|Year : 2016 | Volume
| Issue : 5 | Page : 469-481
|Anti-inflammatory and immunomodulatory effects of antibiotics and their use in dermatology
Swetalina Pradhan1, Bhushan Madke2, Poonam Kabra2, Adarsh Lata Singh2
1 Department of Dermatology, STD and Leprosy, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
2 Department of Dermatology, Venereology and Leprosy, Jawaharlal Nehru Medical College and AVBR Hospital, Wardha, Maharashtra, India
|Date of Web Publication||9-Sep-2016|
Department of Dermatology, Venereology and Leprosy, Jawaharlal Nehru Medical College and AVBR Hospital, Sawangi Meghe, Wardha, Maharashtra
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Antibiotics (antibacterial, antiviral, and antiparasitic) are class of drugs which result in either killing or inhibiting growth and multiplication of infectious organisms. Antibiotics are commonly prescribed by all specialties for treatment of infections. However, antibiotics have hitherto immunomodulatory and anti-inflammatory properties and can be exploited for various noninfectious dermatoses. Dermatologists routinely prescribe antibiotics in treatment of various noninfectious disorders. This study will review anti-inflammatory and immunomodulatory effects of antibiotics and their use in dermatology.
Keywords: Antibiotics, anti-inflammatory, dermatotherapeutics, inflammatory skin diseases, immunomodulation
|How to cite this article:|
Pradhan S, Madke B, Kabra P, Singh AL. Anti-inflammatory and immunomodulatory effects of antibiotics and their use in dermatology. Indian J Dermatol 2016;61:469-81
|How to cite this URL:|
Pradhan S, Madke B, Kabra P, Singh AL. Anti-inflammatory and immunomodulatory effects of antibiotics and their use in dermatology. Indian J Dermatol [serial online] 2016 [cited 2021 May 13];61:469-81. Available from: https://www.e-ijd.org/text.asp?2016/61/5/469/190105
What was known?
- Antibiotics are mainly considered as anti-bacterial agents used for infectious conditions
- In dermatology antibiotics are being used for various infectious conditions.
| Introduction|| |
Antibiotics are chemicals derived from microorganisms that have the capacity, in dilute solutions, to kill other microorganisms (bacteria, virus, fungi, and parasite) or inhibit their growth. In this study, antibiotics refer to collective term for antibacterial, antiviral, and antiparasitic agents. In routine clinical practice, antibiotics are chiefly used to eliminate various pathogens (bacteria, viruses, and parasites). Many antibiotics were later found to have anti-inflammatory properties apart from their antimicrobial action. We have discussed anti-inflammatory and anti-immunomodulatory effects of various antibacterial and antiparasitic drugs. Antiviral and antifungal drugs are seldom used for their anti-inflammatory properties.
| Antibacterial Agents|| |
Clindamycin is a synthetic derivative of lincomycin and isolated from the Streptomyces species. The drug has broad-spectrum antibacterial action by binding irreversibly to 50S subunit of bacterial ribosome and thereby inhibiting bacterial protein synthesis. In dermatology, clindamycin is being used for several indications for its both antibacterial and anti-inflammatory properties [Table 1].
Clofazimine is a iminophenazine dye known for its antimycobacterial properties. Its absorption is increased with food. It is highly lipophilic and concentrates in lipid-rich tissues. Because of slow elimination, the drug has long half-life of approximately 70 days. Metabolism of the drug occurs in liver and elimination occurs through sebum, sputum, tears, sweat, and urine. However, it also possesses good anti-inflammatory actions and is used in many dermatologic diseases for the same [Table 2].
Dapsone (4,4'-diaminodiphenylsulfone) is an aniline derivative belonging to the group of synthetic sulfones. Dapsone is absorbed rapidly and nearly completely from the gastrointestinal tract. Peak plasma concentration is reached within 2–8 h after administration. The mean half-life of elimination is about 20–30 h. It is metabolized in liver by two distinct routes, N-acetylation and N-hydroxylation. It has dual functions of both antimicrobial/antiprotozoal effects and anti-inflammatory features similar to nonsteroidal anti-inflammatory drugs. Dapsone has been used as a treatment option in various dermatological conditions because of its anti-inflammatory effects [Table 3].
|Table 3: Indications of dapsone for its anti-inflammatory and immunomodulatory properties|
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Macrolides contain a macrocyclic lactone ring structure. These are of actinomycetes or semisynthetic derivatives of same bacteria. They are bacteriostatic antibacterial agents which bind irreversibly to the large (50S) ribosomal subunit of bacteria, thereby inhibiting RNA-dependent protein synthesis. However, there have been many dermatological uses of macrolides for their immunomodulatory action. Azithromycin (A), roxithromycin (R), erythromycin (E), and clarithromycin (C) are commonly used in dermatology practice for their immunomodulatory and anti-inflammatory potential [Table 4].
|Table 4: Indications of macrolides in dermatological diseases for their its anti-inflammatory and immunomodulatory properties|
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Metronidazole is a synthetic nitroimidazole antibacterial drug. It acts by DNA disruption and nucleic acid synthesis inhibition. It acts against anaerobic bacteria and protozoa. However, it has many actions other than its antibacterial action for which it is being used in different dermatological diseases [Table 5].
