In looking for new acne treatments, an unexpected finding by medical scientists was that antifungal drugs kill the bacteria that cause acne (Propionibacterium). This has been forgotten lately and really you should mention this to your doctor or dermatologist on your next visit if you are finding your present treatment is not working. Fungi that cause infections are known as dermatophytes and reside in tissue that can be found in many parts of the body including: your nails, the outer surface of your skin, and your hair. As we know, the bacterium Propionibacterium acnes is the causative agent of acne vulgaris and conventionally antibiotics, such as tetracyclines are used to treat acne; however, the antibiotic-resistant P. acnes has been increasing dramatically, so eventually they won’t work. The anti- Propionibacterium activity of Imidazole (antifungal agents) was reported more than 25 years ago, and since then, new Azole antifungal agents have been marketed, for example, Miconazole, Ketoconazole, and Itraconazole showed anti-P. acnes activity, including against the antibiotic-resistant bacteria residing on our skin.
Antifungal drugs attack the small components of the fungal cells. For example, Flucytosine is used to treat serious and systemic fungal infections. When the drug moves into a fungal cell, it is converted to a substance that stops the fungi from growing and replicating. Similarly, the antifungal drug Clotrimazole, treats fungal infections by stopping the fungi from making a chemical called ergosterol. This causes small holes to appear in the cell walls of the fungi, allowing unwanted toxic substances in and letting vital cell components out. This stops the fungi from living and kills the infection.
Systemic oral antifungal drugs, such as Fluconazole (Diflucan), Itraconazole (Sporanox), Ketoconazole (Nizoral), and Miconazole (Monistat I.V.) are available only by prescription form your doctor or dermatologist. They are available in tablet, capsule and liquid forms. Topical skin antifungal treatments are available without a doctor’s prescription and come in lots of forms, including, ointments, solutions, powders and sprays. Ointments and solutions are usually the most effective for treating acne and fungal infections of the skin, as they can get into the small fissures where bacteria and fungi grow.
The results, following the use of antifungal drugs in acne vulgaris, can be quite dramatic for some patients, particularly over the forehead, back and shoulders. The drugs can be taken orally and systemically, in combination, to give the full effect. Patients should still maintain their usual strict skin hygiene regimen, with good skin cleansing, good diet and lots of exercise. So when next visiting your doctor, mention the use of antifungal drugs, especially if you are finding your usual antibiotics etc. are not giving you good results, like they used to.