How can I effectively counsel patients on the use of oral antibiotics for acne vulgaris management?

When counseling patients on the use of oral antibiotics for acne vulgaris, it is important to cover several key areas to ensure effective management and adherence ¹,².

Key Counseling Points for Oral Antibiotics:

• Oral antibiotics, such as lymecycline or doxycycline, are typically considered for moderate to severe acne, often in combination with topical treatments like adapalene with benzoyl peroxide or azelaic acid ¹,².
• They may be particularly effective for treating affected areas that are difficult to reach with topical treatments, such as the back ¹.
• Patients should be informed that oral antibiotics can cause systemic side effects and contribute to antimicrobial resistance ¹.
• Specifically, oral tetracyclines (like doxycycline and lymecycline) can cause photosensitivity, so patients should be advised about sun protection ¹.
• Oral antibiotics are generally not recommended for use in pregnancy, during breastfeeding, or in children under the age of 12 ¹.
• For individuals with childbearing potential, it is crucial to discuss that oral tetracyclines are contraindicated during pregnancy and when planning a pregnancy, and effective contraception will be needed, or an alternative treatment chosen ¹,².
• Patients should be advised that oral antibiotics should not be used as monotherapy, nor should they be combined with a topical antibiotic ¹,².
• Treatment courses typically last for 12 weeks ¹,². If acne has completely cleared at the 12-week review, consider stopping the antibiotic while continuing topical treatment ¹. If acne has improved but not completely cleared, the oral antibiotic may be continued for up to an additional 12 weeks ¹. For those who relapse quickly after stopping, a 6-month course may be beneficial, and courses can be repeated if needed in the future ².
• It is important to complete the full course of treatment, as positive effects may take 6 to 8 weeks to become noticeable ¹,².
• Minocycline is not recommended due to increased risks of drug-induced lupus, skin pigmentation, and hepatitis ². Macrolides (e.g., erythromycin) should generally be avoided unless tetracyclines are contraindicated or not tolerated, due to increased bacterial resistance ².
• Adequate courses of systemic antibiotics and topical therapy are a requirement before considering oral isotretinoin for severe acne ¹.

General Advice for Acne Management (relevant for patients on oral antibiotics):

• Acknowledge that acne of any severity can cause psychological distress and mental health disorders ¹,².
• Advise patients that acne is not caused by poor hygiene, and they should avoid over-cleaning the skin, which can cause dryness and irritation ².
• Recommend using a non-alkaline (skin pH neutral or slightly acidic) synthetic detergent cleansing product twice daily on acne-prone skin ².
• Patients should avoid oil-based, comedogenic skin care products, make-up, and sunscreens, and remove make-up at the end of the day ².
• Warn against persistent picking or scratching of lesions, as this can increase the risk of scarring ².
• Explain that treatments, especially topical ones often used concurrently, may irritate the skin, particularly at the start of treatment ². To reduce irritation, advise starting with alternate-day or short-contact application, gradually increasing frequency if tolerated ¹,².
• Inform patients that there is not enough evidence to support specific diets for treating acne, but encourage maintaining a healthy diet ¹,².