When it comes to treating mild to moderate acne (search), new research suggests that over-the-counter preparations containing benzoyl peroxide (search) usually work just as well as oral or topical antibiotics at a fraction of the price.
Researchers say they hope the new findings will focus the spotlight on what they consider to be the overuse of antibiotics in the treatment of non-severe facial acne.
“In every other area of clinical care there has been a big drive to try and restrict the use of antibiotics, but this isn’t really true of acne treatment,” researcher Tony Avery, DM, tells WebMD. “That is especially surprising because people with acne often end up being treated for months and months.”
Over-the-Counter vs. Antibiotics
Anyone who has ever been a teenager has probably had acne and has probably tried some type of treatment to banish it. Antibiotics have been used for the past four decades to help clear the bacteria that exist in acne. But bacteria have grown resistant to some drugs.
The oral antibiotic tetracycline was once the prescription treatment of choice for acne, but resistance is now common. Resistance has also been seen with newer and more expensive antibiotics like doxycycline (search) and minocycline (search).
Over-the-counter creams and lotions containing benzoyl peroxide, such as Clearasil (search) and Fostex (search), are widely used. But there have been few clinical studies comparing their effectiveness to prescription medications.
In this study, researchers from England's universities of Nottingham and Leeds compared the effectiveness and economic costs of antibiotic and non-antibiotic treatment regimens in people with mild to moderate acne. The findings are published in the Dec. 18/25 issue of the journal The Lancet.
The study involved 649 people with facial acne treated with five different treatments or treatment combinations — oral tetracycline; oral minocycline; topical benzoyl peroxide; a topical combination of the antibiotic erythromycin plus benzoyl peroxide; and topical erythromycin (search) treatment in the morning followed by benzoyl peroxide at night.
Most of the improvement in acne occurred within the first six weeks of treatment. The researchers reported that the differences in effectiveness between the five regimens were small, but the differences in costs were large.
The least expensive treatment evaluated in the study, benzoyl peroxide, was 12 times cheaper than the most expensive treatment, oral minocycline. Bacterial resistance was found to reduce the effectiveness of the two oral antibiotics, but this was not true of the topical erythromycin-containing regimens.
What About Retinoids?
While agreeing that antibiotics are probably used too often to treat acne, New York dermatologist Diane Madfes, MD, says the study’s findings are compromised because researchers failed to include skin treatments (topical retinoids) like the cream Retin-A (search), which are now commonly used in the treatment of acne.
The researchers acknowledged this point, saying that future studies are needed to compare the cost-effectiveness of the topical retinoid treatments to over-the-counter preparations and antibiotics.
Madfes tells WebMD that a combination treatment of retinoids plus benzoyl peroxide has emerged as a first-line treatment for acne within the last two or three years.
“The overall message that you should start treatment with benzoyl peroxide is a good one,” she says. “But most of the patients I see have tried this and they need something more. Benzoyl peroxide is great at treating the bumps that people see on their faces, but the retinoids do a much better job of preventing new acne.”
By Salynn Boyles, reviewed by Brunilda Nazario, MD
SOURCES: Ozolins et al. The Lancet, Dec. 18/25, 2004; vol 364: pp 2188-2195. Tony Avery, DM, head of the division of primary care, School of Community Health Sciences, Queen’s Medical Center, Nottingham, England. Diane Madfes, MD, private practice dermatologist, New York City; spokeswoman, American Academy of Dermatology.
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