A team led by Dr. Seth Orlow, chair of dermatology at NYU Langone Medical Center in New York City, reviewed the medical records of 137 patients over the age of 12. All were treated for severe acne at Langone between 2005 and 2014.
On average, the patients were kept on antibiotics for 11 months before their doctors decided the antibiotics were not effective. Patients were then switched to the acne medication isotretinoin (brand name Accutane).
The study also found that it took an average of nearly six months from the time doctors first mentioned Accutane until patients began taking the drug.
Reasons for the long delay included strict controls placed on Accutane due to its risk of causing birth defects, and concerns about other potential side effects such as depression.
The study, published online Oct. 30 in the Journal of the American Academy of Dermatology, received no funding from the pharmaceutical industry.
“Our study suggests that physicians need to recognize within weeks, not months, when patients are failing to respond to antibiotic therapy in cases of severe acne,” Orlow said in a Langone news release.
Two dermatologists agreed that patients should talk with their physician early on about Accutane.
“Patients often feel as though oral antibiotics are much safer than isotretinoin,” said Dr. Meera Sivendran, instructor in dermatology at the Icahn School of Medicine at Mount Sinai Hospital in New York City. “Though the risks of side effects of isotretinoin are real, the potential side effects of long-term antibiotic use are often overlooked and can also be serious.
“It’s important to start the discussion on isotretinoin early in your relationship with the patient,” she added. “If I see a patient with cystic acne, I will discuss oral antibiotics as well as isotretinoin on the first or second visit. This way they have time to read the literature on isotretinoin and address any concerns at the follow-up visit.”
Dr. Katy Burris, a dermatologist at North Shore-LIJ Health System in Manhasset, N.Y., agreed.
“We need to recognize those patients who are not responding to oral antibiotics sooner rather than later, to minimize overexposure to antibiotics as well as potential scarring, and initiate successful therapy,” she said.
The experts and study authors also pointed to another possible consequence of extending antibiotic treatment too long: the growing problem of antibiotic resistance.
“Long-term use of antibiotics is associated with bacterial resistance, and often, these patients will ultimately end up needing treatment with isotretinoin anyway,” Burris said.
Lead investigator and Langone dermatologist Dr. Arielle Nagler said, “Acne remains the number one reason for young people to visit a dermatologist, and there are no other medications as effective as isotretinoin for treating severe cases of the skin condition.
“We need to find a better balance between trying antibiotics that may work and getting isotretinoin quickly to patients for whom antibiotics are not working,” she said.