• Thrasivoulos Tzellos, Vasiliki Zampeli, Evgenia Makrantonaki, and Christos C Zouboulis.
• Dessau Medical Center, Departments of Dermatology, Venereology, Allergology and Immunology, Auenweg Dessau, Germany. christos.zouboulis@klinikum-dessau.de
• Expert Opin Pharmacother. 2011 Jun 1; 12 (8): 1233-47.

IntroductionAcne is a chronic skin disorder of the pilosebaceous unit; it has a multifactorial pathogenesis. Propionibacterium acnes within the follicle is considered to be a triggering factor of inflammation in acne. Antibiotics have been the primary treatment against P. acnes for more than 40 years. However, a gradual increase in the prevalence of antibiotic-resistant strains of P. acnes has been observed.Areas CoveredThis review discusses the pathophysiology of antibiotic-resistant acne development. It focuses on strategies to minimize the development of resistance and, most importantly, confront the development of antibiotic-resistant acne. The literature search was conducted up to August 2010, using the search terms 'acne', 'antibiotic-resistant acne' and 'bacterial resistance'.Expert OpinionAntibiotic-resistant acne is a real phenomenon. Strategies to prevent and confront it should include not only the use of certain treatment regimens but also rational prescribing policies, combination therapies, use of antibacterial non-antibiotic agents and treatment options targeting all the pathogenetic components of acne. Benzoyl-peroxide-based treatment is the most evidence-based approach. Oral isotretinoin remains the most efficacious option for severe acne.

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