|Table 5: Indications of metronidazole for its anti-inflammatory properties|
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Rifampicin (R) is a semisynthetic derivative of rifamycin B, an antimicrobial agent produced by Streptomyces mediterranei . It is a broad-spectrum antimicrobial and inhibits the growth of most Gram-positive bacteria, as well as many Gram-negative microorganisms. However, it has other properties besides antimicrobial action for which it has been used in various dermatological conditions [Table 6].
|Table 6: Indications of rifampicin for its anti-inflammatory and immunomodulatory properties|
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The tetracyclines are broad-spectrum antibiotics and comprise four main drugs (tetracycline [T], doxycycline [D], minocycline [M], and lymecycline [L]). Tetracycline group of antibacterial agents are indicated in a wide range of infections including Treponema pallidum (syphilis), Borrelia burgdorferi , Borrelia afzelii , Borrelia garinii (Lyme disease), Coxiella burnetii (Q fever), Rickettsia rickettsii (Rocky Mountain spotted fever), and Yersinia More Details pestis (Plague). Their antibiotic effect is primarily exerted by binding to the 30S subunit of bacterial ribosomes, thereby halting protein synthesis. However, many tetracyclines have in addition anti-inflammatory properties. [Table 7] discusses the role of tetracyclines chiefly for their anti-inflammatory properties.
|Table 7: Indications of tetracyclines in dermatology for their its anti-inflammatory properties|
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The parent molecule for the antimalarials is quinine. Among antimalarials, chloroquine (CQ) and hydroxychloroquine (HCQ) are used in various dermatological disorders. Both CQ and HCQ are alkylated 4-aminoquinolines. HCQ is a derivative of CQ and is nearly completely absorbed within 2–4 h of an oral dose and metabolized in liver by dealkylation. The drugs accumulate in thrombocytes, granulocytes, and erythrocytes; hence, their concentration in whole blood is 3–10 times higher than that of plasma. CQ has high affinity for melanin and gets accumulated in the eyes and the skin where the concentration is 100–200 times higher than that of plasma; in the epidermis, it is 3–7 times higher than that of the dermis. The maximum daily dosage is 3.5–4 mg/kg of body weight for CQ and 6–6.5 mg/kg body weight for HCQ. Various indications for antimalarials drug are shown in [Table 8].
Levamisole is an anthelmintic agent with a wide range of immunomodulatory actions. It belongs to the class of imidazothiazole derivatives. It is water-soluble and gets rapidly absorbed from the gastrointestinal tract with peak blood levels achieved after 1.5–4 h. Metabolism of the drugs occurs mainly in liver and the plasma half-life is 16 h. Due to immunomodulatory properties, it has been widely used in various dermatological disorders. Usual dose of the drug is 150 mg/day for 2–4 days each week [Table 9].
All the above-discussed drugs have variety of side effects in the therapeutic dose range. The treating skin physician must be aware of commonly encountered side effects which can enable him or her to rationalize the treatment protocol and manage the side effects with due care [Table 10].
| Conclusions|| |
The study aims to highlight the role of various antibiotic drugs in the management of noninfectious diseases of skin and its appendages. In future, many more cutaneous diseases will be treated and managed with various antibiotics tapping their anti-inflammatory properties. We would like to highlight that in future, these antibiotics will be used albeit in continuous low-dose in various noninfectious dermatoses, thereby minimizing the incidence of side effects.
Financial support and sponsorship
Conflflicts of interest
There are no conflicts of interest.
| References|| |
Del Rosso JQ, Schmidt NF. A review of the anti-inflammatory properties of clindamycin in the treatment of acne vulgaris. Cutis 2010;85:15-24.
Nakano T, Hiramatsu K, Kishi K, Hirata N, Kadota J, Nasu M. Clindamycin modulates inflammatory-cytokine induction in lipopolysaccharide-stimulated mouse peritoneal macrophages. Antimicrob Agents Chemother 2003;47:363-7.
Thomas DR, Raimer S, Smith EB. Comparison of topical erythromycin 1.5 percent solution versus topical clindamycin phosphate 1.0 percent solution in the treatment of acne vulgaris. Cutis 1982;29:624-5, 628-32.
Gold MH, Korotzer A. Sub-group analyses from a trial of a fixed combination of clindamycin phosphate 1.2% and benzoyl peroxide 3.75% gel for the treatment of moderate-to-severe acne vulgaris. J Clin Aesthet Dermatol 2015;8:22-6.
Webster G. Cutaneous safety and tolerability of a fixed combination clindamycin (1.2%) and benzoyl peroxide (3.75%) aqueous gel in moderate-to-severe acne vulgaris. J Clin Aesthet Dermatol 2015;8:22-8.
Powell JJ, Dawber RP, Gatter K. Folliculitis decalvans including tufted folliculitis: Clinical, histological and therapeutic findings. Br J Dermatol 1999;140:328-33.
Yost J, Robinson M, Meehan SA. Fox-fordyce disease. Dermatol Online J 2012;18:28.
George A, Bhatia A, Thomas E. Fox-fordyce disease: A report of 2 cases responding to topical clindamycin. Indian J Dermatol Venereol Leprol 2015;81:87-8.
van der Zee HH, Boer J, Prens EP, Jemec GB. The effect of combined treatment with oral clindamycin and oral rifampicin in patients with hidradenitis suppurativa. Dermatology 2009;219:143-7.
