Dealing with acne can be overwhelming. Many may try various skincare products with little to no success before finding one that finally works for them. Fortunately, there is no shortage of treatments available that can help alleviate the symptoms of acne, including erythromycin. This antibiotic works by targeting the bacteria that contribute to acne, reducing inflammation and preventing the formation of new pimples.¹ 

Erythromycin may be a gentle and effective option for those seeking relief from this frustrating condition. Here, our expert team will break down exactly how erythromycin for acne works, as well as potential adverse effects and other important considerations to know about this ingredient.

What causes acne?

Acne vulgaris, commonly known as acne, is an inflammatory skin condition that starts at the hair follicle. Acne is very common—it affects almost 85% of young adults and teenagers. Moderate and severe acne comprises 15-20% of all cases.² 

Four primary factors are thought to cause acne: increased oil production, clumping of skin cells that can block pores, growth of a particular kind of bacteria known as P. acnes on the skin, and inflammation around an area of the skin called the pilosebaceous unit.³

In recent years, scientists have found a relationship between skin microorganisms and acne. The skin is home to many different types of bacteria. When the normal flora of the skin is disturbed or the body's immune defense is weakened, opportunistic bacteria may trigger or aggravate certain skin problems like acne.⁴ 

Common treatments for acne include azelaic acid (an ingredient found in some of Curology’s personalized formulas), salicylic acid (like the one in this Acne Body Wash), retinoids like tretinoin, and benzoyl peroxide (like the one used in Curology’s Acne Cleanser). These are topical agents used as first-line treatments. Combinations of topical treatments with systemic agents (such as oral antibiotics) are recommended for more severe disease.⁵

What is erythromycin?

Erythromycin is an antibiotic that was discovered in 1952 and is commonly used to treat various types of infections. It has traditionally been used to manage respiratory infections and prevent eye infections in newborns. 

The US Food and Drug Administration (FDA) has given its approval for the use of erythromycin in treating a range of infections such as skin infections, gut infections, and others. Additionally, it can be used by clinicians during pregnancy to prevent infection in newborns.⁶ 

Erythromycin is a bacteriostatic antibiotic, meaning it can stop the growth of bacteria that cause infections. It does this by blocking the production of substances that the bacteria need to survive.⁷

While erythromycin can be used to treat many types of bacteria that cause infections, some bacteria can become resistant to the medication over time, making it less effective.⁸ For this reason, it is recommended that erythromycin be combined with tretinoin or benzoyl peroxide when treating acne. 

In addition to its antibacterial effects, erythromycin can also have anti-inflammatory effects, which means it can help reduce swelling and inflammation caused by infection. However, it's important to follow the directions of a healthcare provider when using erythromycin, as it can have side effects and may not be appropriate for everyone.⁹

Erythromycin for acne

When treating acne, it's important to consider the type and severity of acne, the effectiveness of different treatment options such as topical and oral erythromycin, combination therapies, and the potential side effects.

Topical vs. oral erythromycin

Topical treatments are considered to be the first line of treatment for acne.¹⁰ Mild acne can often be treated with ingredients like topical retinoids, benzoyl peroxide, and azelaic acid. For mild to moderate inflammatory acne, topical antibiotics and medications with bacteriostatic and anti-inflammatory properties are generally effective. 

If topical therapies are not successful, oral antibiotics may be prescribed. Tetracycline and erythromycin have traditionally been used as first-line oral antibiotics for moderate to severe inflammatory acne, but erythromycin is becoming a second-line agent due to increasing bacterial resistance.¹¹ In fact, a large analysis of clinical trials showed a gradual decrease in the effectiveness of topical erythromycin for treating acne, which is believed to be due to antibiotic resistance–whereas another antibiotic, clindamycin, didn’t have this problem.¹² That’s why, at Curology, we don’t include erythromycin in our formulas and use clindamycin instead.

