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Acne (young people)

Acne treatments: antibiotic tablets

More than half of the young people we talked to had taken antibiotic tablets for their acne. Often they had tried topical treatments first and antibiotic tablets were seen as the ‘next step’. Some people used a combination of acne treatments, such as topical treatments and antibiotic tablets. Rebecca felt more comfortable using topical treatments than swallowing a medicine, but some people preferred taking antibiotic tablets. Tom spoke to his GP and “decided that it would probably be easier to go for like a tablet, because you can’t really do wrong with a tablet”. Ollie thinks tablets are a more practical treatment for acne on the chest and back because these are difficult places to reach when applying topical treatments.
 

Hester started on antibiotics as an alternative acne treatment to hormonal contraceptives.

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Age at interview: 21
Sex: Female
Age at diagnosis: 15
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So I took antibiotics for quite a while. I think that's because I was a bit younger, and they didn't want to give me the pill. Because a lot of my friends who have bad skin often get given the pill now and I think that's because, because we're a bit older. And it wouldn't be unusual for like a 20 year old woman to be on the pill, whereas I think if you're 15 it's a bit-. So they started me on antibiotics, I was on them for quite a while. Tried a lot of different topical things, so. Can't remember exactly. I think basically most of them that the NHS offers. So like gels and creams and lotions, and probably changed, changed to different ones quite often. But, yeah. And then I switched to the pill, cos the antibiotics weren't really working. Also the- I think after, because it was so long term, I think it started to affect my sort of, my tummy quite a bit. And, yeah, I wasn't very happy. It kind of gave me like almost IBS-like symptoms. And my Mum was like, “Maybe it's a good idea to get off antibiotics, because you've actually been on them for two and a half years,” [laugh] which isn't, isn't good. So then I changed to the pill and I found that wasn't massively effective. Cos I think, yeah. And then I tried, I tried different pills as well. And then at one point, and I was always on, always on the medicine with a topical thing. And then at one point I was on all three together, when it got really bad. And I think, I've also tried, I tried moments where I'd just go off all medicines, see what happened. And it would get really bad.
 

Marga doesn’t want to take lots of pills every day so she decided not to take antidepressants as well as antibiotics.

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Age at interview: 24
Sex: Female
Age at diagnosis: 18
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So, I went through a little bit of depression at the start of this year, and I've sort of often been prone to like sort of anxiety and stuff like that. But I went through a little bit of a bout of depression at the beginning of this year, and they offered me , they offered me anti-depressants, and I mean they, they prescribed it to me and I just didn’t want to take it, to take them really. So, cos I prob-, generally cos I felt like I'd, I was taking these erythromycin, I was taking it two twice a day, so I was already taking four pills for that; I was already taking the pill every day, and I was like, 'well’, you know, ‘I don’t want to completely medicating myself’ like a-, that’s probably one of the reasons actually because, you know, that’s already five pills in one day, and this one you had to take twice a day, so after-, one-, I think both after meals and it was just completely complicated I thought. And I guess I was concerned that I was completely just medicating my body and I didn’t like the idea of taking anti-depressants partly because I know people who've got addicted to it and saying that they can't act-, they're finding it difficult to get off them.

So I didn’t want to do that. But they basically said that my self-esteem, for example, that was linked to problems with my skin as well. They said it would get better if I went on these but obviously it was totally my decision and I decided not to.
There are different kinds of antibiotics – such as lymecycline, tetracycline and erythromycin. Sometimes a person’s acne doesn’t respond to one type of antibiotic, but does to another. This can mean trying different antibiotics before finding an effective one – something that Molly, Hester, Chris, Emma and Rachael had all done. It can be time-consuming though as it is recommended you try an antibiotic for a few months to see if it helps. Some people, like Marga, noticed a quick improvement in just two weeks. Others waited months to see if their skin cleared up. Chris found it hard to tell if antibiotics were helping as his acne seemed to be at a constant level. Emma stayed on antibiotics for a long time as she wasn’t confident telling her GP that she would like to try another acne treatment. Hester took antibiotics for two and a half years.

Antibiotics are prescribed in different dosages (how many tablets and how often you take them). Antibiotics are thought to work in two ways: by reducing inflammation, which is why they are taken for long courses, and by getting rid of the bacteria involved in the development of spots. Tom’s GP chose which type of antibiotic to prescribe him and a starting dose of one a day. He thought the antibiotics were working, but Tom added that his GP might increase the dose to two a day at his next appointment. Often antibiotics were trialled for a month or two. Marga pays for her prescriptions and found it expensive having to get one month trials of different medicines like antibiotics. The dose varies from person to person depending on the severity of their acne. Both Marga and Rachael remember times when they took four antibiotic tablets a day.

Most people took their antibiotic tablets in the morning after breakfast. This helped some people get into a routine of taking the pills. Molly’s mum used to remind her to take her antibiotics every day when she was younger. When Marga was taking four tablets a day, she took two in the morning and two at night before going to sleep.