Pasquale TR, Tan JS. Nonantimicrobial effects of antibacterial agents. Clin Infect Dis 2005;40:127-35.
Weinkle AP, Doktor V, Emer J. Update on the management of rosacea. Clin Cosmet Investig Dermatol 2015;8:159-77.
Breneman D, Savin R, VandePol C, Vamvakias G, Levy S, Leyden J. Double-blind, randomized, vehicle-controlled clinical trial of once-daily benzoyl peroxide/clindamycin topical gel in the treatment of patients with moderate to severe rosacea. Int J Dermatol 2004;43:381-7.
Fdez-Freire LR, Serrano Gotarredona A, Bernabeu Wittel J, Pulpillo Ruiz A, Cabrera R, Navarrete Ortega M, et al
. Clofazimine as elective treatment for granulomatous cheilitis. J Drugs Dermatol 2005;4:374-7.
Arbiser JL, Moschella SL. Clofazimine: A review of its medical uses and mechanisms of action. J Am Acad Dermatol 1995;32(2 Pt 1):241-7.
Gómez-de la Fuente E, del Rio R, Rodriguez M, Guerra A, Rodriguez-Peralto JL, Iglesias L. Granuloma faciale mimicking rhinophyma: Response to clofazimine. Acta Derm Venereol 2000;80:144.
Seukeran DC, Stables GI, Cunliffe WJ, Sheehan-Dare RA. The treatment of acne agminata with clofazimine. Br J Dermatol 1999;141:596-7.
Goihman-Yahr M. Malignant pyoderma gangrenosum responding to clofazimine. Int J Dermatol 1996;35:757-8.
Kaplan B, Trau H, Sofer E, Feinstein A, Schewach-Millet M. Treatment of pyoderma gangrenosum with clofazimine. Int J Dermatol 1992;31:591-3.
Tan BB, Lear JT, Smith AG. Acne fulminans and erythema nodosum during isotretinoin therapy responding to dapsone. Clin Exp Dermatol 1997;22:26-7.
Prendiville JS, Logan RA, Russell-Jones R. A comparison of dapsone with 13-cis retinoic acid in the treatment of nodular cystic acne. Clin Exp Dermatol 1988;13:67-71.
Sharquie KE, Najim RA, Abu-Raghif AR. Dapsone in Behçet's disease: A double-blind, placebo-controlled, cross-over study. J Dermatol 2002;29:267-79.
Jacyk WK. Behçet's disease in South African blacks: Report of five cases. J Am Acad Dermatol 1994;30(5 Pt 2):869-73.
Harvath L, Yancey KB, Katz SI. Selective inhibition of human neutrophil chemotaxis to N-formyl-methionyl-leucyl-phenylalanine by sulfones. J Immunol 1986;137:1305-11.
Thuong-Nguyen V, Kadunce DP, Hendrix JD, Gammon WR, Zone JJ. Inhibition of neutrophil adherence to antibody by dapsone: A possible therapeutic mechanism of dapsone in the treatment of IgA dermatoses. J Invest Dermatol 1993;100:349-55.
Booth SA, Moody CE, Dahl MV, Herron MJ, Nelson RD. Dapsone suppresses integrin-mediated neutrophil adherence function. J Invest Dermatol 1992;98:135-40.
Debol SM, Herron MJ, Nelson RD. Anti-inflammatory action of dapsone: Inhibition of neutrophil adherence is associated with inhibition of chemoattractant-induced signal transduction. J Leukoc Biol 1997;62:827-36.
Person JR, Rogers RS 3rd
. Bullous pemphigoid responding to sulfapyridine and the sulfones. Arch Dermatol 1977;113:610-5.
Jeffes EW 3rd
, Ahmed AR. Adjuvant therapy of bullous pemphigoid with dapsone. Clin Exp Dermatol 1989;14:132-6.
Hall RP, Lawley TJ, Smith HR, Katz SI. Bullous eruption of systemic lupus erythematosus. Dramatic response to dapsone therapy. Ann Intern Med 1982;97:165-70.
Burrows NP, Bhogal BS, Black MM, Rustin MH, Ishida-Yamamoto A, Kirtschig G, et al
. Bullous eruption of systemic lupus erythematosus: A clinicopathological study of four cases. Br J Dermatol 1993;128:332-8.
Rao CL, Hall RP. Linear immunoglobulin a dermatosis and chronic bullous disease of childhood. In: Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, editors. Fitzpatrick's Dermatology in General Medicine. New York: McGraw Hill Medical; 2003. p. 485-90.
Knudson RM, Kalaaji AN, Bruce AJ. The management of mucous membrane pemphigoid and pemphigus. Dermatol Ther 2010;23:268-80.
Bolotin D, Petronic-Rosic V. Dermatitis herpetiformis. Part II. Diagnosis, management, and prognosis. J Am Acad Dermatol 2011;64:1027-33.
Antiga E, Caproni M. The diagnosis and treatment of dermatitis herpetiformis. Clin Cosmet Investig Dermatol 2015;8:257-65.
Kim JH, Kim YH, Kim SC. Epidermolysis bullosa acquisita: A retrospective clinical analysis of 30 cases. Acta Derm Venereol 2011;91:307-12.
