Is doxycycline (antibiotic) effective for treating acne?

From the Guidelines

Doxycycline is a strongly recommended antibiotic treatment for moderate to severe acne, with a typical dosage of 50-100 mg once or twice daily, and treatment usually lasting 3-6 months. According to the most recent guidelines of care for the management of acne vulgaris 1, doxycycline is an effective treatment option for acne. It works by killing acne-causing bacteria (Propionibacterium acnes) and reducing inflammation in the skin.

When taking doxycycline, it's essential to take it with a full glass of water, either with or without food, though taking it with food can reduce stomach upset. Avoid taking it within 2 hours of calcium-containing products, antacids, or iron supplements as these can reduce absorption. Doxycycline increases sun sensitivity, so it's crucial to use sunscreen while taking this medication. Common side effects include nausea, diarrhea, and yeast infections.

For best results, combine doxycycline with topical treatments like benzoyl peroxide or retinoids, as recommended by the guidelines 1. If you're pregnant or planning pregnancy, avoid doxycycline as it can harm fetal development. Improvement typically begins after 4-8 weeks of consistent use, and your doctor may recommend transitioning to topical treatments after the course is complete to maintain results.

It's also important to note that systemic antibiotic use should be limited to the shortest possible duration, and re-evaluation at 3-4 months is recommended to minimize the development of bacterial resistance, as suggested by previous guidelines 1. Concomitant topical therapy with benzoyl peroxide or a retinoid should be used with systemic antibiotics and for maintenance after completion of systemic antibiotic therapy.

Some studies have also explored the use of subantimicrobial dosing of doxycycline, which has shown efficacy in patients with moderate inflammatory acne 1. However, the most recent guidelines 1 provide strong recommendations for the use of doxycycline in the management of acne, making it a preferred treatment option.

Key points to consider when using doxycycline for acne include:

• Typical dosage: 50-100 mg once or twice daily
• Treatment duration: 3-6 months
• Combination with topical treatments: recommended for best results
• Sunscreen use: essential due to increased sun sensitivity
• Potential side effects: nausea, diarrhea, yeast infections
• Pregnancy and breastfeeding: avoid doxycycline due to potential harm to fetal development.

From the FDA Drug Label

In severe acne, doxycycline may be useful adjunctive therapy.

Doxycycline may be useful as an adjunctive therapy for severe acne 2.

• The drug label does not provide detailed information on the treatment of acne with doxycycline.
• It only mentions that doxycycline may be useful in severe acne cases.

From the Research

Doxycycline for Acne Treatment

• Doxycycline is an oral antibiotic used to treat moderate to severe acne vulgaris, particularly inflammatory lesions 3, 4, 5.
• The efficacy of doxycycline in reducing inflammatory lesions has been demonstrated in several studies, with a mean reduction of 58% at 6-month follow-up 3.
• A study comparing subantimicrobial dose, modified-release doxycycline 40 mg to doxycycline 100 mg and placebo found that the lower dose was superior to placebo and comparable to the higher dose in reducing inflammatory lesions, with a lower incidence of drug-related adverse events 4.
• Doxycycline can be used in combination with topical therapies, such as adapalene and benzoyl peroxide, to enhance efficacy in treating severe inflammatory acne 5.
• Combination therapy with oral doxycycline, topical retinoids, and benzoyl peroxide has been shown to be effective in reducing acne lesion counts and improving quality of life 6, 5.

Efficacy and Safety of Doxycycline

• Doxycycline has been found to be effective in reducing inflammatory lesion counts, with a mean percent reduction of 66.2% at week 12 5.
• The safety profile of doxycycline is generally favorable, with a lower incidence of adverse events compared to higher doses 4.
• However, gastrointestinal adverse events can occur with doxycycline use, particularly at higher doses 4.

Comparison to Other Treatments

• Doxycycline has been compared to other oral antibiotics, such as minocycline, and found to be effective in reducing acne lesion counts 3, 6.
• Topical therapies, such as benzoyl peroxide and azelaic acid, can also be effective in treating mild to moderate acne, with a lower risk of antibiotic resistance 7.