Thursday, October 21, 2021

How It Works, Dosage, Side Effects and More

  • Minocycline is a tetracycline antibiotic with antibacterial and anti-inflammatory effects
  • It is an alternative acne treatment to other antibiotics such as doxycycline
  • Minocycline is prescribed in combination with other acne medications
  • Improvements in acne can take weeks to one or two months 

Acne vulgaris is a very common and distressing skin disease that affects both sexes across all age groups. In the United States, this condition affects almost 50 million people per year. If left untreated, symptoms can become more severe and cause permanent facial scarring. Minocycline for acne is an antibiotic that is prescribed to reduce the symptoms of moderate-to- severe acne. 

What Is Minocycline?

Minocycline is an antibiotic from the tetracycline family, a group of antibiotics that work against bacteria by blocking bacterial protein synthesis. It is available in both oral and topical formulations.

Minocycline is effective against a broad range of infections such as pneumonia and other respiratory infections, skin infections and meningitis.

As an oral medication, minocycline is most commonly available in the form of an extended-release tablet or capsule, as this format reduces the risk of adverse side effects. The pill remains in your body and slowly releases the medication over a prolonged period to keep a relatively steady concentration in your bloodstream.

The US Food & Drug Administration (FDA) approved 4% topical minocycline foam for moderate-to-severe acne in 2019. 

How Minocycline Works to Treat Acne

Minocycline is effective against Cutibacterium acnes (formerly Propionibacterium acnes), the bacteria associated with acne formation. 

C. acnes is normally present on the skin and is usually harmless. However, if there is an imbalance in the skin microbiome or if an aggressive strain of the bacteria is present, it can play a role in the development of acne.

In addition to its activity against bacteria, the anti-inflammatory effects of minocycline target the redness, swelling, and itchiness that is commonly associated with acne.

Minocycline for cystic acne

Cystic acne is a severe form of acne in which pores are clogged, allowing pus and debris to accumulate under the skin and form a cyst. The presence of cysts indicates severe acne.

Since acne cysts contain inflammatory debris and C. acnes bacteria, minocycline is an appropriate and effective treatment for cystic acne.

How to Use Minocycline for Acne

The extended-release form of minocycline (Ximino, Minolira, CoreMino, Solodyn) is usually taken once daily at any time. 

You can take minocycline with or without food but it is recommended to take it with a full glass of water and some food to reduce the risk of irritation of the esophagus.

Oral dosage 

Accurate dosing of minocycline depends on your body weight. The appropriate dosage generally follows this formula: 1 mg of minocycline per kg of your body weight each day.

For example, if you weigh 65 kilograms (143 lbs), your daily minocycline dose should be 65 mg.

A wide range of dosage forms is available to make it easier to accurately dose minocycline. If the exact dose you need is not available, it is acceptable to approximate to the nearest available dosage form (e.g., if your estimated dose is 62 mg/day, it is ok to take a 65 mg pill instead).

Topical application

Minocycline 4% topical foam is typically applied once daily, 1 hour before bedtime. Dispense a small amount of foam in your palm and gently apply the foam to the treatment area. Wash hands well to remove any residue. 

How to deal with the purging stage

When you first start taking minocycline, there is a tendency for acne to worsen before you see improvements. This is referred to as the purging stage, and is a result of deep acne lesions being drawn to the surface at a higher rate before resolving. However, not everyone experiences a purging stage.

The purging typically resolves within 4–6 weeks, after which your acne should begin to improve. If it persists or causes you significant distress, you should consult your dermatologist; you should not discontinue minocycline on your own.

During the purging stage, you should focus on skin hygiene by using gentle and protective skin care products such as cleansers, moisturizers and sunscreen.

Avoid wearing heavy makeup and diets high in sugar, saturated fats and dairy products, as these can worsen your acne, particularly during the purging stage.

Results 

Oral minocycline can generate significant improvements in the number and severity of inflamed acne lesions. It is not effective against noninflamed lesions (whiteheads or blackheads) or acne scars.

In the past, minocycline was believed to be more effective than other tetracyclines or other acne medications. However, more recent studies concluded that while it is effective, it has not been proven to be more so than other treatments. 

Concerns over side effects and the lack of advantages over other treatments have made minocycline a less attractive option as an acne treatment. The use of minocycline is now reserved for acne that does not respond to other treatments or for those people who are unable to take other treatments.

Looking at topical 4% foam, it has demonstrated effectiveness in treating both inflamed and noninflamed acne lesions in people with moderate-to-severe acne. It is well tolerated with no serious side effects. Mild adverse effects including headache, rash, dryness and hyperpigmentation.

How long does it take to work? 

Some people can begin to see improvements in as little as 2 weeks after starting the treatment. In others, improvements can take up to eight weeks or longer, particularly if they experience a purging stage. Every person will respond differently.

