Oral Antibiotics

Oral antibiotics used to treat acne include erythromycin or one of the tetracycline antibiotics (tetracycline, the better absorbed oxytetracycline, or one of the once daily doxycycline, minocycline, or lymecycline). Trimethoprim is also sometimes used (off-label use in UK). However, reducing the P. acnes bacteria will not, in itself, do anything to reduce the oil secretion and abnormal cell behaviour that is the initial cause of the blocked follicles. Additionally the antibiotics are becoming less and less useful as resistant P. acnes are becoming more common. Acne will generally reappear quite soon after the end of treatment—days later in the case of topical applications, and weeks later in the case of oral antibiotics. Furthermore side effects of tetracycline antibiotics can include yellowing of the teeth and an imbalance of gut flora, so are only recommended after topical products have been ruled out. It has been found that sub-antimicrobial doses of antibiotics such as minocycline also improve acne. It is believed that minocycline's anti-inflammatory effect also prevents acne. These low doses do not kill bacteria and hence cannot induce resistance.

Sebaceous glands

Sebaceous glands secrete an oily substance called sebum (Latin, meaning fat or tallow) that is made of fat (lipids) and the debris of dead fat-producing cells. In the glands, sebum is produced within specialized cells and is released as these cells burst; sebaceous glands are thus classified as holocrine glands. Sebum itself is odorless, but its bacterial breakdown can produce odors. Sebum is one cause of some people experiencing "oily" hair or skin if not washed for several days. Earwax is partly composed of sebum. Sebum acts to protect and waterproof hair and skin, and keep them from becoming dry, brittle, and cracked. It can also inhibit the growth of microorganisms on skin. Sebaceous glands are a branched type of acinar gland, these glands exist in humans throughout the skin except in the palms of the hands and soles of the feet. Sebaceous glands can usually be found in hair-covered areas, where they are connected to hair follicles. The glands deposit sebum on the hairs, and bring it to the skin surface along the hair shaft. The structure consisting of hair, hair follicle, arrector pili muscle, and sebaceous gland is known as a pilosebaceous unit. Sebaceous glands are also found in non-haired areas (glabrous skin) of eyelids, penis, labia minora, and nipples. Here, the sebum traverses ducts which terminate in sweat pores on the surface of the skin. Pores range in size from 50 to 80 μm on average. The inner surface of the lip and the buccal surface of the cheek can potentially contain ectopic sebaceous glands commonly known as Fordyce's spots or Fordyce granules. These occur as yellowish circular dots that form clusters. 80 percent of the population have Fordyce granules and these sebaceous glands are asymptomatic. At the rim of the eyelids, meibomian glands are a specialized form of sebaceous gland. They secrete sebum into the tears coating the eye, to slow evaporation.


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