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Sporotrichosis of the face by autoinoculation in a patient undergoing tacrolimus treatment

clindamycin-resistant strains. Therefore, our results indicate that the increased macrolide–clindamycin resistance rates in P. acnes in 2008 are related to the prevalence of erm(X). The erm(X) gene can be transferred within a species or among species. Therefore, the dissemination of a high level of macrolide– clindamycin-resistant P. acnes is expected in the future. In the current study, we demonstrated the increase in macrolide–clindamycin resistance among P. acnes strains in Japan. However, no significant differences were seen with regard to therapeutic effect, regardless of the presence or absence of resistant strains, suggesting that an anti-inflammatory effect is involved as well. In addition, combination therapy of antimicrobial agents with adapalene or benzoyl peroxide was recommended to reduce antibiotic use and antimicrobial-resistant P. acnes. Therefore, the adequate use of antimicrobial agents is important to prevent the spread of antimicrobial-resistant strains of P. acnes.