Skin tightness                                      42%
Dryness                                             40%
Itching                                             24%

* Gastrointestinal complaints included nausea, diarrhea, black hairy
tongue, esophagitis, and flatulence.

TABLE 2

Treatment recommendations to reduce antimicrobial resistance

Do not prescribe systemic antibiotics if a topical medication will
  suffice

Avoid concomitant topical and systemic use of different antibiotics

Antibiotic therapy should continue for no longer than necessary, with
  a maximum period of 6 months

Do not "switch" or "rotate" antibiotics in patients who are not
  responding to therapy

Try systemic retinoids if acne fails to respond within 6 months of
  antibiotic therapy or quickly relapses

Adapted from Cooper et al. (2)

REFERENCES

(1.) Shapiro LE, Knowles SR, Shear NH. Comparative safety of tetracycline, minocycline, and doxycycline. Arch Derm 1997; 133:1224-1230.

(2.) Cooper AJ. Systematic review of P acnes resistance to system antibiotics. Med J Australia 1998; 169:259-261.

(3.) Cunliffe WJ. Propionibacterium acnes resistance and its clinical relevance. J Dermatol Treatment 1995; 6:S3-S4.

(4.) Tan HH, Goh CL, Yeo MCG, Tan ML. Antibiotic sensitivity of Propionibacterium acnes isolates from patients with acne vulgaris in a tertiary dermatological referral centre in Singapore. Ann Acad Med Singapore 2001; 30:22-25.

(5.) Helms SE, Bredel DL, Zajic J, Jarjoura D, Brodell RT, Krishnarao I. Oral contraceptive failure rates and oral antibiotics. J Am Acad Dermatol 1997; 36:705-710.