Combination therapies

Benzoyl peroxide (BPO) is commonly used in acne treatment due to its bactericidal effect against C. acnes, as well as its anti-inflammatory and keratolytic properties.¹³ It can be combined with topical antibiotics to help prevent the development of resistance against C. acnes. Studies have also shown that combining 5% BPO with 3% erythromycin is effective for treating acne.¹⁴

The development of antibiotic resistance has resulted in changes in the susceptibility of bacteria to previously effective antibiotics. These changes mean the bacteria are less sensitive to erythromycin.

To avoid promoting bacterial resistance, it's best to avoid using antibiotics alone to treat acne. When using oral antibiotics, it is recommended to pair it with a topical retinoid and benzoyl peroxide. Experts suggest that this combination therapy should be used for at least six to eight weeks, but not longer than six months. If there is no improvement after six to eight weeks, a change in oral antibiotic therapy may be needed.¹⁵

During treatment with prescribed medications, patients should use moisturizers and gentle facial washes, like The Cleanser from Curology.

Side effects

Local irritation may be a side effect of topical erythromycin. Oral erythromycin side effects may include nausea and vomiting, diarrhea, stomach pain and discomfort, skin rash, liver damage, and yellowing of the skin or eyes.¹⁶

Finding effective acne treatments

Treating acne can be overwhelming. Although erythromycin may be effective in treating acne, it may not be the best treatment for your skin. Curology’s licensed medical providers are here to prescribe you custom skincare with ingredients such as clindamycin, azelaic acid, and tretinoin. They can also help answer any questions you may have as you go along on your skincare journey. Sign up for a trial* today, and you’ll be one step closer to finding solutions that work for your skin. 

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P.S. We did the homework so you don't have to:

1. Farzam, K. et al. Erythromycin. StatPearls. (2022, December 27).

2. Xu, H. and Li, H. Acne, the Skin Microbiome, and Antibiotic Treatment. American Journal of Clinical Dermatology. (June 2019).

3. Xu, H. and Li, H. Acne, the Skin Microbiome, and Antibiotic Treatment. American Journal of Clinical Dermatology. Ibid.

4. Xu, H. and Li, H. Acne, the Skin Microbiome, and Antibiotic Treatment. American Journal of Clinical Dermatology. Ibid.

5. Eichenfield, D.Z., et al. Management of Acne Vulgaris: A Review. JAMA Network. (2021, November 30).

6. Farzam, K. et al. Erythromycin. StatPearls. Ibid.

7. Farzam, K. et al. Erythromycin. StatPearls. Ibid.

8. Farzam, K. et al. Erythromycin. StatPearls. Ibid.

9. Farzam, K. et al. Erythromycin. StatPearls. Ibid.

10. American Academy of Dermatology Association. Acne Clinical Guideline. (n.d.).

11. Feldman, S., et al. Diagnosis and Treatment of Acne. American Family Physician. (2004, May 1).

12. Simonart, T. and Dramaix, M. Treatment of acne with topical antibiotics: lessons from clinical studies. Br J Dermatol. (August 2005).

13. Matin, T. and Goodman, M.B. Benzoyl Peroxide. StatPearls. (2022, October 10).

14. Kozan, A., et al. A retrospective assessment and comparison of the effectiveness of benzoyl peroxide; the combination of topical niacinamide, gallic acid, and lauric acid; and the combination of benzoyl peroxide and erythromycin in acne vulgaris. Dermatologic Therapy. (2020, May 10).

15. Del Rosso, J.Q. and Kim, G. Optimizing Use of Oral Antibiotics in Acne Vulgaris. Dermatologic Clinics. (January 2009).

16. Farzam, K., et al. Erythromycin. StatPearls. Ibid.

Erin Pate is a board-certified Family Nurse Practitioner at Curology. She earned her Masters of Science in Nursing at Florida Atlantic University in Boca Raton, FL.

*Cancel anytime. Subject to consultation. Results may vary.

Written by

Curology Team

Medically reviewed by

Erin Pate, NP-C