Erythromycin for Acne

There are a lot of factors that lead to an acne outbreak, but the bacteria living on your skin is most responsible for their eruption.

Washing your face with a cleanser every day is designed to control these bacteria. Yet in some cases a cleanser is not enough. If you find that you are unable to control your acne outbreaks, your doctor may prescribe a type of medicine.

The most common types of medicines prescribed for acne are antibiotics, because antibiotics are designed to kill bacteria. One option your doctor may consider is erythromycin for acne.

What is Erythromycin?

Erythromycin is a prescription drug that some doctors use to cure acne. It's known as a macrolide antibiotic, which means that it falls under a different class of drugs than the tetracycline antibiotics, which are also commonly used to treat acne.

Like other types of antibiotics, erythromycin is not designed specifically for acne. It is considered a narrow spectrum antibiotic that is used to treat a variety of conditions including, but not limited to:

• Sinusitis
• Syphilis
• Tonsillitis
• Pneumonia
• Middle ear infection
• Scarlet fever
• Whooping cough

Erythromycin works similarly to penicillin, so doctors may prescribe it for nearly any type of bacterial infection that needs treatment. As is often the case with antibiotics, erythromycin may be prescribed for both serious disease and less serious diseases. One of the most common prescriptions is erythromycin for acne.

Using Erythromycin for Acne

Erythromycin both kills and slows the growth of the bacteria that causes acne. Unlike many other antibiotics for acne, erythromycin can come in either an oral (pill) form, or a topical (gel or cream) form. Both may be used to reduce the bacterial buildup in acne.

In 1987, researchers compared the difference between tetracycline (the most common type of antibiotic acne treatment) with erythromycin. They found that both managed to have similar effects on acne, with roughly 80 to 90% reporting a significant reduction in their acne buildup during the first 3 months of the study.

Most studies comparing these two treatment options reported that acne and erythromycin had roughly the same effect as tetracycline in nearly every case. The differences were largely inconsequential between the two.

Similar benefits were found in the topical erythromycin group. A study of 253 patients found that those using topical erythromycin found a significant decrease in the number of acne lesions compared to those using other methods of acne cleansing.

However, some researchers have posited that the effect of topical erythromycin for acne is different than the oral type. In one study, researchers claim that the effect is more of an anti-inflammatory rather than a decrease in the amount of bacteria. Essentially, erythromycin is not killing bacteria, but rather preventing the effects of bacteria from creating skin lesions. 

Regardless, research has fairly consistently shown that erythromycin is a useful choice for clearing up acne.

Resistant Acne and Erythromycin

One common issue that arises from using erythromycin for acne is bacterial resistance.

This is a problem for all types of antibiotics, and is not limited to erythromycin. But it is a concern when taking an erythromycin for acne.

Bacteria have the ability to adapt. When taking erythromycin, there is a strong possibility that, over time, drug resistant bacteria will develop. While not necessarily dangerous, this means that at any point during the course of your treatment, the erythromycin may stop working, and a new treatment will need to be used.

Further, in very rare cases this can lead to more serious problems of drug resistant bacteria for other conditions. Because of this, no antibiotic should be taken without a prescription, and it's best to ensure that you've exhausted all non-medicinal options before trying any antibiotic for acne, including erythromycin.

To reduce the likelihood of this resistance, it's crucial to take the drug exactly as directed at the same times each day. Failure to take the drug according to the prescription (for the length of time as required by the prescription) will increase the likelihood of developing resistance.

In addition, there is some evidence that combining erythromycin with benzoyl peroxide will also reduce the risk of developing resistance. Research at the University of Leeds in the UK has found that the combination of those two acne treatments may improve the ability to use erythromycin in the long term.

Side Effects of Erythromycin for Acne

Erythromycin, like most antibiotics, is prone to side effects. Compared to tetracycline antibiotics, these effects may be considered more mild, but there are certainly risks associated with using the antibiotic – especially the oral antibiotic.

There are very few side effects of topical erythromycin, presumably because of the lack of ingestion. Most side effects are surface level on the skin where the topical treatments were applied, including skin redness, burning, itching, and peeling. Allergic reaction is also possible, although these allergies generally tend to be less severe (more severe allergic reaction is possible, but less likely due to the lack of the drug within the skin).

The most common side effects of erythromycin oral were gastrointestinal disturbances. This includes issues such as:

• Diarrhea
• Abdominal Pain
• Nausea
• Vomiting

Erythromycin affects a hormone known as motilin. This hormone is responsible for moving food along the intestine in order to make room for future meals. Erythromycin causes your body to create more of this hormone, which in turn leads to more rapidly emptying bowels – which is generally (although not always) the reason that erythromycin causes these gastrointestinal disturbances.

Allergic reaction is a rare but possibly dangerous risk with erythromycin for acne, with reactions ranging everywhere from mild hives and rash to seizure and jaundice.  Erythromycin can also cause yeast infections, although this appears to be less common than with tetracycline antibiotics.

Severe adverse (non-allergic) reactions to this type of medication are exceedingly rare. While erythromycin has been linked to severely adverse drug reactions such as toxic epidermal necrolysis, but the likelihood of contracting these diseases is extremely slim. It has also been linked to psychological reactions (such as nightmares) but the mechanism that causes these reactions is less clear.

As with any prescription drug, tell your doctor if you are taking any other medications in addition to using erythromycin for acne. There are some drug interactions linked to erythromycin.

Erythromycin may also prevent some oral contraceptives from working, due to the way the drug affects the gut. It may increase metabolic rate of oral contraceptives (as well as other medications), which means those drugs may leave your body too early, resulting in a failure to prevent pregnancy.

Erythromycin Dosing for Acne

Like other antibiotics, erythromycin must be taken exactly as prescribed by a doctor to prevent bacterial resistance and improve efficacy.

Always follow your doctor's dosing instructions. They may recommend a dose that differs from what others take for the drug based on your height, weight, age, family history, acne level, brand of the drug, and more.

Generally oral erythromycin is taken an hour before eating, although some doctors state that it is acceptable to take it with food.  Dosage is generally between 250 and 500 mg per day, anywhere from 2 to 4 times per day. It's also possible that your doctor recommends some other type of topical treatment to complement the oral erythromycin.

Topical erythromycin is generally used twice a day, although your doctor may prescribe something different.

Overall Benefits of Erythromycin for Acne

Using erythromycin for acne can be advantageous, at least compared to other antibiotic drugs. While gastrointestinal side effects appear to be more common, the risk of severe side effect is lower and the drug does appear to be well tolerated.

As usual, erythromycin cannot clear all types of acne or all acne buildup. It also does not clear acne scarring, so those with severe acne should expect some of their pimples to remain. Furthermore, the risk of resistance is fairly strong, so it's not unlikely that you will need to switch to a different type of antibiotic if/when the bacteria stops responding to erythromycin.

In general, it is always recommend that you exhaust all non-medicinal options before using an antibiotic acne treatment. Taking any antibiotic for acne represents a risk, both in terms of how it affects future use of the drug and how it affects acne itself.

Still, using erythromycin for acne has been a common practice for years, and many doctors still recommend the antibiotic for those living with mild, moderate, and severe acne, so it may be something worth considering.