From the FDA Drug Label
DOSAGE AND ADMINISTRATION Adults: Usual daily dose, 1 gram as 500 mg twice a day or 250 mg four times a day. In cases of moderate to severe acne which, in the judgement of the clinician, require long-term treatment, the recommended initial dosage is 1 gram daily in divided doses.
The recommended course of tetracycline for treating periorificial dermatitis is not explicitly stated in the drug label. However, for moderate to severe acne, the recommended initial dosage is 1 gram daily in divided doses.
- The dosage can be reduced gradually to maintenance levels ranging from 125 mg to 500 mg daily when improvement is noted.
- In some patients, it may be possible to maintain adequate remission of lesions with alternate day or intermittent therapy 1. Note that periorificial dermatitis treatment may be similar to acne treatment, but the label does not directly address periorificial dermatitis.
From the Research
For treating periorificial dermatitis, the recommended course of tetracycline is typically 250 mg twice daily for 8 weeks, as it has been shown to be significantly more effective than topical metronidazole in reducing the median number of papules to 0% of the initial number 2. The medication should be taken on an empty stomach, either 1 hour before or 2 hours after meals, with a full glass of water. Patients should avoid taking tetracycline with dairy products, antacids, iron supplements, or calcium supplements, as these can reduce absorption.
Important Considerations
- Improvement is usually seen within 2-4 weeks, but the full course should be completed to prevent recurrence.
- Tetracycline works by inhibiting bacterial protein synthesis and also has anti-inflammatory properties that help reduce the redness and pustules characteristic of periorificial dermatitis.
- This antibiotic should not be used in children under 8 years old, pregnant women, or nursing mothers due to the risk of dental staining and bone growth inhibition.
- Common side effects include photosensitivity, so patients should use sunscreen and avoid excessive sun exposure during treatment.
Alternative Treatments
- Topical erythromycin and topical pimecrolimus are also effective treatments for periorificial dermatitis, with the latter rapidly reducing the severity of the disease, particularly if prior corticosteroid use has occurred 3.
- However, oral tetracycline remains the first-line treatment due to its high efficacy and rapid resolution of symptoms.