Krähe J, Galal O, Kordass U, Bornemann P. Epidermolysis bullosa atrophicans gravis. Report of a therapeutic trial with dapsone. Monatsschr Kinderheilkd 1988;136:140-2.
Fort SL, Rodman OG. Erythema elevatum diutinum. Response to dapsone. Arch Dermatol 1977;113:819-22.
Cream JJ, Levene GM, Calnan CD. Erythema elevatum diutinum: An unusual reaction to streptococcal antigen and response to dapsone. Br J Dermatol 1971;84:393-9.
Nanda KB, Saldanha CS, Jacintha M, Kamath G. Hailey-Hailey disease responding to thalidomide. Indian J Dermatol 2014;59:190-2.
Beutner EH, Chorzelski TP, Wilson RM, Kumar V, Michel B, Helm F, et al
. IgA pemphigus foliaceus. Report of two cases and a review of the literature. J Am Acad Dermatol 1989;20:89-97.
Fredenberg MF, Malkinson FD. Sulfone therapy in the treatment of leukocytoclastic vasculitis. Report of three cases. J Am Acad Dermatol 1987;16:772-8.
Rao CL, Hall RP. Linear immunoglobulin a dermatosis and chronic bullous disease of childhood. In: Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, editors. Fitzpatrick's Dermatology in General Medicine. New York: McGraw Hill Medical; 2003. p. 485-90.
Chopra A, Mittal RR, Kaur B. Dapsone versus corticosteroids in lichen planus. Indian J Dermatol Venereol Leprol 1999;65:66-8.
Stendahl O, Molin L, Lindroth M. Granulocyte-mediated release of histamine from mast cells. Effect of myeloperoxidase and its inhibition by antiinflammatory sulfone compounds. Int Arch Allergy Appl Immunol 1983;70:277-84.
Macmillan AL, Champion RH. Generalized pustular psoriasis treated with dapsone. Br J Dermatol 1973;88:183-5.
Powell FC, Collins S. Pyoderma gangrenosum. Clin Dermatol 2000;18:283-93.
Martin J, Roenigk HH, Lynch W, Tingwald FR. Relapsing polychondritis treated with dapsone. Arch Dermatol 1976;112:1272-4.
Barranco VP, Minor DB, Soloman H. Treatment of relapsing polychondritis with dapsone. Arch Dermatol 1976;112:1286-8.
Reed J, Wilkinson J. Subcorneal pustular dermatosis. Clin Dermatol 2000;18:301-13.
Nishijima C, Hatta N, Inaoki M, Sakai H, Takehara K. Urticarial vasculitis in systemic lupus erythematosus: Fair response to prednisolone/dapsone and persistent hypocomplementemia. Eur J Dermatol 1999;9:54-6.
Eiser AR, Singh P, Shanies HM. Sustained dapsone-induced remission of hypocomplementemic urticarial vasculitis – A case report. Angiology 1997;48:1019-22.
Labro MT. Anti-inflammatory activity of macrolides: A new therapeutic potential? J Antimicrob Chemother 1998;41 Suppl B: 37-46.
Scaglione F, Rossoni G. Comparative anti-inflammatory effects of roxithromycin, azithromycin and clarithromycin. J Antimicrob Chemother 1998;41 Suppl B: 47-50.
Kus S, Yucelten D, Aytug A. Comparison of efficacy of azithromycin vs. doxycycline in the treatment of acne vulgaris. Clin Exp Dermatol 2005;30:215-20.
Thanou-Stavraki A, Aberle T, Aksentijevich I, Bane BL, Harley JB. Clarithromycin in adult-onset still's disease: A potentially useful therapeutic. J Clin Rheumatol 2011;17:373-6.
Saviola G, Benucci M, Abdi-Ali L, Baiardi P, Manfredi M, Bucci M, et al
. Clarithromycin in adult-onset Still's disease: A study of 6 cases. Rheumatol Int 2010;30:555-60.
Mensing H, Krausse S. Erythromycin treatment for bullous pemphigoid. Med Klin 1990;85:481-4.
Altomare G, Capella GL, Fracchiolla C, Frigerio E. Treatment of bullous pemphigoid with erythromycin: A reappraisal. Eur J Dermatol 1999;9:583-5.
Fox BJ, Odom RB, Findlay RF. Erythromycin therapy in bullous pemphigoid: Possible anti-inflammatory effects. J Am Acad Dermatol 1982;7:504-10.
Jang HS, Oh CK, Cha JH, Cho SH, Kwon KS. Six cases of confluent and reticulated papillomatosis alleviated by various antibiotics. J Am Acad Dermatol 2001;44:652-5.
Tomazic J, Kotnik V, Wraber B.In vivo
administration of azithromycin affects lymphocyte activity in vitro
. Antimicrob Agents Chemother 1993;37:1786-9.
Kobayashi M, Shimauchi T, Hino R, Tokura Y. Roxithromycin downmodulates Th2 chemokine production by keratinocytes and chemokine receptor expression on Th2 cells: Its dual inhibitory effects on the ligands and the receptors. Cell Immunol 2004;228:27-33.
Kim JY, Park SH, Cho KS, Kim HJ, Lee CK, Park KK, et al
. Mechanism of azithromycin treatment on gingival overgrowth. J Dent Res 2008;87:1075-9.
