A proportion of individuals fail to respond to antibiotics - epidemiological studies estimated that this is between 10%180 and 17%181 of individuals. Theories that have been proposed include individual differences in the absorption, distribution and elimination of the antibiotic as well as poor compliance, the follicular microenvironment and P. acnes resistance.180 The underlying severity of the disease may also determine response to antibiotics, as severe acne and acne of the trunk has been shown to respond less well than moderate acne,182,183 possibly as a result of the higher sebum excretion rate184 diluting follicular drug concentrations.180 Clinically another important impact of alteration in cutaneous microflora is the possibility of the development of gram-negative folliculitis, which presents with profuse superficial pustules around the nose and deep cystic lesions on the face and neck, usually colonised by Proteus, Enterobacter or Klebsiella species.185

0 0

Post a comment