Have you recently completed a round of antibiotics only to find that your acne has come straight back afterwards? You’re definitely not alone. Antibiotics are usually the first treatment people try when it comes to clearing acne. But, a lot of people who try antibiotics as a solution for persistent acne, end up frustrated when their breakouts return after stopping treatment. In fact, most of my clients have done at least one round of antibiotics—some have even been on them for years without seeing long-term improvements.

It’s incredibly frustrating. You thought you were finally on the road to clear skin, only for everything to take a turn for the worse as soon as you finished your treatment. So, what’s going on? Why does this happen?

Usually, recurring acne after antibiotics is a sign that there are underlying imbalances that haven’t been addressed. Let’s dive into how antibiotics work for acne. Why they might not be a long-term solution, and what you can do to support your skin and gut health for lasting results.

How Do Antibiotics Help Acne?

To understand why acne might return after stopping antibiotics, we first need to discuss how these medications actually work in the first place.

The primary role of antibiotics in acne treatment is to reduce inflammation and kill acne-causing bacteria. Acne, especially the more inflamed, cystic kind, is often linked to an overgrowth of Propionibacterium acnes (now called Cutibacterium acnes). This bacteria naturally exists on healthy skin. But when imbalances occur and oil production increases, the bacteria feed on the oil, multiply within the pore, and trigger inflammation. This leads to those painful, red pimples we all know too well.

Antibiotics work by targeting this bacteria, reducing its numbers and decreasing inflammation. By doing this, they can help lessen the severity of acne. But they don’t directly address the root causes of breakouts.

What Are the Main Antibiotics Used for Acne?

There are a few different antibiotics commonly prescribed for acne treatment. These include:

• Oral antibiotics: These are taken by mouth and include tetracyclines like doxycycline, but other treatments can include erythromycin.
• Topical antibiotics: These are applied directly to the skin. Topicals can include clindamycin and erythromycin. They’re often combined with other acne-fighting ingredients like benzoyl peroxide.

If you’ve used antibiotics for acne, you might currently be on one of these or have tried them in the past. Some people even rotate through different antibiotics if one stops being effective or doesn’t fully clear their skin.

Typically, antibiotics for acne are prescribed for short-term use. This can range from a few weeks to several months. It will depend on the severity of your acne and how well your skin is responding. Most doctors aim to keep you on antibiotics for as short a time as possible. This is to help avoid side effects and antibiotic resistance. However, I’ve had clients who have been on antibiotics for years—and this can come with significant consequences, which we’ll explore next.

Why Does Acne Return After Stopping Antibiotics?

I just want to point out, I’m not against medication. In fact, I often work alongside medical treatments for acne to help you get the best results on your treatment plan. But antibiotics are a double-edged sword— yes, they kill the bad bacteria causing acne, but they also wipe out some of the good bacteria in your gut. This can have a cascading effect on your whole body, not just your skin. Unfortunately, antibiotics often act as a temporary solution rather than a cure. These are some of the main reasons your acne may be returning after stopping antibiotics:

1. Underlying Hormonal Imbalances

One of the biggest reasons acne returns post-antibiotics is that you actually had hormonally-driven acne and antibiotics do nothing to regulate your hormones. If your acne is hormonally driven (which is extremely common), antibiotics might suppress inflammation temporarily but fail to address the root cause.

Hormonal acne is often linked to imbalances in androgens (such as testosterone and DHT), insulin resistance, or conditions like polycystic ovary syndrome (PCOS). If these issues aren’t addressed, acne can come back once antibiotics are stopped.

2. Gut Microbiome Disruption

As mentioned earlier, antibiotics don’t just kill acne-causing bacteria—they also wipe out beneficial bacteria in your gut. This can have widespread effects on your overall health, including your skin. When your gut microbiome is thrown off by antibiotics, it can lead to digestive issues, a damaged gut lining, an increased risk of yeast infections, and a decrease in good bacteria. All of these things can then trigger or worsen a skin condition. Why? Because the bacteria we have in our guts affect our immune system, inflammation, hormones, mood, nutrient absorption and so much more.

3. Blood Sugar and Insulin Imbalances

A common driver of acne is issues with blood glucose levels and insulin. This can increase hormones which contribute to hormonal imbalances which cause increased oil production, blocked pores and inflammation in the skin. You might have guessed by now, but antibiotics also don’t target this underlying cause of acne. Again we’re going back to the gut here, but your gut microbiome actually plays a role in metabolism and glucose regulation, so wiping out your gut bacteria with long-term antibiotics isn’t going to help this underlying issue.

4. Antibiotic Resistance

Overuse or long-term use of antibiotics can eventually lead to antibiotic resistance, which makes the bacteria that cause acne more resistant to the medication. This can lead to antibiotics becoming less effective over time, which means your acne might not stay controlled even while on them.

Supporting Your Gut While on Antibiotics

If you’re currently on antibiotics or considering them, don’t panic! Please don’t stop your prescription just because you’ve read this blog. I’d encourage you to always follow the advice of your medical professional. But if you’re questioning whether the treatment plan is correct for you, you can bring it up with your doctor or dermatologist. Know that there are options to work alongside a nutritionist (like me) to help work on underlying imbalances while on antibiotics, and protect your gut as much as possible. But there are a few steps you can take to support your gut and keep things balanced:

Try a Probiotic:

One of the most common recommendations when you’re on antibiotics is to take a probiotic. Probiotics help replenish the good bacteria in your gut that antibiotics can deplete. You’ll want to leave some space between your antibiotic and probiotic though, to make sure the probiotic survives. I’d recommend 4 hours between your antibiotic and the probiotic.

Eat bacteria-boosting foods:

Eating well is important while on antibiotics. You want to help feed beneficial bacteria so incorporating prebiotic foods (which act like fertiliser for good bacteria). This includes foods like garlic, onions, leeks, bananas, and asparagus can help support the good bacteria in your gut. Fermented foods like kefir, sauerkraut, and kimchi are also great for feeding your microbiome as they contain live bacteria (similar to a probiotic capsule!).

support your gut lining:

Supplements like L-glutamine can help support the healing and repair of your gut lining. I also like to include things like cabbage and bone broth which can help repair the gut further.

What Can You Do If Your Acne Comes Back After Antibiotics?

If you’ve noticed that your acne is returning after finishing antibiotics, it could be a sign that there’s something deeper going on with your skin. Antibiotics alone won’t always address the root cause of acne, so it’s worth considering a deeper dive into your health. This could involve:

• Hormonal testing to check for imbalances (such as high androgens)
• Gut health testing to see if there are any imbalances or dysbiosis contributing to inflammation
• A personalised skincare routine to target your unique skin needs

These functional tests are things we can do in 1:1 sessions.

Acne is a complex condition and often has a few different underlying drivers. If your breakouts have returned after stopping antibiotics, it’s likely due to unresolved root causes like hormonal imbalances, gut dysbiosis, blood sugar issues, nutrient deficiencies and more.

The good news? Clear skin is possible when you take a holistic approach. This doesn’t mean everything needs to be natural. It means investigating all areas of your health and using a combination of treatments to support you as a whole. If you’re ready to dig deeper and create a long-term plan for healthy skin, feel free to get in touch and we can see what could help you.