Wahlstrom E, Zamora JU, Teichman S. Improvement in cyclosporine-associated gingival hyperplasia with azithromycin therapy. N Engl J Med 1995;332:753-4.
Ramalho VL, Ramalho HJ, Cipullo JP, Azoubel R, Burdmann EA. Comparison of azithromycin and oral hygiene program in the treatment of cyclosporine-induced gingival hyperplasia. Ren Fail 2007;29:265-70.
Ianaro A, Ialenti A, Maffia P, Sautebin L, Rombolà L, Carnuccio R, et al
. Anti-inflammatory activity of macrolide antibiotics. J Pharmacol Exp Ther 2000;292:156-63.
Ohe M, Hashino S. Successful treatment with erythromycin for idiopathic thrombocytopenic purpura. Korean J Hematol 2011;46:139-42.
Ohe M, Kohno M. Three cases of idiopathic thrombocytopenic purpura showing an increase in the platelet count following clarithromycin treatment. Rinsho Ketsueki 2003;44:1044-6.
Tlaskalová-Hogenová H, Stepánková R, Hudcovic T, Tucková L, Cukrowska B, Lodinová-Zádníková R, et al
. Commensal bacteria (normal microflora), mucosal immunity and chronic inflammatory and autoimmune diseases. Immunol Lett 2004;93:97-108.
Koizumi N, Hatamochi A, Shinkai H. Treatment of lupus miliaris disseminatus faciei with roxithromycin. Nishinihon J Dermatol 2003;65:70-3.
Aoki D, Ueno S, Kubo F, Oyama T, Sakuta T, Matsushita K, et al
. Roxithromycin inhibits angiogenesis of human hepatoma cells in vivo
by suppressing VEGF production. Anticancer Res 2005;25:133-8.
Goel NS, Burkhart CN, Morrell DS. Pediatric periorificial dermatitis: Clinical course and treatment outcomes in 222 patients. Pediatr Dermatol 2015;32:333-6.
Ehsani A, Esmaily N, Noormohammadpour P, Toosi S, Hosseinpour A, Hosseini M, et al
. The comparison between the efficacy of high dose acyclovir and erythromycin on the period and signs of pitiriasis rosea. Indian J Dermatol 2010;55:246-8.
Miranda SB, Lupi O, Lucas E. Vesicular pityriasis rosea: Response to erythromycin treatment. J Eur Acad Dermatol Venereol 2004;18:622-5.
Sharma PK, Yadav TP, Gautam RK, Taneja N, Satyanarayana L. Erythromycin in pityriasis rosea: A double-blind, placebo-controlled clinical trial. J Am Acad Dermatol 2000;42(2 Pt 1):241-4.
Truhan AP, Hebert AA, Esterly NB. Pityriasis lichenoides in children: Therapeutic response to erythromycin. J Am Acad Dermatol 1986;15:66-70.
Skinner RB, Levy AL. Rapid resolution of pityriasis lichenoides et varioliformis acuta with azithromycin. J Am Acad Dermatol 2008;58:524-5.
Ohshima A, Takigawa M, Tokura Y. CD8+ cell changes in psoriasis associated with roxithromycin-induced clinical improvement. Eur J Dermatol 2001;11:410-5.
Saxena VN, Dogra J. Long-term oral azithromycin in chronic plaque psoriasis: A controlled trial. Eur J Dermatol 2010;20:329-33.
Komine M, Tamaki K. An open trial of oral macrolide treatment for psoriasis vulgaris. J Dermatol 2000;27:508-12.
Konno S, Adachi M, Asano K, Okamoto K, Takahashi T. Inhibition of human T-lymphocyte activation by macrolide antibiotic, roxithromycin. Life Sci 1992;51:PL231-6.
Wakita H, Tokura Y, Furukawa F, Takigawa M. The macrolide antibiotic, roxithromycin suppresses IFN-γ-mediated immunological functions of cultured normal human keratinocytes. Biol Pharm Bull 1996;19:224-7.
Bakar O, Demirçay Z, Yuksel M, Haklar G, Sanisoglu Y. The effect of azithromycin on reactive oxygen species in rosacea. Clin Exp Dermatol 2007;32:197-200.
Fernandez-Obregon A. Oral use of azithromycin for the treatment of acne rosacea. Arch Dermatol 2004;140:489-90.
Rubin BK. Immunomodulatory properties of macrolides: Overview and historical perspective. Am J Med 2004;117 Suppl 9A: 2S-4S.
Levert H, Gressier B, Moutard I, Brunet C, Dine T, Luyckx M, et al
. Azithromycin impact on neutrophil oxidative metabolism depends on exposure time. Inflammation 1998;22:191-201.
Kadota J, Iwashita T, Matsubara Y, Ishimatsu Y, Yoshinaga M, Abe K, et al
. Inhibitory effect of erythromycin on superoxide anion production by human neutrophils primed with granulocyte-colony stimulating factor. Antimicrob Agents Chemother 1998;42:1866-7.
Colina M, Lo Monaco A, Khodeir M, Trotta F. Propionibacterium acnes
and SAPHO syndrome: A case report and literature review. Clin Exp Rheumatol 2007;25:457-60.