Minocycline foam was found to significantly improve acne symptoms in a 12-week clinical trial study.

When to stop taking minocycline for acne

While minocycline is normally taken for three to four months, your dermatologist will determine the specific length of treatment and will then reevaluate whether you need to continue taking it.

Systemic antibiotics, including minocycline, should be taken for the shortest possible duration as bacteria can become resistant to the antibiotic with long-term use. Antibiotic-resistant bacteria are more difficult to kill.

Minocycline is usually combined with one or more other acne treatments such as retinoids or benzoyl peroxide. Your dermatologist may ask you to continue taking these treatments after completing your minocycline treatment course to improve your results.

Minocycline Safety and Side Effects

Minocycline can cause adverse effects that range from mild to potentially serious. Common side effects include:

  • Color changes or pigmentation of the teeth, nails, or skin
  • Diarrhea
  • Dizziness or a spinning sensation
  • Fatigue
  • Headache
  • Joint or muscle pains
  • Nausea and vomiting
  • Rash and/or itching
  • Ringing in your ears

More serious side effects are rare and include:

  • Lupus erythematosus (an autoimmune disease)
  • Liver or kidney dysfunction
  • Increased pressure in the brain
  • Increased susceptibility for sunburns

Additional safety considerations include:

  • Children under eight years of age should avoid minocycline. Minocycline can cause weakening and discoloration of teeth and bone in young children or infants whose mothers used it during pregnancy
  • People who are taking oral retinoids such as isotretinoin with minocycline may experience increased pressure inside the skull
  • People with preexisting liver or kidney disorders may be at increased risk for liver and kidney problems with minocycline

Alternatives

Systemic antibiotics are an important component in the treatment of acne. Minocycline is usually prescribed when other acne-specific antibiotics have failed to produce improvements or when they cannot be taken. 

Systemic antibiotics should always be combined with other acne treatments such as benzoyl peroxide for greater results and to minimize antibiotic resistance.

Clindamycin

Topical clindamycin is available as a gel, solution, lotion, or foam. It is often combined with benzoyl peroxide and is effective at treating mild-to-moderate inflammatory acne.

Oral clindamycin is not recommended for acne due to the risk of causing pseudomembranous colitis, an inflammation of the colon that occurs with some antibiotics.

Doxycycline

Doxycycline is another member of the tetracycline family of antibiotics. It is considered a first-line medication for moderate to severe acne. 

Doxycycline is also generally safer and less expensive than minocycline.

Macrolides

Macrolides are another class of systemic antibiotics that can be prescribed for people who cannot take tetracyclines. Macrolides that have shown effectiveness in acne include erythromycin and azithromycin.

Compared to tetracyclines, macrolides have less anti-inflammatory effects and a higher risk of antibiotic resistance.

Takeaway

Minocycline is an oral and topical antibiotic with demonstrated activity against moderate-to-severe acne vulgaris. Due to its associated side effects, and that it doesn’t provide greater results than other safer alternatives, oral minocycline is typically prescribed for acne that is treatment-resistant or for those who are unable to take other treatments.

Topical minocycline has a better safety profile compared to the oral formulation, with fewer adverse events. It has also been shown to be effective against noninflammatory acne. 

Minocycline can reduce the number of acne-causing bacteria and soothe the inflammation that accompanies this condition. It is typically prescribed with another acne treatment such as benzoyl peroxide and taken once daily for three to four months.

