Doxycycline is an antibiotic commonly prescribed for moderate to severe acne. It is also used to treat mild forms of inflammatory acne that cannot be treated by other methods. Doxycycline is usually combined with other acne treatments to increase efficacy and safety. Doxycycline is usually taken for three to four months.

Acne is a common skin condition that, if left untreated, can cause serious disorders and long-term skin damage. Symptoms can range from mild (pimples, blackheads, and white dots) to severe (papules, pustules, and nodules). Although effective treatment can be difficult and time-consuming, doxycycline for acne has earned a reputation as one of the most effective acne medications available.

What is doxycycline

Doxycycline is an oral antibiotic that belongs to a class of drugs called tetracyclines, which are broad-spectrum antibiotics. This means they can kill a wide range of bacteria, making them effective against infections such as pneumonia and chlamydia.

Doxycycline also has anti-inflammatory properties and is commonly prescribed to treat rosacea, also known as acne in adults.

This antibiotic can also effectively kill infections caused by gram-positive and gram-negative bacteria.

How doxycycline works in treating acne

Doxycycline helps treat acne in several ways. It prevents the reproduction of the bacteria associated with acne, Cutibacterium acnes (formerly Propionibacterium acnes). By suppressing the multiplication of C. Acnes, doxycycline helps to restore the balance of the skin microbiome. The microbiome is the trillions of microorganisms invisible on the skin that keep the skin healthy.

Doxycycline also has anti-inflammatory properties. By inhibiting certain pro-inflammatory enzymes and acting as an antioxidant, it can reduce the inflammation associated with acne.

How to use

Doxycycline should not be taken as a stand-alone acne treatment for several reasons. Although it is effective against inflammation and bacteria, it can do little to eliminate grease, debris and dead skin cells, the material that blocks pores and causes blemishes.

Adding other medications, such as topical retinoids and benzoyl peroxide, can work together with doxycycline to clear blocked pores. Finally, using doxycycline with drugs other than antibiotics reduces the risk of developing antibiotic resistance.

You will most likely be prescribed doxycycline for 3 months, and then your dermatologist will review your treatment depending on the severity of your acne and your skin reaction. Some patients may require a longer course of doxycycline.

A typical doxycycline dose for acne is 50–100 mg twice daily or 100 mg once daily. Because it can cause stomach upset and digestive problems, it should be taken with food.

Concerns about the emergence of antibiotic-resistant strains of bacteria have prompted some experts to suggest lower doses of 20 mg twice a day or 40 mg once a day. In this range, doxycycline maintains its anti-inflammatory effects and has proven effective against moderate inflammatory acne.

What to do during the purging phase

As with other acne medications, in the first 4–6 weeks of treatment your symptoms may worsen before they improve. This is called cleansing and is due to an increase in skin cell renewal and the accelerated release of deep-seated comedones.

Be especially careful with the skin at this stage to avoid causing further skin irritation. Avoid all abrasive skin care products and choose a sulfate-free cleanser and a light moisturizer.

You should not stop taking doxycycline without professional advice. If symptoms persist or worsen, consult a dermatologist.

Follow a few simple rules to prevent further skin irritation at this time:

● Do not touch or dislodge lesions; do not touch the face completely to keep hygiene

● Avoid heavy makeup and oily skin care products that can aggravate acne.

Regularly change the pillowcase to prevent oil and debris from getting on your face.

● Watch your skin care regimen to clear pores of fat buildup.

Results obtained

Doxycycline is a major acne treatment that has been proven to effectively treat acne, and is a component of a first-line treatment regimen for moderate to severe inflammatory acne.

As part of the tetracycline class, it may be superior to other antibiotics because of its antibacterial and anti-inflammatory properties.

A review of numerous clinical trials has shown that doxycycline successfully reduces up to 75% of inflammatory acne lesions and up to 54% of comedones (blackheads and white dots).

Doxycycline is not effective against acne scars because they are no longer actively inflamed.

How long it takes to get results?

Optimal combination therapy with doxycycline, benzoyl peroxide, and a topical retinoid can result in improvement in as little as 2 weeks. However, it may take up to 12 weeks for some people to see improvement.

Interactions and side effects

It is especially important to avoid the sun and apply a protective layer of sunscreen, as doxycycline can cause skin hypersensitivity, leading to rashes, itching, redness, and sunburns.

Some drugs can reduce the absorption of doxycycline in the body, making it less effective, including:

Some antibiotics, such as rifampicin.

● Iron supplements and multivitamins with iron.

● Minerals and vitamins such as calcium, iron, and zinc.

Anticonvulsants such as barbiturates, carbamazepine, and phenytoin.

Particular caution and control should be exercised when combining doxycycline with the following drugs:

● Aminolevulinic acid (ALA) may cause increased risk of skin reactions.

● Blood thinners, such as warfarin, may increase the risk of bleeding.

● Some retinoids, such as isotretinoin, can cause high blood pressure in the brain.

Other medications may also interact with doxycycline; make sure your dermatologist knows about all prescription and over-the-counter medications you are taking.

Side effects

Some common side effects may occur, including:

Esophagitis (inflammation of the esophagus), which may appear as heartburn or chest discomfort; as a precaution, take doxycycline with a full glass of water, and do not lie down for 30 minutes after that.

Loss of appetite, diarrhea, nausea, or vomiting

Photosensitivity (increased tendency to sunburn).

Other side effects

Rare but more serious side effects include:

● Irreversible dental and bone damage in children and infants when doxycycline is taken during pregnancy.

● Stevens-Johnson syndrome and toxic epidermal necrolysis (TEM), severe skin reactions causing blistering and peeling of the skin.

Alternatives

Antibiotic therapy is the cornerstone of acne treatment. Other antibiotics proven to be effective against acne include macrolides, trimethoprim and other members of the tetracycline family.

Tetracyclines

Like doxycycline, minocycline and tetracycline (named after the group) are effective treatments for acne. (Doxycycline and minocycline replaced the old tetracycline as the drugs of choice for severe to moderate acne.)

Doxycycline and minocycline are comparable in effectiveness; however, doxycycline is less likely to cause side effects, such as gastrointestinal upset.

Macrolide antibiotics such as erythromycin and azithromycin are effective treatments for acne and have significant anti-inflammatory effects. Macrolides are prescribed as an alternative for people who cannot take doxycycline because of allergies or serious side effects, pregnancy, or young age.

Trimethoprim

Although trimethoprim-sulfamethoxazole (TMP-SMX) is an effective antibiotic for acne, the possibility of serious side effects, such as suppression of bone marrow function and TEN, limits its use.

With this in mind, TMP-SMX is recommended as a third-line antibiotic for the treatment of persistent acne or for those who cannot tolerate tetracycline antibiotics.

To conclude

Doxycycline is a very effective antibiotic with anti-inflammatory properties that is prescribed as a first-line treatment for moderate to severe inflammatory acne. It is also prescribed for mild acne when conventional treatments are ineffective.

For maximum results and safety, doxycycline is usually combined with other acne treatments such as topical retinoids and benzoyl peroxide, another mainstay of acne treatment.