The tetracyclines are the workhorses in oral acne therapy. They’re the first-line oral antibiotic drugs of choice in managing moderate to severe acne.
The tetracycline for acne preparations inhibit the growth of P. acnes by going right to your sebaceous glands to attack the bacteria. They’re bacteriostatic antibiotics, which means that they inhibit the growth of bacteria rather than kill them. In addition, they have an anti-inflammatory action that is equally important in treating patients with papules and pustules.
There are three types of tetracyclines for acne:
- “Plain” (generic) tetracycline
- Minocycline
- Doxycycline
Improvement of acne is usually noticeable in a few weeks or less with all of these tetracyclines. This response varies and depends on the severity of your acne; however, you may see the papules and pustules begin to flatten and disappear, and new ones should stop popping up.
Tetracyclines may be tapered when this improvement persists. The decision about when and if to taper your dosage will be up to you and your doctor to decide. Often they have to be continued for long periods — sometimes even for years.
Taking generic (“plain”) tetracycline for acne
“Plain” tetracyclines are the most cost-effective of the tetracyclines and are much less expensive than minocycline and doxycycline, both of which I describe later in this chapter. However, “plain” tetracycline for acne isn’t always as effective as the other two drugs.
Tetracycline is given in dosages ranging from 250 milligrams twice a day to 500 milligrams twice a day. It is usually begun at a dose of 500 milligrams twice daily, although 250 milligrams twice daily may also be effective.
Plain tetracycline for acne is taken with a full glass of water not to irritate your esophagus, which can be a harrowing experience. Take it on an empty stomach. (Your stomach is empty one hour before or two hours after meals.) And finally, don’t take it with dairy products such as milk or with products that contain iron, magnesium, zinc, or calcium because these compounds may interfere with tetracycline’s absorption from your stomach and make it less effective.
The drug dosage may be tapered as inflammation lessens (usually after six to eight weeks), but this will vary depending upon your response.
Taking minocycline
Minocycline is a very effective oral antibiotic for treating acne. It’s also the most expensive.
Minocycline is given in doses ranging from 50 milligrams twice a day to 100 milligrams once or twice a day. Minocycline’s excellent absorption means it may be taken with food, even dairy products, without interfering with its efficacy, so you’re less likely to get an upset stomach than if you were taking a “plain” tetracycline.
As with “plain” tetracycline for acne and doxycycline, the dosage of the drug can be tapered when the inflammation has lessened.
Additional advantages of minocycline include:
- Few, if any, sun-related problems.
- It appears to be less likely to induce vaginal yeast infections than plain tetracycline (see the section “Taking generic ‘plain’ tetracycline”).
Taking doxycycline
Doxycycline is also a tetracycline for acne. Doxycycline is given in doses ranging from 50 milligrams twice a day to 100 milligrams once or twice a day. It may also be prescribed to be taken as 75 milligrams once or twice a day. Doxycycline is well absorbed and may be taken with food. Taking it with food will make you less likely to get an upset stomach.
In addition to the slightly lower cost of doxycycline versus minocycline, another advantage of doxycycline is that the severe potential side effects are sometimes seen with minocycline (dizziness, vertigo, skin darkening, and the lupus-like syndrome) have not been reported with doxycycline.
Warning of using tetracycline for acne
Despite the low risk of side effects from tetracyclines, you should know a few things before taking the drugs.
Because patients frequently use anti-acne oral antibiotics on a long-term basis (in some instances, for years), many people are understandably concerned about possible consequences. Studies have indicated that routine laboratory supervision of healthy young people given long-term tetracycline for acne therapy isn’t necessary. In a nutshell, in most cases, you don’t need regular blood tests done while taking these antibiotics.
However, when treatment extends for more than one to two years, some dermatologists recommend periodically monitoring specific blood tests. This is particularly important if you have a liver, kidney, or autoimmune disease history. In such cases, you should get them checked more often.
Strategies to lower the use of antibiotics
I recommend that you make every effort to taper off oral antibiotics as soon as your acne is under control. An oral antibiotic may be intended for daily use over an extended period, often for four to six months and possibly much longer. Eventually, your doctor will taper off the medication and finally discontinue using it as your acne improves. The ideal long-term goal is to stop oral antibiotics altogether and rely only on topical antibiotics therapy. This section explains ways your doctor may decrease the total amount of antibiotics you have to take while treating your acne.
If necessary, antibiotics may be continued at the lowest effective dose for long periods, especially if your acne is persistent. However, this practice can lead to antibiotic resistance. (See the “Addressing some common concerns” section, earlier in this chapter, to find out about bacterial resistance.)