But dermatologists say
the bacteria that causes acne is increasingly developing resistance
to some commonly prescribed antibiotics, including tetracycline and
erythromycin. And while the superbug MRSA is a widely known threat
in the general medical community, some patients are surprised to
learn that the P. acnes bacterium is equally capable of rebelling
against drugs and developing superpowers. It’s acne gone
wild.
“There’s been so much
attention to MRSA and other kinds of resistant bacteria which truly
can kill you, whereas acne doesn’t kill you,” says Dr. Alan
Fleischer, a professor and chair of dermatology at Wake Forest
University School of Medicine. “And yet we doctors see patients who
have resistant acne, and we do need to be cognizant of changes. The
bacteria are changing, are adapting and becoming
resistant.”
It sounds like the stuff of
teenage nightmares: super strong, freakishly clever, mutant
acne.
Antibiotics are one of
the most frequently prescribed treatments for acne. They target the
bacteria and inflammation, and often are key in clearing up the
patient’s skin. But as antibiotic-resistant acne becomes a growing
concern, dermatologists are moving away from using antibiotics as a
primary weapon against acne, fearing that the long-held go-to
treatments may be contributing to communal antibiotic resistance.
If they do prescribe antibiotics, it may be for only a limited
time, usually a few months, and it's often combined with another
medication that can lessen the drug resistance. Previously,
patients might have continued on antibiotics for years.
“The strong survive, the
mutants survive and they become resistant,” says Dr. Jonette Keri,
a University of Miami dermatologist.
Public
health threat?
While drug-resistant acne can
be devastating, the real danger is that it contributes to deadly
drug-resistant staph infections.
“The dangerous thing
about putting zillions of folks on antibiotics is that this
pressures bacteria to develop resistance methods,” says Dr. Peter
Lio, a Northwestern University dermatologist. “So while the acne
bacteria almost never causes life-threatening infection, the ways
that it can be resistant to our antibiotics can be passed over to
bacteria that can cause life-threatening infection, which
means that our only weapons against the bad guys suddenly do not
work anymore.
“If it became bad
enough, it would be like the days before antibiotics, when
infection was a common cause of death.”
He has a
appointment with his doctor next week to figure out what went
wrong, but from his own medical Googling and time spent on message
boards such as acne.org, he expects he’s developed this antibiotic
resistance. But maybe the strangest thing about this particular
affliction is that patients never really know for sure that they
have it at all.
Fewer dermatologists now
rely on antibiotics alone to treat acne. A recent University of
Pennsylvania study found that people on antibiotics were about
twice as likely to develop an upper respiratory tract infection.
And a study Fleischer co-authored in 2005 found a significant shift
from dermatologists prescribing antibiotic to non-antibiotic
treatments.
When Fleishcher started
his practice 20 years ago, erythromycin was the treatment he most
commonly prescribed. “Now maybe I have one patient on it,
maybe.
“[Acne] is not a
life-threatening situation; it is a quality of life situation.
Using drugs that don’t display drug resistance will allow us to
make patients look and feel better.”
“Most people in private
practice do not do a test,” says Keri, the Miami dermatologist. “If
they thought [patients] were resistant, they might switch
antibiotics or add topical treatment to the mix.”
The P. acnes bacterium
can be tested for resistance, but that’s usually done only in
clinical trials or study circumstances. When a patient stops
responding to antibiotics, most dermatologists assume the bacteria
have developed resistance, and doctors simply try something
else.
A bevy of
effective treatments
Bacteria, resistant or
not, is only one contributer to the formation of a zit. Four things
have to happen for people to get a pimple: First, oil increases in
a pore. Second, the skin cells that line the pore get sticky from
the extra oil, creating a clog in that pore. Third, bacteria feasts
on all that oil and begin to overgrow. Finally, the body responds
to the bacteria, causing the inflammation.
“The fact is, because
acne is much more complicated than a simple infection, there really
are a wide variety of other approaches that are very useful,” says
Fleischer of Wake Forest University.
Doctors found that
combining benzoyl peroxide with an antibiotic counteracts the drug
resistance. And there are plenty of other methods dermatologists
use to attack acne, including using anti-inflammatory drugs such as
retinoids and isotretinoin, most commonly known as the brand name
Accutane.
Acne is a common teenage
ailment, afflicting about 75 percent to 90 percent of teens. Even
adult acne may be more common than many realize, with about 50
percent of adults suffering from acne at some degree,
dermatologists say.
“Acne is a really tough
disease,” Lio says. “We can make a big difference with many
patients, but it’s a humbling disease; it brings people down.
People can be incredibly depressed coming in, so our job is to do
whatever it takes to make them better.”
Between 10 percent and 30
percent of acne patients harbor at least some resistant bacteria,
dermatologists say. Few studies have been published about
drug-resistant acne, but French researchers found in 2001 that more
than 50 percent of the isolates of the bug P. acnes were resistant
to erythromycin, a commonly prescribed antibiotic.
When the antibiotics stop
working for a patient, the results are devastating. In most cases
of drug resistance, the antibiotics initially work, and patients
think their skin has finally cleared, maybe for good this time.
Then, all of a sudden the acne comes back — in some cases, worse
than ever before.
When
antibiotics fail
About six months ago, 16-year-old Chris Fields started taking 500
mg of tetracycline once a day, every morning. A month later, his
skin cleared and stayed that way for two months. He started to
remember what it was like to look people in the face without
privately agonizing that they were scrutinizing his.
“I had more
self-confidence and stuff,” says Chris, a high-school sophomore who
lives in Concrete, Wash. “When I’d go out in public, I’d actually
look people in the eye, and not be so worried about how my face
looks. Right now, that’s starting to slip away again.”
That’s because a couple
of weeks ago, his acne started to come back. He’s not sure if it’s
worse than it was before, or if he’s just imagining that it is, but
either way, its presence couldn’t be more unwelcome: Prom is less
than three weeks away.