A range of
antibiotics has been shown to modify host functions apart from the antimicrobial potency. They may directly influence phagocyte and lymphocyte function, as well as chemotaxis. Effects on the generation and release of various
cytokines involved in the inflammatory process have been studied both in vivo and in vitro. However, the molecular mechanisms have not been elucidated in detail. It is suggested that
antibiotics can exert immunopharmacological effects on the basis of structure-activity relationships independent of their antibacterial activity. We present a collection of clinical studies and case reports dealing with the potential benefits of systemic
antibiotics in the treatment of selected
dermatoses which have primarily been classified as non-infectious. Generally accepted treatments such as
dapsone in
dermatitis herpetiformis and
leukocytoclastic vasculitis or
chloroquine in lupus erythematosus have not been considered. Based on existing clinical trials with a higher number of cases the following
antibiotics have been shown to be effective:
erythromycin in
bullous pemphigoid and
pityriasis rosea as well as
tetracyclines in
pemphigus vulgaris,
bullous pemphigoid and
pustulosis palmaris et plantaris. However, most reports have to be viewed critically due to the uncontrolled study design, particularly in
dermatoses with a tendency to spontaneous resolution. Despite this lack of evidence-based data, it is important for the clinician to know about the potential use of
antibiotics for various skin disorders as a primary treatment option or
steroid-sparing therapeutic adjunct. In clinical practice the use of
antibiotics depends on various factors including the severity of the disease, the patient's age,
contraindications to conventional therapeutic regiments and economic considerations.