Antibiotic resistant acne.

Our approach to a patient who fails to respond to antibiotics is as follows: First, take a careful history. Look for use of cosmetics and topical corticosteroids, anticonvulsive agents and systemic corticosteroids. Inquire about marked increases in emotional or psychological stresses accompanied by noticeable seborrhea. Probe the patient about habits of leaning on or squeezing acne areas, and most importantly, inquire how often and in what manner the patient washes. In the physical examination, look for evidence of sinus tract formation--extending, tunneling lesions with openings to the surface. Use Wood's light examination for the density of follicular fluorescence to rule out failure to properly absorb an antibiotic; fluoresce the oral mucosa to rule out failure to comply when the antibiotic is a tetracycline. Culture the surface aerobic flora on routine media with and without the antibiotic in question to settle any question of malabsorption. A systematic approach to these possibilities will usually uncover the factor or factors responsible for therapeutic failure. Clinical improvement promptly follows, once proper measures are initiated to neutralize the aggravating forces.