Submicrobial Antibiotics for the Treatment of Acne Disorders
Some antibiotics, particularly the tetracycline family of antibiotics, have long been thought to act in two possible ways: 1. By killing or suppressing bacterial growth. 2. As anti-inflammatory medications.
The potential for an anti-inflammatory effect of tetracyclines has led to research into smaller-than-average doses of tetracycline drugs to treat acne-like conditions, particularly Rosacea. One such medication, brand name Oracea, is currently FDA approved for the treatment of Rosacea.
Oracea uses a combination low dose, long acting form of doxycycline to suppress the inflammation of Rosacea. The lower dose of doxycycline should result in a decreased risk of side effects; however women should not take doxycycline or tetracyclines in any form if they might be or might become pregnant or nursing.
The abstract below and the article if references, discusses sub-microbial antibiotics in the treatment of skin disorders.
Clinical applications of non-antimicrobial
tetracyclines in dermatology.
Pharmacol Res. 2010 Oct 18.
Monk E, Shalita A, Siegel D.
Dermatology Resident, PGY-4, SUNY
Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, United
States.
Abstract
There are many proposed non-antimicrobial
actions of tetracyclines.
The pathways affected by these medications,
such as those involving matrix metalloproteinase (MMP) activity, are often
overexpressed in various dermatologic conditions. Non-antimicrobial effects of
tetracyclines that are important in dermatology include inflammatory cytokine
regulation, inhibition of leukocyte chemotaxis and activation, and
anti-oxidation.
Dermatologists have utilized the
non-antimicrobial benefits of using tetracycline, through their success in treating
disorders that do not have a primary infectious etiology such as rosacea.
Even in acne, there is believed to be
overactive inflammation to a normally commensal organism which is inhibited by
tetracyclines.
These medications have also been reported as
successful in cases of less common skin conditions, such as pyoderma
gangrenosum and bullous pemphigoid, both of which involve inflammation and
dermal destruction which are inhibited by tetracyclines.
In the Dermatology section, the pathologic
mechanisms of several dermatologic conditions are reviewed, followed by
evidence of how tetracyclines and its derivatives, including chemically
modified tetracyclines (CMTs) affect these pathways.
Clinical testing of sub-antimicrobial
doxycycline, in both 20mg twice daily and 40mg once daily (controlled release;
30mg immediate release, 10mg delayed release) forms, in rosacea and acne is
reviewed as evidence that non-antimicrobial actions are valuable for treatment.
Chemically modifies tetracycline-3 (CMT-3) for Kaposi's sarcoma is highlighted
as the only clinical evidence available for CMTs.
Certain evidence of success using
antimicrobial tetracyclines in inflammatory conditions of the skin is reviewed
as well, because they are likely working through non-antimicrobial properties.
Finally, dermatologic side effects of non-antimicrobial tetracyclines are
assessed.