Improving Acne Treatment Through Antibiotic Stewardship and Gut-Skin Health

“When it comes to oral antibiotics, one of the topics I focused on is the fact that antibiotic stewardship is needed. I also like to say that we are honorary gastroenterologists in dermatology because the antibiotics we prescribe affect the gut. We know that the gut microbiome is so important to human health,” said Christopher Bunick, MD, PhD, in an interview at the 2025 American Academy of Dermatology (AAD) Annual Meeting in Orlando, Florida.

Bunick, associate professor of dermatology and translational biomedicine at Yale School of Medicine in New Haven, Connecticut, and Dermatology Times’ Editor in Chief, presented “Updates on Antibiotics for Acne and Rosacea” at the annual meeting.

In his presentation, Bunick reviewed the evolving role of antibiotics in acne management. His presentation focused on the importance of antibiotic stewardship while outlining the latest recommendations from the 2024 AAD guidelines.

Bunick emphasized the efficacy of new triple combination topical therapies that include clindamycin and benzoyl peroxide. These formulations have demonstrated both strong safety profiles and significant clinical benefits for patients with acne. While topical treatments are a key part of acne treatment, oral antibiotics, particularly tetracyclines, remain widely prescribed.

According to Bunick, tetracyclines account for approximately 75% of oral antibiotic prescriptions in dermatology. He stressed that dermatologists should be well-versed in their use, not only for their antimicrobial properties but also for their potent anti-inflammatory effects, which play a crucial role in acne management.

Another key point of his presentation was the need for responsible antibiotic prescribing. Bunick discussed the importance of protecting the gut microbiome, reinforcing that dermatologists should be mindful of the gut-skin connection. To mitigate the risks of antibiotic resistance and gut dysbiosis, he advocated for the use of narrow-spectrum antibiotics, which effectively target inflammation while minimizing disruption to the microbiome. He demonstrated their clinical value by showing patient cases where narrow-spectrum antibiotics were successfully used for acne, rosacea, JAK inhibitor-induced acne, and Staphylococcus aureus infections, including MSSA and MRSA.

While oral antibiotics are still a key option in acne treatment, Bunick encouraged dermatologists to consider alternative systemic therapies when appropriate. He discussed the benefits of spironolactone, particularly for adult women seeking an effective systemic option without using isotretinoin. Additionally, he highlighted the importance of integrating oral isotretinoin when indicated, often in combination with topicals for optimal results. Bunick’s discussion reinforced a patient-specific approach to antibiotic use to ensure efficacy and long-term sustainability in acne treatment.

Reference

1. Reynolds RV, Yeung H, Cheng CE, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2024 May;90(5):1006.e1-1006.e30. doi: 10.1016/j.jaad.2023.12.017.