Is Seysara (Sarecycline) a safe and efficient treatment option for acne in teenagers?

Safety and Efficiency of Seysara (Sarecycline) for Acne in Teenagers

Seysara (sarecycline) is a safe and effective FDA-approved treatment option for moderate to severe acne in teenagers aged 9 years and older, with a narrow antibacterial spectrum that offers advantages over older tetracyclines by causing less disruption to gut microbiome and lower rates of side effects. 1, 2

Efficacy Profile

• Sarecycline is specifically designed for treating inflammatory acne with demonstrated efficacy in reducing inflammatory lesions by approximately 50% after 12 weeks of treatment at the recommended dose of 1.5 mg/kg/day 3, 4
• Clinical improvement can be observed as early as 3 weeks after starting treatment, making it an effective option for teenagers seeking relatively quick results 4
• Sarecycline is included in the American Academy of Dermatology guidelines as a conditionally recommended systemic antibiotic option for moderate to severe acne in adolescents and preadolescents (≥9 years) 5
• It is particularly effective for inflammatory acne lesions on both the face and trunk (chest and back), which is notable as many acne studies focus only on facial acne 6

Safety Profile

• Sarecycline has a narrow spectrum of antibacterial activity primarily targeting Cutibacterium acnes (formerly Propionibacterium acnes), with minimal activity against enteric Gram-negative bacteria 2, 6
• This narrow-spectrum activity leads to fewer gastrointestinal side effects compared to older tetracyclines, with similar gastrointestinal adverse event rates to placebo in clinical trials 3, 4
• Common side effects include nausea (4.6%), nasopharyngitis (2.5-3.1%), and headache (2.7-2.9%), with most not considered treatment-related 4
• Notably low rates of side effects commonly associated with tetracyclines:
  • Vestibular effects (dizziness, tinnitus, vertigo) occur in ≤1% of patients 4
  • Photosensitivity reactions occur in ≤1% of patients 4
  • Vulvovaginal candidiasis rates are very low (0.3-1.1%) compared to other tetracyclines 4, 6

Dosing and Administration

• Sarecycline is administered once daily at a dose of 1.5 mg/kg/day with or without food 1, 3
• Available in tablet form in various strengths (60 mg, 100 mg, 150 mg) to accommodate weight-based dosing 1
• Should be taken with enough fluid to completely swallow the tablet and reduce risk of esophageal irritation 1

Contraindications and Precautions

• Contraindicated in patients with hypersensitivity to tetracycline-class antibiotics 1
• Should not be used during pregnancy as it may harm the unborn baby 1
• Not recommended during breastfeeding 1
• Like other tetracyclines, should not be used in children under 8 years of age due to risk of permanent teeth discoloration during tooth development 1
• May cause photosensitivity; patients should minimize sun exposure and use sunscreen 1

Treatment Algorithm for Teenagers with Acne

1. For mild acne: Start with topical therapy (benzoyl peroxide and/or topical retinoid) 7
2. For moderate acne: Use combination topical therapy (benzoyl peroxide + topical retinoid or benzoyl peroxide + topical antibiotic) 7
3. For moderate to severe acne with inadequate response to topical therapy after 6-8 weeks: Add oral antibiotic therapy, with sarecycline being a good option for teenagers ≥9 years old 5, 7
4. For severe acne with scarring or significant psychosocial impact: Consider isotretinoin 5, 8

Important Considerations and Pitfalls to Avoid

• Sarecycline should not be used as monotherapy; always combine with topical treatments to enhance efficacy and prevent bacterial resistance 5, 7
• Limit systemic antibiotic use to the shortest possible duration (ideally ≤3 months) to minimize risk of bacterial resistance 5
• Monitor for rare but serious side effects such as intracranial hypertension (symptoms include headache, blurred vision) 1
• Consider the psychological impact of acne when determining treatment aggressiveness, as acne can significantly affect quality of life in teenagers 8
• Advise patients to drink plenty of fluids when taking sarecycline to reduce the risk of esophageal irritation 1

In conclusion, Seysara (sarecycline) represents an effective and well-tolerated treatment option for moderate to severe acne in teenagers aged 9 years and older, with advantages over older tetracyclines due to its narrow spectrum of activity and favorable side effect profile.