Oral antibiotics are highly effective in the management of inflammatory (non-blackhead) acne. The most commonly prescribed medications are in the tetracycline family, which includes both minocycline (Solodyn, Minocin) and doxycycline (Doryx, Adoxa, Monodox). These antibiotics are typically given as a single dose each day and are rapidly eliminated from the body within 24 hours. They are not suitable for children younger than 10 years old because they may cause brown or gray staining of teeth.
- Highly effective for inflammatory or non-blackhead acne
- Most commonly used are minocycline, doxycycline
- Usually single daily dose
- Rapidly eliminated from body within 24 hrs
- May stain teeth in children younger than 10 years of age
Mechanism of Action
These medications are available by prescription only and work to lower the amount of specific bacteria (P. acnes) on the skin's surface which are implicated in the pathogenesis of acne. They are considered "narrow spectrum" in that they are useless against most bacteria except those that are involved in causing acne. In addition to eliminating bacteria, oral antibiotics are highly effective in reducing the inflammation which causes pus and results in pimples.
- Effectively reduces acne-causing bacteria on skin's surface
- Anti-inflammatory action decreases redness and pus formation
- Useless against most bacteria except acne-causing strains
Acne is one of the most common of all skin problems, characterized by whiteheads, blackheads, pimples and, in some people, deep painful bumps that look and feel like boils. When it's severe, acne can cause permanent scarring of the skin. There are many factors which contribute to the development of acne, including hormones and genetics. The most common reason is due to hormones. When hormones surge during puberty or pregnancy, the sebaceous glands enlarge in the areas where acne occurs. There is also a genetic component involved with acne. Individuals may inherit an increased chance of suffering from acne if their parents did.
Acne occurs when the lining of the wall of the hair follicle sheds skin cells, which then stick together with the sebum produced by the sebaceous glands. This causes a plug to form below the surface of the skin. This plug cannot be washed away. This process can take days to weeks for a visible lesion to form. Whiteheads and blackheads are the result. The sebum and cell debris together contribute to the growth of bacteria that naturally live in your pores. Your body's own immune system will naturally attempt to clear the clogged pores by sending in certain specialized cells that invade the follicle to help clean it up. However, in the process, the wall of the follicle may weaken and rupture, emptying the contents of the follicle into the surrounding tissue. When this occurs, swelling or redness can develop around the affected follicle, resulting in the larger bumps or pimples characteristic of acne. These are known as papules and pustules and can sometimes cause scarring.
Oral antibiotics have the advantage of superior penetration of the hair follicle or pore, which is the site of every acne pimple. By reducing inflammation and acne-causing bacteria more effectively than topical medications, improvement is often seen more rapidly and control of acne is achieved more efficiently. Ease of administration as a single daily dose allows patients to avoid time-consuming, less effective , and potentially irritating topical acne treatment regimens. This results in improved compliance and may lead to better overall long-term control of acne.
- Superior penetration of pores where all pimples form
- More rapid results
- Ease of single daily dosing
- Avoidance of irritation from topical products
- Improved compliance
- Better overall long-term control of acne
There are a few side effects and risks associated with oral antibiotic use in acne. They are minimal and uncommon, but can occur and are listed below:
- Allergy: antibiotics can cause a variety of rashes in those who are susceptible. These can be mild or life-threateningly severe. Allergy to tetracyclines such as minocycline and doxycycline is very uncommon. Tel your doctor if you have ever reacted badly to an antibiotic before starting.
- Photosensitivity or increased tendency to sunburn when exposed to UV light may be a problem for those taking minocycline and doxycycline can be a problem for some patients, especially those who are outdoor enthusiasts or participate in sports. Taking the medicine with the evening meal reduces the risk of sunburn, as does using sunblock and wearing protective clothing.
- Gastrointestinal upset affects about 5% of patients and includes nausea, diarrhea and abdominal discomfort.
- Possible increased chance of failure of the oral contraceptive pill. The risk is very small and additional forms of contraceptive are recommended.
- Bacterial resistance--this is a common concern of patients, however since the antibiotics used for acne are most effective only against acne-causing bacteria and are useless against most other bacteria, resistance most frequently arises with intermittent use. This is seen as persistent or recurrent acne lesions in patients who are not compliant with their oral antibiotic medication.
Our dermatologists at The Menkes Clinic will thoroughly discuss your acne treatment plan with you and answer all questions during and between each office visit. We will explain in detail the oral antibiotic that is prescribed for you, as well as how it works and exactly how it should be taken to achieve the best results while maintaining the highest degree of safety. We are committed to treating our patients with the safest, most effective medications available and to minimize any potential side effects. With tetracycline antibiotics, we ask patients to take their single dose at dinner time, avoiding calcium-rich products (foods, beverages, vitamins) within two hours before and after taking their medication. This allows the oral antibiotic to be fully absorbed in the gut and also assures that the patient's peak sun sensitivity will occur while asleep at night.
The usual treatment course is an initial six week trial of the oral antibiotic, followed by continued use for several months to years if effective. Office visits are scheduled every three months to monitor continued success and review side effects, if any.
What to Expect with Acne Antibiotics:
- Detailed discussion of your prescribed oral acne medications
- Available to answer your questions during and between each office visit
- Single daily dose with dinner
- Avoid calcium 2 hours before and 2 hours after taking medication to maximize absorption in the gut
- After initial 6 week trial, continued use for months to years if successful in controlling acne
- No lab tests needed
- Follow-up office visits every three months to monitor progress and check for side effects (uncommon)