Sources

  • Yentzer BA, Hick J, Reese EL, Uhas A, Feldman SR, Balkrishnan R. Acne vulgaris in the United States: a descriptive epidemiology. Cutis. 2010 Aug;86(2):94-9. https://pubmed.ncbi.nlm.nih.gov/20919604/
  • Oge’ LK, Broussard A, Marshall MD. Acne Vulgaris: Diagnosis and Treatment. Am Fam Physician. 2019 Oct 15;100(8):475-484. https://pubmed.ncbi.nlm.nih.gov/31613567/
  • Dréno, B., Pécastaings, S., Corvec, S., Veraldi, S., Khammari, A. and Roques, C. (2018), Cutibacterium acnes (Propionibacterium acnes) and acne vulgaris: a brief look at the latest updates. J Eur Acad Dermatol Venereol, 32: 5-14. doi:10.1111/jdv.15043
  • Grice EA, Segre JA. The skin microbiome [published correction appears in Nat Rev Microbiol. 2011 Aug;9(8):626]. Nat Rev Microbiol. 2011;9(4):244-253. doi:10.1038/nrmicro2537
  • Mayslich C, Grange PA, Dupin N. Cutibacterium acnes as an Opportunistic Pathogen: An Update of Its Virulence-Associated Factors. Microorganisms. 2021 Feb 2;9(2):303. doi:10.3390/microorganisms9020303
  • Ochsendorf F. Minocycline in acne vulgaris: benefits and risks. Am J Clin Dermatol. 2010;11(5):327-41. doi:10.2165/11319280-000000000-00000
  • Zaenglein AL, Pathy AL, Schlosser BJ, Alikhan A, Baldwin HE, Berson DS, Bowe WP, Graber EM, Harper JC, Kang S, Keri JE, Leyden JJ, Reynolds RV, Silverberg NB, Stein Gold LF, Tollefson MM, Weiss JS, Dolan NC, Sagan AA, Stern M, Boyer KM, Bhushan R. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016 May;74(5):945-73.e33. doi: 10.1016/j.jaad.2015.12.037. Epub 2016 Feb 17. Erratum in: J Am Acad Dermatol. 2020 Jun;82(6):1576. https://pubmed.ncbi.nlm.nih.gov/26897386/
  • Bowe WP, Joshi SS, Shalita AR. Diet and acne. J Am Acad Dermatol. 2010 Jul;63(1):124-41. doi:10.1016/j.jaad.2009.07.043
  • Garner SE, Eady A, Bennett C, Newton JN, Thomas K, Popescu CM. Minocycline for acne vulgaris: efficacy and safety. Cochrane Database of Systematic Reviews 2012, Issue 8. Art. No.: CD002086. doi:10.1002/14651858.CD002086.pub2
  • McManus P, Iheanacho I. Don’t use minocycline as first line oral antibiotic in acne. BMJ. 2007 Jan 20;334(7585):154. doi:10.1136/bmj.39048.540394.BE
  • Gold LS, Dhawan S, Weiss J, Draelos ZD, Ellman H, Stuart IA. A novel topical minocycline foam for the treatment of moderate-to-severe acne vulgaris: Results of 2 randomized, double-blind, phase 3 studies. J Am Acad Dermatol. 2019 Jan;80(1):168-177. doi:10.1016/j.jaad.2018.08.020
  • Raoof TJ, Hooper D, Moore A, Zaiac M, Sullivan T, Kircik L, Lain E, Jankicevic J, Stuart I. Efficacy and safety of a novel topical minocycline foam for the treatment of moderate to severe acne vulgaris: A phase 3 study. J Am Acad Dermatol. 2020 Apr;82(4):832-837. doi:10.1016/j.jaad.2019.05.078
  • Onge ES, Mobley WC. Minocycline Topical Foam: A New Drug for the Treatment of Acne. Ann Pharmacother. 2021 Jan;55(1):105-110. doi:10.1177/1060028020939926
  • Paik J. Topical Minocycline Foam 4%: A Review in Acne Vulgaris. Am J Clin Dermatol. 2020 Jun;21(3):449-456. doi:10.1007/s40257-020-00523-1
  • Gollnick HP, Graupe K, Zaumseil RP. Comparison of combined azelaic acid cream plus oral minocycline with oral isotretinoin in severe acne. Eur J Dermatol. 2001 Nov-Dec;11(6):538-44. https://pubmed.ncbi.nlm.nih.gov/11701404/
  • Kelly Smith, James J. Leyden. Safety of doxycycline and minocycline: A systematic review. Clinical Therapeutics, Volume 27, Issue 9, 2005, Pages 1329-1342, ISSN 0149-2918. https://doi.org/10.1016/j.clinthera.2005.09.005
  • Ochsendorf F. Minocycline in acne vulgaris: benefits and risks. Am J Clin Dermatol. 2010;11(5):327-41. doi:10.2165/11319280-000000000-00000
  • Leyden J, Thiboutot DM, Shalita AR, Webster G, Washenik K, Strober BE, Shupack J. Comparison of tazarotene and minocycline maintenance therapies in acne vulgaris: a multicenter, double-blind, randomized, parallel-group study. Arch Dermatol. 2006 May;142(5):605-12. doi:10.1001/archderm.142.5.605
  • Ochsendorf F. Systemic antibiotic therapy of acne vulgaris. J Dtsch Dermatol Ges. 2006 Oct;4(10):828-41. English, German. doi:10.1111/j.1610-0387.2006.06053.x
  • Simonart, T., Dramaix, M. and De Maertelaer, V. (2008), Efficacy of tetracyclines in the treatment of acne vulgaris: a review. British Journal of Dermatology, 158: 208-216. https://doi.org/10.1111/j.1365-2133.2007.08286.x
  • Ochsendorf F. Systemic antibiotic therapy of acne vulgaris. J Dtsch Dermatol Ges. 2006 Oct;4(10):828-41. English, German. doi:10.1111/j.1610-0387.2006.06053.x

» Show all

Latest Articles