Schaeverbeke T, Lequen L, de Barbeyrac B, Labbé L, Bébéar CM, Morrier Y, et al
. Propionibacterium acnes
isolated from synovial tissue and fluid in a patient with oligoarthritis associated with acne and pustulosis. Arthritis Rheum 1998;41:1889-93.
Kirchhoff T, Merkesdal S, Rosenthal H, Prokop M, Chavan A, Wagner A, et al
. Diagnostic management of patients with SAPHO syndrome: Use of MR imaging to guide bone biopsy at CT for microbiological and histological work-up. Eur Radiol 2003;13:2304-8.
Assmann G, Kueck O, Kirchhoff T, Rosenthal H, Voswinkel J, Pfreundschuh M, et al
. Efficacy of antibiotic therapy for SAPHO syndrome is lost after its discontinuation: An interventional study. Arthritis Res Ther 2009;11:R140.
Nishimuta K, Ito Y. Effects of metronidazole and tinidazole ointments on models for inflammatory dermatitis in mice. Arch Dermatol Res 2003;294:544-51.
Khodaeiani E, Fouladi RF, Yousefi N, Amirnia M, Babaeinejad S, Shokri J. Efficacy of 2% metronidazole gel in moderate acne vulgaris. Indian J Dermatol 2012;57:279-81.
Akamatsu H, Oguchi M, Nishijima S, Asada Y, Takahashi M, Ushijima T, et al
. The inhibition of free radical generation by human neutrophils through the synergistic effects of metronidazole with palmitoleic acid: A possible mechanism of action of metronidazole in rosacea and acne. Arch Dermatol Res 1990;282:449-54.
Khan KJ, Ullman TA, Ford AC, Abreu MT, Abadir A, Marshall JK, et al
. Antibiotic therapy in inflammatory bowel disease: A systematic review and meta-analysis. Am J Gastroenterol 2011;106:661-73.
Green B, Morrell DS. Persistent facial dermatitis: Pediatric perioral dermatitis. Pediatr Ann 2007;36:796-8.
Vanderweil SG, Levin NA. Perioral dermatitis: It's not every rash that occurs around the mouth. Dermatol Nurs 2009;21:317-20, 353.
Boeck K, Abeck D, Werfel S, Ring J. Perioral dermatitis in children – Clinical presentation, pathogenesis-related factors and response to topical metronidazole. Dermatology 1997;195:235-8.
Rodriguez-Caruncho C, Bielsa I, Fernandez-Figueras MT, Ferrándiz C. Childhood granulomatous periorificial dermatitis with a good response to oral metronidazole. Pediatr Dermatol 2013;30:e98-9.
Schmadel LK, McEvoy GK. Topical metronidazole: A new therapy for rosacea. Clin Pharm 1990;9:94-101.
Del Rosso JQ, Baum EW. Comprehensive medical management of rosacea: An interim study report and literature review. J Clin Aesthet Dermatol 2008;1:20-5.
Del Rosso JQ. A status report on the medical management of rosacea: Focus on topical therapies. Cutis 2002;70:271-5.
Zip CM. Innovative use of topical metronidazole. Dermatol Clin 2010;28:525-34.
Miyachi Y, Imamura S, Niwa Y. Anti-oxidant action of metronidazole: A possible mechanism of action in rosacea. Br J Dermatol 1986;114:231-4.
Bikowski J. Facial seborrheic dermatitis: A report on current status and therapeutic horizons. J Drugs Dermatol 2009;8:125-33.
McFalda WL, Roebuck HL. Rational management of papulopustular rosacea with concomitant facial seborrheic dermatitis: A case report. J Clin Aesthet Dermatol 2011;4:40-2.
Seckin D, Gurbuz O, Akin O. Metronidazole 0.75% gel vs. ketoconazole 2% cream in the treatment of facial seborrheic dermatitis: A randomized, double-blind study. J Eur Acad Dermatol Venereol 2007;21:345-50.
Mendonça CO, Griffiths CE. Clindamycin and rifampicin combination therapy for hidradenitis suppurativa. Br J Dermatol 2006;154:977-8.
Mela M, Mancuso A, Burroughs AK. Review article: Pruritus in cholestatic and other liver diseases. Aliment Pharmacol Ther 2003;17:857-70.
LeCluyse EL. Pregnane X receptor: Molecular basis for species differences in CYP3A induction by xenobiotics. Chem Biol Interact 2001;134:283-9.
Marschall HU, Wagner M, Zollner G, Fickert P, Diczfalusy U, Gumhold J, et al
. Complementary stimulation of hepatobiliary transport and detoxification systems by rifampicin and ursodeoxycholic acid in humans. Gastroenterology 2005;129:476-85.
Khurana S, Singh P. Rifampin is safe for treatment of pruritus due to chronic cholestasis: A meta-analysis of prospective randomized-controlled trials. Liver Int 2006;26:943-8.
Kazandjieva J, Kamarashev J, Hinkov G, Tsankov N. Rifampicin und psoriasis. Akt Dermatol 1997;23:78-81.
Paunescu E.In vivo
and in vitro
suppression of humoral and cellular immunological response by rifampicin. Nature 1970;228:1188-90.
Nilsson BS. Rifampicin: An immunosuppressant? Lancet 1971;2:374.
Dajani BM, Canady MS, Thompson JS, Kasik JE. Rifampicin: An immunosuppressant? Lancet 1972;2:1094.
