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Betamethasone la vs with methotrexate [5]. One-third of patients had a history heart attack or stroke. Patients with methotrexate-resistant acne reported a higher incidence of infections (28.8% vs 7.4%). The authors hypothesized that methotrexate may decrease the number of clinically relevant bacterial organisms, but they do not know why or how. Facial acne is one of the most common skin diseases and the risk of developing skin cancer is greater than any other. Although there is no evidence that the incidence of acne is associated with the use of antibiotics, it is highly likely that the use of antibiotics in acne is associated with the development of acne. Therefore, it is important to determine whether the use of antibiotics is associated with acne. This information may aid in the selection of antibiotics for acne treatment. The American Academy of Dermatology has identified the most common bacteria in acne and has proposed the use of antibiotics directed against these bacteria. There is no treatment for acne. Antibiotics are used to treat infections. The authors conclude that use of methotrexate is associated with an increased incidence of infection in patients with acne. The authors also suggest that further studies should be performed to determine whether the relationship between methotrexate and skin infections is causal or merely coincidental. (Bacteroides fragilis and Streptococcus mutans are the most common bacterial organisms found in acne.) References 1. Murgatroyd D, Laidlaw A, et al. Epidemiology of acne vulgaris. J Prozac 30 Pills 20mg $39 - $1.3 Per pill Am Acad Dermatol 2002;46(3):325-34. 2. Kulldorff M, Leung-Ching W, et al. Antibiotic therapy for adult acne. Cochrane Database Syst Rev 2001:CD007729. 3. Lee M, E, YM, et al. Antibiotics for treatment of acne vulgaris: a retrospective analysis of clinical outcomes. Med J Aust 1999;174:1037-42. 4. Leung JL, Chen X, et al. An outbreak of methotrexate-resistant bacteria among young children. J Am Acad Dermatol 2004;53:1321-4. 5. Stensel EA, Lee JM, et al. Randomized, controlled trial of methotrexate in canada drug rehab cost patients with severe acne. J Am Acad Dermatol 2000;44:1077-82. 6. Stensel EA, Wong JW, et al. Methotrexate treatment of acne: is the risk associated with methotrexate itself low? Dermatol Ther 2000;9:744-9. 7. Vickers G, Cattaruzza L, Mazzoni P, et al. Methotrexate resistance in Candida albicans and the need for antibiotic prophylaxis. J Antimicrob Chemother 2003;51:1313-8. 8. O'Donnell T, McAlindon S, et al. Methotrexate resistance in Candida albicans. J Antimicrob Chemother 2003;51:1317-9.



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