Note from CCFA's Patient Education Committee: The safety of common acne treatments in people with IBD has not been clearly established.  Additional studies are needed to determine if long-term antibiotics usage increases the risk of developing IBD.

Common acne treatments linked to bowel problems

Last Updated: 2010-08-20 15:40:27 -0400 (Reuters Health)

By Rachael Myers Lowe

NEW YORK (Reuters Health) - Acne is a difficult enough burden for a young person to bear. Now there's evidence that antibiotics commonly used to help control severe breakouts may, in a very small number of patients, lead to inflammatory bowel disease (IBD).

Bowel disorders linked to acne treatment are "a rare outcome," lead author Dr. David Margolis told Reuters Health.

Nonetheless, previous studies have suggested that the acne drug isotretinoin (Accutane) might be causing IBD in a small number of patients being treated for severe acne.

Noting that most people given isotretinoin have already been taking antibiotics for months, if not years, Dr. Margolis and colleagues at the University of Pennsylvania wondered if the antibiotics might be playing a role.

Drugs from the tetracycline family are the most commonly prescribed antibiotics for the treatment of severe acne. "They limit scarring and the outbreak of pimples. They're exceedingly effective and have been used for years," Dr. Margolis said.

The researchers looked at the medical records of 94,487 British teenagers and young adults diagnosed with acne between 1998 and 2006. Nearly 78,000 had received prescriptions for antibiotics.

As reported online August 10th in the American Journal of Gastroenterology, long-term use of antibiotics appeared to double the risk of developing IBD. Of the 207 patients diagnosed with IBD, 152 were taking one of three commonly prescribed tetracycline-based antibiotics.

Patients taking doxycycline had a slightly higher risk (0.21%) of developing IBD compared to patients taking minocycline (0.17%) or tetracycline (0.20%).

"The association was probably most pronounced in terms of Crohn's disease," Dr. Margolis said.

This risk "should be considered when prescribing this medication," the authors write. They also urge more study of the connection between acne drugs and bowel disorders. It is possible, for instance, that the risk of IBD is related to the biology of severe acne itself and not to treatments for it, they note.

"This is a rare outcome, rare enough you need to be careful about making decisions to change clinical practice," Dr. Margolis said.

As for the other possible culprit, "I'm not sure if isotretinoin (Accutane) is on or off the hook all by itself," he said. "I think this research indicates that in a careful study one should probably consider antibiotic use" as well.

SOURCE: http://link.reuters.com/dur36n

Am J Gastroenterol 2010.