What to Know Before Taking Cephalexin for Acne

Meet the Expert

• Nikhil Dhingra, MD, is a board-certified dermatologist at Spring Street Dermatology in Manhattan.
• Jeanette Black, MD, is a board-certified dermatologists at Skin Care and Laser Physicians in Beverly Hills.
• Rebecca Baxt, MD, is a board-certified dermatologist at BAXT CosMedical.
• Ehsan Ali, MD, is a board-certified internal medicine specialist of Beverly Hills Primary Doctor.

Cephalexin

Type of ingredient: Antibiotic

Main benefits: Typically used to treat a variety of bacterial infections, including bacterial skin infections and infected post-operative wounds.

Works well with: Since very few oral medications are ideal as a monotherapy, Dhingra stresses the importance of continuing a topical regimen prescribed by your dermatologist.

Don't use with: Ali says when taking cephalexin, alcohol should be avoided; otherwise, there are no restrictions.

Benefits of Cephalexin for Acne

Using antibiotics to treat acne is nothing new. Because they can eliminate acne- causing bacteria and they also have an anti-inflammatory property, which helps prevent and treat acne, antibiotics are one of the main categories of internal treatments for acne. However, the oral antibiotics used for this purpose are typically minocycline and doxycycline. According to Dhingra, cephalexin isn’t actually able to penetrate into the oil glands like the more traditional antibiotic choices are able to. So then the question becomes: in what instances would someone use cephalexin over all the other acne treatments? A few to note below:

• Those unable to tolerate other antibiotics: "The data is scarce, so it’s hard to offer a broad recommendation, but for a patient for whom doxycycline isn’t cutting it and patients are maybe hesitant about other highly effective tried- and-true acne treatment—like spironolactone and isotretinoin—cephalexin may be a reasonable thing to bring up with your dermatologist," Dhingra explains. It should also be noted that cephalexin should only be used for inflammatory acne (think the red angry bumps, cysts, and pustules).
• Pregnant women: Since traditional acne treatments are not safe during pregnancy, Dhingra says cephalexin might be a good option for women planning a pregnancy or who are currently pregnant but experiencing moderate-to-severe acne flares. It's important to note that consideration for this approach should be done in conjunction with a board-certified dermatologist and obstetrician.

Side Effects of Cephalexin

To sum it up: before taking cephalexin, make sure you are not allergic to it, be aware of the potential side effects, and notify your doctor of any unusual reactions.

How to Use It

If you miss a dose, Ali advises taking it when you remember and never doubling up on it.

Dhingra says if the decision is made between you and your doctor to go down this route, it’s very important to continue a topical regimen prescribed by your dermatologist as very few oral medications are as ideal as a monotherapy.

TL;DR: "For someone who has struggled longterm with acne, despite the best attempts at treatment with the standard fare of treatment options like doxycycline or minocycline, cephalexin might be a good option to try if you have inflammatory acne," Dhingra says. "This should be done in conjunction with a board-certified dermatologist comfortable with the gamut of acne treatments available."

According to Dhingra, cephalexin is occasionally used for acne flares for patients unable to tolerate tetra-, mino-, and doxycycline (the common antibiotics for moderate-to-severe inflammatory acne). Cephalexin also might be a good option for women planning to be pregnant or currently pregnant but experiencing moderate-to-severe acne flares and can't use traditional acne treatments. Black says the medication is usually well-tolerated, but it should be avoided in patients with allergies to cephalosporins.

Cephalexin should be taken as advised by your doctor, but Baxt says for acne, it would likely be prescribed twice daily for two to four weeks. Black adds, "long-term antibiotic use can be avoided by using other, often more effective treatment modalities."

According to Black, cephalexin is commonly prescribed for skin infections and infected post-operative wounds. "Given the growing risks of antibiotic resistance, prescribing cephalexin is typically reserved for active infections," Black explains. "Wound cultures can be taken to confirm a bacterial infection and test its sensitivity to antibiotics."

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Herman TF, Hashmi MF. Cephalexin. In: StatPearls. StatPearls Publishing; 2021.

Kraft J, Freiman A. Management of acne. CMAJ. 2011;183(7): E430-E435.

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