Ethical Dilemmas in Cosmetic Dermatology Regarding Antibiotic Usage

In an increasingly populated world, the spread of bacteria and disease can be rampant.  Thanks to Alexander Fleming and his associates, antibiotics have become widely available for mass production and consumption. Regardless of the medical field, antibiotics may be necessary to treat a range of mildly harmful to deadly pathogens. Within the last fifty years, our current society has grown incredibly comfortable prescribing these medications for mundane issues, such as acne within the field in dermatology. From personal experience, it is not uncommon for people to enter a dermatology office looking for a way to cure their stubborn acne, and leave with a prescription for a low-dose antibiotic. The vast amount of antibiotic prescriptions given to these patients are unfortunately contributing to the occurrence of pathogenic superbugs – or bacteria that has an increasingly high amount of antibiotic resistance, so much so, that there no antibiotics that can kill the bacteria, leading to a persons death. To many dermatologists, the idea of prescribing antibiotics for acne is considered to be “non-essential,”   however some are still  prescribing these oral antibiotics because of their high success rate (1). Yet, these antibiotics must be taken topically or orally for a long time, usually for months, leading many to question whether the high success rate is really worth any potential long term acne-clearing benefits.

While, of course, no one enjoys having stubborn acne, so clearly a major benefit of this type of treatment is the fairly immediate eradication of not only acne, but acne scars as well. This has the potential to lead to some new, outstanding confidence and self-care.  There are an plenty of studies discussing the mind-body connection and the association between one’s skin and overall psychology is no exception. Kristina G. Gorbatenko-Roth Ph.D. and Rick Fried M.D., Ph.D., both psychodermatologists, found and explained, “In a 2014 National Rosacea Society survey of 1,675 patients with rosacea — a condition that causes facial redness and related symptoms — 90 percent of respondents reported lowered self-esteem and self-confidence, 54 percent reported anxiety and helplessness, and 43 percent reported depression, for example. More than half said they avoided face-to-face contact” (2).  Therefore, if one is obviously able alleviate what could be a significant stressor in one’s life with taking a simple medication everyday, then this type of antibiotic therapy seems like an obvious, easy treatment strategy. It takes the fuss out of the trial-and-error technique behind non-antibiotic topical treatments such as benzoyl peroxide, and can begin working within a matter of days (dependent upon the bacteria’s life cycle).

Clearly, there are some potential hazards with this treatment -one hazard being the encouragement of highly resistant superbugs with the potential to harm the entire human population. Yet, it can be difficult to understand this concept because it affects the population as whole, rather than the individual. In other words, it’s the mentality behind “it will happen to them, not me.” But, in the individual’s case, long-term antibiotic use can harm the healthy, symbiotic bacteria found with a persons gastrointestinal (GI), genitourinary (GU), and respiratory tracts. David Margolis, a researcher tracking upper respiratory infections of acne patients at University of Pennsylvania states, “People who used antibiotics for their acne — as compared to people who had acne who weren’t using antibiotics — were about twice as likely to develop an upper respiratory tract infection within a year’s period of time” (3). These findings suggest something major – human’s immune systems may be suppressed/altered by these antibiotics, or even potentially our bacteria may be up-taking antibiotic resistance. Clearly, more research is required in the areas of antibiotic resistance acquired within the individual’s body and how it affects the human body.

All in all, antibiotic use for the treatment of acne is a quick, highly effective method of clearing psychologically damaging acne from a patients skin, however, there are growing concerns about the potential harm these antibiotics have on our GI, GU, and respiratory systems. The widespread use of antibiotics on the system do require more evidence and studies to help gain a better understanding of the inner workings behind these mechanism.

 

 

 

 

Works Cited

  1. Hines, Sarah. “The Ethics of Dermatology.” Center for Science, Ethics & Public Policy, 17 June 2012, www.sepp.udel.edu/blog/2012-06-27/ethics-dermatology.html.
  2. Clay, Rebecca A. “The Link Between Skin and Psychology.” Monitor on Psychology, American Psychological Association, Feb. 2015, http://www.apa.org/monitor/2015/02/cover-skin.aspx.
  3. Aubrey, Allison. “Doubts Raised Over Antibiotic Use for Acne.” National Public Radio, NPR, 19 Jan. 2006, http://www.npr.org/templates/story/story.php?storyId=5162937.

 

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