Some people found it difficult or scary to swallow tablets. Some people were worried about antibiotic resistance (when bacteria stop responding to antibiotics) and that the chances of this increased if they sometimes forgot a tablet. Nina talked about it being time-consuming having to go back for repeat prescriptions and worried about running out if she forgot to do so. Some people were uncomfortable about being on tablets altogether – Marga didn’t want to be “completely medicating myself” and Deborah disliked the idea that she was “ill”.
 

Emma learnt to take tablets when she started on antibiotics for acne.

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Age at interview: 20
Sex: Female
Age at diagnosis: 10
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And with those treatments, what were they sort of like to take?

They were fine to take. I have to say, the antibiotics were a bit difficult because I couldn't swallow tablets at that point [laughs] so I had to learn to swallow tablets. But they were fine to take. Timing, like you have to take them at like specific times of the day and that was always a bit of a pain [laughs]. But yeah I never found them too difficult to take and never had any sort of negative side effects. So it was okay. 

With the difficulty of swallowing tablets, was that something that you’d had as a child as well and then it continued?

Yeah it had, I hadn’t had any paracetamol or anything. My parents had to try and persuade me to take them [laughs]. I was just was really bad, [laughs] I was afraid I was going to choke on them or something. It was a bit silly [laughs]. 

Did it take you a little while to get into the habit of it when you were doing the antibiotics with acne?

It did take a while to get into the habit of taking them at the right times. But since I was taking them then for a couple of years, I soon got into the [laughs] soon got into the habit.
 

Deborah had first taken antibiotics for acne whilst living abroad and found the pills in the UK were much bigger.

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Age at interview: 25
Sex: Female
Age at diagnosis: 12
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So yeah, it wasn't until I'd come back after being in Australia that I knew there were alternatives to the nasty gel or just the over the counter things. I don't think they were able to give me exactly the same thing that I'd been on in Australia, they gave me an alternative. And it was really huge tablets, and I'm not very good with tablets. The ones in Australia were really little. So again, my compliance went down with those, because I didn't enjoy taking them. And so my skin got worse because, you know, if you're on mild antibiotics for things you have to keep your dose up. So yeah, that was why I decided to come off the pills, because I wasn't seeing the benefit, and I was feeling like I was constantly ill because I was always going everywhere taking tablets. And like if I was going to stay with at a friend's I'd put my overnight bag down and it would rattle, so you could obviously tell that I'd got a pot full of tablets in there. And it was just - wasn't overly pleasant. So yeah, that's - that's why I decided to come off the tablets. 
 
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Nina felt uncomfortable taking antibiotics for such a long time and worried about resistance.

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Age at interview: 20
Sex: Female
Age at diagnosis: 12
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I think I probably started taking antibiotics when I was about 12 and after about, because I knew they took a while to work, after maybe about two years on one I ended up swapping to another one and then about two years later swapped to another one and took that one for two or three years. But that also made me feel kind of rubbish because I was becoming more aware of the fact that taking antibiotics you almost feel like you don’t really need them when it’s your skin and like you kind of want to save it for when you really need it because I mean obviously that’s [antibiotic-resistant infections] a growing problem and actually like whenever I went to the GP or anyone that had a list of the medication I was on, it’s the first thing they would comment on like ‘Do you really need that like your skin looks alright’ but was my skin looking, you know, I mean like alright, alright or a bit worse than it is now you know, was it okay because I was taking medication, I don’t know. But and I guess it’s their responsibility to do that you know but that also kind of, makes it’s feel less satisfactory. 
Antibiotic tablets can have side effects for some people, but not everyone. This includes some antibiotic tablets having an unpleasant after-taste, as Naomi and Rachael found. Abbie got stomach aches when she took antibiotic tablets. Hester had an upset tummy but her GP was “very dismissive” that it was caused by antibiotics. Nina had sun sensitivity and staining of her teeth. No one we talked to had this, but Tom and Nina heard that antibiotics can give unusual side effects like turning the tongue a different colour. Others, like Tom, were less concerned about possible side effects and thought reading the information leaflet with the antibiotic medication would make him become “paranoid”.
 

Tom finds it hassle-free taking antibiotics for acne.

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Age at interview: 15
Sex: Male
Age at diagnosis: 15
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And then now I’ve got like, I don’t know what it’s called, well, I can’t, I can’t pronounce it. But it’s like this tablet that you take every morning with water and it’s just, seems to be doing all right. I don’t know. I’ve got like a month, three months’ worth. And it’s once a morning. It was going to be two a morning, two a day, but he was like, “Actually, no, once a morning.” So, yeah, it seems to be working all right though.

How far through are you on the course?

I don’t know. I got two boxes of them for the whole three months, and if each box has the same amount in then I’ve nearly finished the first box. I’ve got like two more days on the first box. So I’m nearly halfway, yeah.

