Erythromycin Gel

Erythromycin is a macrolide antibiotic used for the local treatment of acne. It acts against the acne bacterium Propionibacterium acnes and reduces inflammation.

The antibiotic is available in various formulations: gel, solution and in combination with other active ingredients. To prevent resistance, it should ideally be used together with benzoyl peroxide.

Erythromycin gel is particularly suitable for sensitive skin and causes less irritation than benzoyl peroxide or retinoids.

Erythromycin has antibacterial and anti-inflammatory effects:

Antibacterial effect:

• Inhibits bacterial protein synthesis
• Binds to the 50S subunit of the ribosomes
• Acts bacteriostatically against P. acnes
• Reduces the number of bacteria in the follicles

Anti-inflammatory effect:

• Inhibits pro-inflammatory cytokines
• Reduces redness and swelling
• Independent of the antibacterial effect

The problem of resistance development: Due to frequent use, many P. acnes strains have become resistant. Combining it with benzoyl peroxide prevents this and increases effectiveness.

Erythromycin gel is suitable for:

• Mild to moderate inflammatory acne
• Patients with sensitive skin
• Use in combination with other acne medications
• An alternative in case of intolerance to other preparations

Advantages:

• Well tolerated
• Minimally irritating
• Suitable for sensitive skin
• Anti-inflammatory

Limitations:

• Development of resistance when used alone
• Less effective than combination preparations
• Not for purely comedonal acne

Erythromycin gel/solution:

• Concentration: 2% or 4%
• Apply to the affected areas 2x daily

Combination preparations:

• Erythromycin + isotretinoin (Isotrexin®)
• Erythromycin + zinc (Zineryt®)
• Erythromycin + tretinoin

Pack sizes:

• 25 g, 30 g, 50 g tube
• Solutions 30 ml, 50 ml

Application: 1. Cleanse the skin thoroughly 2. Allow it to dry completely 3. Apply thinly to the affected areas 4. Use in the morning and evening 5. Allow to absorb

Duration of treatment:

• Improvement after 4-6 weeks
• Maximum treatment: 6 weeks

Important notes:

• Do not use alone (risk of resistance)
• Ideally erythromycin in the evening, benzoyl peroxide in the morning
• Not when using oral erythromycin

Do not use in case of:

• Hypersensitivity to erythromycin or macrolides
• In the area of the eyes and mucous membranes

Use with caution in case of:

• Concurrent intake of oral erythromycin or clindamycin
• Atopic skin

Pregnancy and breastfeeding: Can be used. Low systemic absorption.

Common:

• Dry skin
• Mild burning
• Scaling
• Itching

Uncommon:

• Skin redness
• Skin irritation
• Contact dermatitis

Rare:

• Allergic reactions

After prolonged treatment:

• Worsening of the skin condition due to development of resistance

Note: Erythromycin gel is well tolerated and causes little irritation.

Do not combine with:

• Clindamycin (topical) – antagonistic effect possible
• Erythromycin (oral) – increased risk of resistance

Useful combinations:

• With benzoyl peroxide (apply at different times)
• With retinoids (at different times)

Recommended use: Benzoyl peroxide in the morning, erythromycin in the evening – or vice versa.