New area of acne research that is proving promising is using antibiotics for a period of a few months to start a successful treatment regimen, then replacing them with other non-antibiotic medications to maintain results over time. "step-down" approach is important, as an increasing concern of long-term antibiotic use is that bacteria are evolving to become resistant to these medications - prompting dermatologists to seek alternative therapies in order to get their patients off of oral antibiotics as soon as possible. Recent clinical studies using the step-down approach from antibiotics and a topical retinoid to topical retinoids alone have shown positive results in maintaining improvement in acne patients, despite the abrupt discontinuation of oral antibiotics.
Dermatologist Hilary E. Baldwin, MD, FAAD, associate professor of clinical dermatology at the State University of New York reported that another category of oral medications that dermatologists are using to treat acne is anti-inflammatory medications, which can be used in some cases to lessen the severity of acne. Used by some dermatologists to reduce the redness and swelling of acne, controlled-release doxycycline is one new anti-inflammatory medication. controlled-release doxycycline is not an antibiotic, it does not kill the bacteria involved in the pathogenesis of acne and is therefore not expected to be as effective as antibiotics in controlling acute acne. But for some patients, such as women who may be prone to yeast infections from using antibiotics, this anti-inflammatory medication may offer noticeable improvement in the inflammation caused by acne.
Dr. Baldwin also added that a new oral medication on the horizon could be another viable alternative for acne patients in the next few years. Incyclinide, a chemically modified tetracycline that is not an antibiotic, is now in phase two of clinical trials and shows promise in treating both acne and rosacea.
James Q. Del Rosso, D.O., clinical associate professor of dermatology, University of Nevada School of Medicine, Las Vegas says that use of doxycycline in a dosage formulation that is devoid of antibiotic activity yet is capable of exhibiting anti-inflammatory properties relevant to the treatment of acne and rosacea. This formulation, a 40 mg controlled release doxycycline monohydrate capsule administered once daily, is referred to specifically as anti-inflammatory dose doxycycline.