Were there any sort of side effects to the medications and the creams that you’ve tried?

One of them hurt on my face, like not hurt, hurt but sort of burned a bit. Which was the one my mum got from the pharmacy. The pills have side effects, but I haven’t got any of them. Like they can turn your tongue sort of white, not white as in the whole colour but like the top bit gets like a white thing on it. And I think there’s something else but I don’t really know.
 

Rachael felt queasy (sick) whilst on antibiotics which became “annoying and unbearable”.

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Age at interview: 18
Sex: Female
Age at diagnosis: 16
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I think the worst one was probably erythromycin – which was like red circular ones and I had, I know I had to take four a day and they just made me feel incredibly queasy, like the worst queasiness ever. I just sat in class and just… it was horrible. But , yeah because, and I know a friend that went on them once for something, I think some ear infection and like she just like went home ill one day and she was like, "I'm on Erythromycin," and I was like, "I've been on it for ages." So, I think eventually, like the longer you're on it the more you don’t get the side-effects. But that didn’t do anything either, so I was just feeling ill and then still had bad skin and it was just frustrating yeah. 

So, how long did you try each of the antibiotics for?

I'm not entirely sure; I think probably, in some cases like a month, two months, probably is the average. Like, give it enough time but, wasn’t on it for ages cos if it's not working it's just not working, you can tell I think. 
 
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Molly thinks GPs should do more check-ups with patients taking antibiotics for acne.

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Age at interview: 20
Sex: Female
Age at diagnosis: 11
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I don’t necessarily know all the, the names of them because there’ve been quite a few. But there’ve been like antibiotic medications, which the only reason I have been wary about taking them is that like I don’t necessarily feel like the doctors I've seen there’s not much like, …like any check-up has been initiated by me and so I kind of felt uncomfortable with being on antibiotics cos it’s, obviously it’s a long term thing in my case, I didn’t necessarily want to be on antibiotics for that long period of time without feeling that like I was, had doctor who was kind of continually aware of it and since, yes since I was initiating the check-ups that didn't really feel like that, that way to me and I kind of feel a bit more comfortable about creams than pill medication. 
People had different outcomes from using antibiotics. Some found they helped clear up their acne. Marga is due to stop taking her antibiotics soon but worries that her acne might return. Other people didn’t find antibiotics effective, even after trying a few different ones. Will gave each type of antibiotic he was prescribed “a good shot” but eventually was referred to a dermatologist for isotretinoin (e.g. Roaccutane) tablets. A few people wish they had been more committed to trying antibiotics for their acne. Shu En says she “didn’t take the antibiotics very seriously” and often missed them, which she thinks caused her acne to become resistant to the medicine. The size of the antibiotic tablets Deborah took meant she didn’t take them as regularly “because I didn’t enjoy taking them”.
 

Lymecycline cleared up Marga’s acne and, when it returned, erythromycin worked well.

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Age at interview: 24
Sex: Female
Age at diagnosis: 18
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So then they, they put me on a, a pill , sort of an acne pill on and off for a long time but I can't remember what it was called now. They put me on some pills, some acne pills, but [sigh], so my acne problems basically were really carried on for a long, long time until I got to maybe two years ago where they stuck me on maybe, I think they stuck me on Lymecycline, maybe that’s a year and a half-, about a year and a half ago they stuck me on Lymecycline and that worked really, really well. And I, like all my spots went and I had real faith in it and it worked really, really well, so I was on that about, for about six to nine months I think. And then they told me to go off it, and then, so then I went, I went travelling for a bit and my skin was fine – like I had a spot here or there – but it was absolutely no problem at all. Had benzoyl peroxide alongside that and that’s rea-, I really like that; I think that’s really good, it's always been really good for my skin actually. But then I came back and I actually, it was the start of this year I think may-, it could have been maybe a change of scenery or something; I'm not quite sure whether it was stress, I'm not sure, but my skin got quite bad from probably about October time till about February. My skin was just as-, just got bad again and I was, you know, I'd turned 24 and I was just really stressed out about it because I thought , you know, I'm 24, this is the sort of thing that typically you associate with teenagers, with adolescence, and I guess it just got me down quite a lot. So that wasn’t really that fun. And like every-, you know, round my, sort of round my mouth I had lots of spots and like sort of here [points to cheeks], and so then I went back to the doctors and they put me on Lymecycline again. I think that’s around Christmas time and it just didn’t work so I was a bit frustrated about that because it had once worked really, really well. So they stuck me on erythromycin and I've been on that for about five months now I think. For-, I think I'm due to finish end of August, beginning of September, which I will have been on it for about six months by that point. And I really, really like it; like my skin's improved so much like, you know, I haven’t really got anything-, haven’t got any spots anymore and my scars are like pretty much gone now. 
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