Monk E, Shalita A, Siegel DM. Clinical applications of non-antimicrobial tetracyclines in dermatology. Pharmacol Res 2011;63:130-45.
Griffin MO, Fricovsky E, Ceballos G, Villarreal F. Tetracyclines: A pleitropic family of compounds with promising therapeutic properties. Review of the literature. Am J Physiol Cell Physiol 2010;299:C539-48.
Sarici G, Cinar S, Armutcu F, Altinyazar C, Koca R, Tekin NS. Oxidative stress in acne vulgaris. J Eur Acad Dermatol Venereol 2010;24:763-7.
Skidmore R, Kovach R, Walker C, Thomas J, Bradshaw M, Leyden J, et al
. Effects of subantimicrobial-dose doxycycline in the treatment of moderate acne. Arch Dermatol 2003;139:459-64.
Webster GF, Leyden JJ, McGinley KJ, McArthur WP. Suppression of polymorphonuclear leukocyte chemotactic factor production in Propionibacterium acnes
by subminimal inhibitory concentrations of tetracycline, ampicillin, minocycline, and erythromycin. Antimicrob Agents Chemother 1982;21:770-2.
Bahrami F, Morris DL, Pourgholami MH. Tetracyclines: Drugs with huge therapeutic potential. Mini Rev Med Chem 2012;12:44-52.
Rao TN, Guruprasad P, Sowjanya CH, Nagasridevi I. Confluent and reticulated papillomatosis: Successful treatment with minocycline. Indian J Dermatol Venereol Leprol 2010;76:725.
Bachelez H, Senet P, Cadranel J, Kaoukhov A, Dubertret L. The use of tetracyclines for the treatment of sarcoidosis. Arch Dermatol 2001;137:69-73.
Webster GF, Toso SM, Hegemann L. Inhibition of a model of in vitro
granuloma formation by tetracyclines and ciprofloxacin. Involvement of protein kinase C. Arch Dermatol 1994;130:748-52.
McCarty M, Fivenson D. Two decades of using the combination of tetracycline derivatives and niacinamide as steroid-sparing agents in the management of pemphigus: Defining a niche for these low toxicity agents. J Am Acad Dermatol 2014;71:475-9.
Le Saché-de Peufeilhoux L, Raynaud E, Bouchardeau A, Fraitag S, Bodemer C. Familial benign chronic pemphigus and doxycycline: A review of 6 cases. J Eur Acad Dermatol Venereol 2014;28:370-3.
Shan XF, Zhang FR, Tian HQ, Wang N, Zhou SJ, Wang GJ. A case of linear IgA dermatosis successfully treated with tetracycline and niacinamide. Int J Dermatol 2016;55:e216-7.
Richards C, Pantanowitz L, Dezube BJ. Antimicrobial and non-antimicrobial tetracyclines in human cancer trials. Pharmacol Res 2011;63:151-6.
Dezube BJ, Krown SE, Lee JY, Bauer KS, Aboulafia DM. Randomized phase II trial of matrix metalloproteinase inhibitor COL-3 in AIDS-related Kaposi's sarcoma: An AIDS malignancy consortium study. J Clin Oncol 2006;24:1389-94.
Hantash BM, Kanzler MH. The efficacy of tetracycline antibiotics for treatment of lichen planus: An open-label clinical trial. Br J Dermatol 2007;156:758-60.
Kloppenburg M, Verweij CL, Miltenburg AM, Verhoeven AJ, Daha MR, Dijkmans BA, et al
. The influence of tetracyclines on T cell activation. Clin Exp Immunol 1995;102:635-41.
Esteves T, Faria A, Alves R, Marote J, Viana I, Vale E. Lupus miliaris disseminatus faciei: A case report. Dermatol Online J 2010;16:10.
Joshi RK, Atukorala DN, Abanmi A, al Khamis O, Haleem A. Successful treatment of Sweet's syndrome with doxycycline. Br J Dermatol 1993;128:584-6.
Berth-Jones J, Tan SV, Graham-Brown RA, Pembroke AC. The successful use of minocycline in pyoderma gangrenosum – A report of seven cases and review of the literature. J Dermatol Treat 1989;1:23-5.
Piamphongsant T. Tetracycline for the treatment of pityriasis lichenoides. Br J Dermatol 1974;91:319-22.
Kim TI, Choi JW, Jeong KH, Shin MK, Lee MH. Pustular prurigo pigmentosa treated with doxycycline. J Dermatol 2016. [Epub ahead of print].
Matsumoto C, Kinoshita M, Baba S, Suzuki H, Kanematsu S, Kanematsu N. Vesicular prurigo pigmentosa cured by minocycline. J Eur Acad Dermatol Venereol 2001;15:354-6.
Oberholzer PA, Nobbe S, Kolm I, Kerl K, Kamarachev J, Trüeb RM. Red scalp disease – A rosacea-like dermatosis of the scalp? Successful therapy with oral tetracycline. Dermatology 2009;219:179-81.
Wollina U. Red scrotum syndrome. J Dermatol Case Rep 2011;5:38-41.
Baldwin HE. Diagnosis and treatment of rosacea: State of the art. J Drugs Dermatol 2012;11:725-30.
