Antibiotics: A Good Dermatitis Strategy Made Better When Paired With Lotion

Many strategies in dermatology consist of choosing a topical or an oral antibiotic that will improve the skin problem and treat excess inflammation. The right antibiotic/antimicrobial product by itself can have significant anti-inflammatory effects on skin problems like dermatitis/eczema, acne, Rosacea, and perioral dermatitis. The problem is that the antibiotic often requires months to help, or it doesn’t help the inflammation enough, even after weeks and months. Because of this, the dermatologist must decide on combination therapy with a product that works more directly on inflammation. If it’s a topical steroid, it often carries the risk of being too strong for use with chronic recurring dermatitis, Rosacea, or perioral dermatitis. Most topical steroids will thin the skin for recurring rashes of the groin and flexures.

Lotion Works Well With Antibiotics

Besides directly helping itching and inflammation associated with chronic dermatitis, SmartLotion® is designed to help in combination with antibiotic strategies. The intention and expectation of its use are a faster resolution of inflammation, and better control when combined with an antibiotic strategy. The expectation is, and all the evidence indicates, the avoidance of side effect risks, especially when compared to potent topical steroids. (See Dr. Harlan’s peer-reviewed study on side effects.)

At least three problems can occur with strong steroids. The first is the well-understood atrophy or thinning of the skin. Skin thinning occurs with the prolonged use of strong steroids on sensitive skin areas like the inner arms, inner thighs, groin creases, and perianal area. The problem with strong topical steroids and the facial skin is that long before thinning or atrophy occurs, the facial skin will develop acne-like rashes and burning inflammation related to dysregulation of the skin’s immune system.

The overgrowth of noxious microbes contributes to inflammation and immune dysregulation. This adverse reaction to topical steroids on the face was always called steroid rebound phenomenon, or steroid addiction. Now it’s called TSW, Topical Steroid Withdrawal.

Eczema And The Immune System 

Very fortunate people (perhaps 30-40% of us) have rock-solid immune systems that neither overreact nor underreact to environmental insults like bacteria, yeast, and other microbes. Unfortunately, at different times in our lives, the rest of us develop skin disorders caused by the overgrowth of noxious microbes on the skin and runaway inflammation. For example, people prone to eczema and psoriasis tend to develop runaway inflammation in the skin from many different stimuli and environmental factors, including stress. These situations produce redness, itching, scaling, and many other problems.

When eczema is acute and oozy, it almost always has an overgrowth of Staph aureus producing Super-antigens that make eczema worse. Psoriasis is often made worse by Super-antigens from Streptococcal bacteria. Microbes can also directly contribute to pimples and acne. However, pimples, inflammation, and acne flare-ups can occur after the noxious microbes are gone. The inflammation and immune dysregulation they cause can linger and produce acne-like rashes long after the microbes disappear.

Teenage Eczema 

In teenage acne, there is activated oil (sebum) production, follicles fracturing and plugging, and dysregulation or overreaction of inflammation to these conditions within the pore (pilosebaceous gland). Therefore, we must improve the pore integrity and stability in acne, reduce the microbes, and reduce the inflammatory reaction. In our 2008 Clinical experience, I provided evidence that when using a retinoid-like tretinoin to improve the integrity of the pores, excess irritation or inflammation can be safely reduced with a SmartLotion® strategy.

Antibiotics And The SmartLotion® Strategy

Poorly controlled inflammation by antibiotics alone was another indication for using combination therapy with the SmartLotion® strategy. Our acne patients were able to tolerate RetinA® (tretinoin) and Benzaclin®/Benzamycin® (products containing BPO benzoyl peroxide) significantly better and achieve superior results. This strategy is also essential when treating Rosacea in patients with stinging “sensitive skin”, or those with a background of Atopic dermatitis and Rosacea. The 2008 paper also pointed to the evidence that antibiotics and retinoid strategies themselves reduce the risk of problems with mild topical steroids.

*For Dermatologists: A product for melasma (Triluma®) has been around for 40 years, that combines a steroid (fluocinolone) with tretinoin and is used for months on the face. The retinoid in this has consistently protected from and largely prevented TSW from this product.

By Steven Harlan, MD