Macrolides in Chronic Skin Disorders

Macrolide antibiotics are widely used to treat infections of soft tissues and the respiratory tract due to their efficacy against Gram-negative and Gram-positive bacteria. In addition to being antimicrobials, in the late 1980s long-term therapy with the macrolide antibiotic erythromycin was shown to alter the clinical course of diffuse panbronchiolitis. Since that time, macrolides have been found to have immunomodulatory properties. These effects provided the rationale for studies performed to assess the usefulness of macrolides in other inflammatory diseases including skin and hair disorders, including rosacea, palmoplantar pustulosis, psoriasis, pityriasis rosea, bullous pemphigoid, pityriasis lichenoides, alopecia areata, cutaneous adverse reactions specific to epidermal growth factor receptor inhibitors, and atopic dermatitis. This review summarizes these clinical studies, case reports, and animal studies dealing with the potential benefits of macrolides antibiotics in the treatment of selected dermatoses which have primarily been classified as noninfectious.