Perret LJ, Tait CP. Non-antibiotic properties of tetracyclines and their clinical application in dermatology. Australas J Dermatol 2014;55:111-8.
Ní Raghallaigh S, Powell FC. Epidermal hydration levels in patients with rosacea improve after minocycline therapy. Br J Dermatol 2014;171:259-66.
Ben-Zvi I, Kivity S, Langevitz P, Shoenfeld Y. Hydroxychloroquine: From malaria to autoimmunity. Clin Rev Allergy Immunol 2012;42:145-53.
Abarientos C, Sperber K, Shapiro DL, Aronow WS, Chao CP, Ash JY. Hydroxychloroquine in systemic lupus erythematosus and rheumatoid arthritis and its safety in pregnancy. Expert Opin Drug Saf 2011;10:705-14.
Sisó A, Ramos-Casals M, Bové A, Brito-Zerón P, Soria N, Muñoz S, et al
. Previous antimalarial therapy in patients diagnosed with lupus nephritis: Influence on outcomes and survival. Lupus 2008;17:281-8.
Costedoat-Chalumeau N, Dunogué B, Morel N, Le Guern V, Guettrot-Imbert G. Hydroxychloroquine: A multifaceted treatment in lupus. Presse Med 2014;43(6 Pt 2):e167-80.
Carlin MC, Ratz JL. A case of generalized granuloma annulare responding to hydroxychloroquine. Cleve Clin J Med 1987;54:229-32.
Babuna G, Buyukbabani N, Yazganoglu KD, Baykal C. Effective treatment with hydroxychloroquine in a case of annular elastolytic giant cell granuloma. Indian J Dermatol Venereol Leprol 2011;77:110-1.
Jones E, Callen JP. Hydroxychloroquine is effective therapy for control of cutaneous sarcoidal granulomas. J Am Acad Dermatol 1990;23(3 Pt 1):487-9.
Atzmony L, Reiter O, Hodak E, Gdalevich M, Mimouni D. Treatments for cutaneous lichen planus: A systematic review and meta-analysis. Am J Clin Dermatol 2016;17:11-22.
van Loosdregt J, Spreafico R, Rossetti M, Prakken BJ, Lotz M, Albani S. Hydroxychloroquine preferentially induces apoptosis of CD45RO effector T cells by inhibiting autophagy: A possible mechanism for therapeutic modulation of T cells. J Allergy Clin Immunol 2013;131:1443-6.e1.
Reeves GE, Boyle MJ, Bonfield J, Dobson P, Loewenthal M. Impact of hydroxychloroquine therapy on chronic urticaria: Chronic autoimmune urticaria study and evaluation. Intern Med J 2004;34:182-6.
Ochsendorf FR. Use of antimalarials in dermatology. J Dtsch Dermatol Ges 2010;8:829-44.
Rassai S, Mehri M, Yaghoobi R, Sina N, Mohebbipour A, Feily A. Superior efficacy of azithromycin and levamisole vs. azithromycin in the treatment of inflammatory acne vulgaris: An investigator blind randomized clinical trial on 169 patients. Int J Clin Pharmacol Ther 2013;51:490-4.
De Cree J, De Cock W, Verhaegen H. Levamisole treatment of inflammatory acne. Restoration of impaired T-cell function accompanied by clearing of the lesions. Biomedicine 1979;31:95-9.
Scherak O, Smolen J, Kolarz G, Kojer M, Menzel J. Clinical experience with levamisole treatment of patients with systemic lupus erythematosus (author's transl). Wien Klin Wochenschr 1979;91:758-62.
Rovenský J, Cebecauer L, Zitnan D, Lukác J, Ferencík M. Levamisole treatment of systemic lupus erythematosus. Arthritis Rheum 1982;25:470-1.
Lozada F, Spitler L, Silverman S Jr. Clinical and immunologic responses to levamisole in 13 patients with erythema multiforme. Int J Immunopharmacol 1980;2:63-8.
Lozada F. Levamisole in the treatment of erythema multiforme: A double-blind trial in fourteen patients. Oral Surg Oral Med Oral Pathol 1982;53:28-31.
Castro Garzón M, Mubita M, Kachinka L. Levamisole treatment in HIV-infected Zambian children. Lancet 1992;340:1099-100.
Kar HK, Bhatia VN, Kumar CH, Sirumban P, Roy RG. Evaluation of levamisole, an immunopotentiator, in the treatment of lepromatous leprosy. Indian J Lepr 1986;58:592-600.
Lu SY, Chen WJ, Eng HL. Response to levamisole and low-dose prednisolone in 41 patients with chronic oral ulcers: A 3-year open clinical trial and follow-up study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;86:438-45.
Khondker L, Khan SI. Efficacy of levamisole for the treatment of slow spreading vitiligo. Mymensingh Med J 2013;22:761-6.
Renoux G. Modulation of immunity by levamisole. J Pharmacol Ther 1978;2:288-96.
What is new?
- Antibiotics refer to collective term for antibacterial, antiviral, and antiparasitic
- Antibiotics have multifaceted actions besides killing the infectious organisms
- Anti-inflammatory and immunomodulatory effects of antibiotics make them
- eligible to be used in various non-infectious conditions in dermatology
- Anti-parasitic drugs are also used in dermatology for their anti-inflammatory
- and immunomodulatory properties.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10]
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