Optimising Dermatological Infection Management: The Emerging Role of Retinoid–Antibiotic Synergy (Preprint)

UNSTRUCTURED Systemic retinoids, such as isotretinoin and acitretin, are recognised as essential treatment options for conditions like severe acne and psoriasis. This is mainly due to their influence on keratinocyte differentiation and sebaceous gland activity. However, the combined effects of retinoids with antibiotics on skin infections have yet to be thoroughly studied. This review explores the novel concept that systemic retinoids may improve the efficacy of antibiotics in treating skin conditions such as acne vulgaris, folliculitis and rosacea. It synthesises emerging evidence that systemic retinoids enhance the effectiveness of antibiotics through immunomodulation, biofilm disruption and microbiome disruption. These mechanisms are yet to be fully integrated into clinical guidelines. Given the rise of antibiotic resistance and the overuse of antibiotics in dermatology, incorporating retinoid-antibiotic synergy offers a promising yet practical approach to improve treatment effectiveness while respecting stewardship principles. Current restrictions on the combination of retinoids and antibiotics should be re-evaluated through further clinical studies and reviews of national guidelines. This strategy can support a more personalised approach alongside broader public health aims, providing a framework to enhance the management of skin infections and combat antibiotic resistance.