My daughter has been on antibiotics for acne for 24 years
QSINCE the age of 16, my daughter, now 40, has been prescribed the antibiotic erythromycin for acne. She doesn’t take it all the time, just when she has a severe flare-up — about every three months. Her doctor seems to think it’s OK to continue prescribing this long term, but will it affect her health?
She’s read about Roaccutane but is concerned about the potential side-effects, having heard that it can lead to mental health problems.
Daphne Bateman, by email.
Ataking antibiotics for 24 years, even in episodes — rather than constantly — does raise concerns about the effect on the microbiome, the bacteria within the large intestine upon which we depend for good health, so i am sympathetic to your anxiety.
antibiotics are not targeted — they destroy not just the bad, i.e. acne-causing, bacteria but beneficial ones, too.
and there are concerns that this can lead to changes in the microbiome that may affect the immune system and lead to an increase in infections, for example.
(although i should stress there is nothing formally documented about erythromycin causing this, the concern is speculative.)
However erythromycin is known to cause gastro-intestinal side- effects, particularly diarrhoea and abdominal pain.
in your longer letter, you say your daughter has had iBS (irritable bowel syndrome) that began at roughly the same time she was first prescribed this antibiotic — and i do wonder if this is related.
acne is the most common skin condition we see as gPs, affecting more than 80 per cent of adolescents due to hormonal changes that cause the sebaceous (oil- secreting) glands in the skin to enlarge.
the condition normally resolves itself by the age of 30, but post-adolescent acne does commonly occur, predominantly affecting women.
Based on my experience, there is nothing to be gained for your daughter at this stage from gels or lotions, or from a change to a different type of antibiotic, but i do think it would be wise for her to consider isotretinoin (Roaccutane), despite her misgivings.
this drug is the only medication that can permanently alter the natural course of acne.
it works by counteracting the factors that cause the spots: it shrinks the sebaceous glands and limits the amount of oil that the glands secrete. this deprives the bacterium ( Cutibacterium acnes) which causes the red, inflamed skin, of food.
according to nHS figures, four out of five people who take isotretinoin have clear skin after one course of the drug — with a typical course lasting between four and six months.
the concerns that your daughter expresses about taking it, however, are not without foundation, and for this reason gPs are not permitted to prescribe isotretinoin — it has to be prescribed by a dermatologist who then retains the patient under their care.
the drug is associated with multiple side-effects which include dryness of the skin, cracked lips, itching, nosebleeds, muscle ache, and dry, gritty eyes.
these can be eased to a large extent by emollients and skin care and usually resolve once the medication ceases.
it should not be taken by women who might conceive, because of risks to the baby. the concern about depression and suicide is controversial, and the relationship between isotretinoin and mood disorder remains uncertain.
nevertheless, the key point is that patients being treated with this drug remain under informed, expert supervision.
i would advise that your daughter discusses referral to a dermatologist to be assessed for further acne treatment rather than continue with erythromycin.
at the very least, an informed discussion about the merits and otherwise of isotretinoin should take place.
QMY THREE-WHEEL mobility scooter capsized on top of me while turning into a kerb and trapped me underneath last July. I suffered abrasions and soft tissue injury to my right forearm, and other injuries, for which I have been taking eight tablets of paracetamol a day.
I now have problems walking even short distances or standing. The pain is increasing and even with paracetamol is developing into a ring of fire around my lower back. Aged 84, I feel life is no longer worth living. It appears there is no operation which would bring relief, unless you know better? Commodore Philip Pearce-Smith,
Holbury, Southampton.
AalmoSt a year after the accident, you remain disabled by symptoms. What is lacking is a diagnosis to account for this disastrous outcome.
my concern is that you may have suffered an injury to your lower spine, and it may be that at the time this was not recognised, the focus being drawn to your other injuries. So it is not possible to make an accurate assessment of what might have happened without knowing more detail of your previous history.
i must assume that the use of a mobility scooter was dictated by a former disability, presumably owing to earlier health problems.
these might have included degenerative disease of the lumbar spine such as osteoarthritis, or degenerative disc disease which leads to deterioration of the shock-absorbing discs between the lumbar vertebrae.
this can lead to inflammation and pressure on nearby nerves, leading to pain and some impairment of mobility.
in either case, a fall in the circumstances you describe could have exacerbated the problem. the other possibility is that the fall caused a fracture to one of the vertebral bones of the spine.
What is vital, i think, is that some form of scan of your spine is done — ideally, by mRi (magnetic resonance imaging). once you have an accurate diagnosis, plans for corrective treatment to alleviate your pain can be put in place.
the possibilities could include a steroid injection, physiotherapy or indeed a referral to a spinal surgeon. all of this is speculative until you have a diagnosis, so i urge you to visit your gP, and please don’t lose hope.