Antibiotic Stewardship in Dermatology: A Call to Prescribe Less

Dermatology accounts for roughly 1% of the medical workforce but is responsible for 5% to 10% of all antibiotic prescriptions written in the United States. This disproportionate share has dermatologist Douglas DiRuggiero, PA-C, a physician assistant at Skin Cancer & Cosmetic Dermatology in Rome, Georgia, calling for a hard look at the specialty's prescribing habits.1

DiRuggiero presented "Prescribing with Precision: Antibiotic Stewardship in Dermatology" at the 2026 Society of Dermatology Physician Assistants (SDPA) Summer Dermatology Conference in Denver, Colorado, making the case that dermatologists must change how—and how long—they prescribe antibiotics or risk accelerating a resistance crisis with consequences far beyond the clinic.1

“We have bacteria that we're trying to treat that are far smarter than we are and adapt more quickly than we do and always seem to be able to stay well ahead of us. We're not seeing a lot of research go into the development of new antibiotics,” DiRuggiero told HCPLive. “In order to try to stave [off] that [antibiotic] resistance, we have to be good shepherds of how we're using them, because the only way that a bacteria becomes resistant is if it's exposed to it and then it figures out a way around it.”

Research into new antibiotics remains limited, largely because development is costly and commercial returns are low. While the US Food & Drug Administration (FDA) approved brand-new systemic therapies for psoriasis every year for 7 years between 2013 and 2020, the same was not happening with antibiotics. A 2023 report did highlight a handful of relatively newer agents with dermatologic relevance, among them linezolid, daptomycin, quinupristin/dalfopristin, tigecycline, oritavancin, and dalbavancin.2

DiRuggiero explained that the core problem is that dermatology leans heavily on antibiotics not to treat infections but to harness their anti-inflammatory properties in conditions like acne, rosacea, and hidradenitis suppurativa. That prolonged, inflammation-driven use creates exactly the exposure window bacteria need to develop resistance.

“If the exposure is not there, then we decrease their chance to learn how to adapt against what we have,” DiRuggiero said. “In short, we're not keeping up.”

The stakes of inaction are significant. The World Health Organization has projected that antibiotic resistance could account for 10 million deaths annually within the next decade if current trends continue. DiRuggiero noted the resistance problem extends beyond antibiotics to include topical agents like mupirocin and all major antifungal classes.

His prescription for the specialty: shorten antibiotic courses, integrate combination strategies using benzoyl peroxide, retinoids, and topical leave-on products, and lean into systemic alternatives like spironolactone and isotretinoin where appropriate. Emerging evidence around the microbiome, probiotics, and dietary modification also warrants attention, he added.

"[It] require[s] more education and maybe a little more time in the room," DiRuggiero acknowledged, "and quite frankly, a desire to change your habits.”

Editor’s note: Reported disclosures include E.R. Squibb & Sons, L.L.C, GENZYME CORPORATION, Janssen Biotech, Regeneron Healthcare Solutions, Eli Lilly and Company, Novartis Pharmaceuticals Corporation, ABBVIE., Galderma Laboratories, L.P., Boehringer Ingelheim Pharmaceuticals, Arcutis Biotherapeutics, and more.

References

1. DiRuggiero D. Prescribing with Precision: Antibiotic Stewardship in Dermatology. Session presented at SDPA Summer 2026 in Colorado from June 10 – 14.

2. Bubna AK. Newer antimicrobials in dermatology: An overview. Indian Journal of Drugs in Dermatology. 2023;9(2):53-61. doi:https://doi.org/10.4103/ijdd.ijdd_33_23