Doxycycline (Vibramycin®) for Acne

Doxycycline is a broad-spectrum tetracycline antibiotic available as hyclate, calcium and monohydrate salts. It is derived from and related to oxytetracycline. Doxycycline differs from other tetracyclines in that it more lipid-soluble, has a higher oral absorption and a longer plasma half-life, and may cause less tooth staining.

Doxycycline indicated uses:

• Urinary tract infections
• Respiratory tract infections
• Gingivitis (Periostat)
• Acne
• Sexually transmitted diseases (STDs): gonorrhea, chlamydia
• Inhalational anthrax due to Bacillus anthracis, including postexposure prophylaxis
• Plague (due to Yersinia pestis), including naturally occurring or endemic bubonic, septicemic, or pneumonic plague
• Malaria (due to Plasmodium falciparum)
• Tickborne Rickettsial diseases
• Lyme disease [6], bartonellosis
• Trachoma (chronic infections of the eye)
• Anti-infective prophylaxis in sexual assault victims

Doxycycline Efficacy for Acne Vulgaris

Acne vulgaris develops at distinctive pilosebaceous folliclesand and is characterized by comedones, papules, pustules, and cysts. Acne lesions may be inflammatory or noninflammatory.

Doxycycline is safe and effective in the treatment of moderate to severe inflammatory acne vulgaris15. Doxycycline presumably works by decreasing the population of the skin bacterium, Propionibacterium acnes. In addition, Doxycycline exerts various anti-inflammatory and immunomodulatory properties. It reduces lipase production in P. acnes, resulting in a reduction of fatty acids in sebum on the skin surface.

Effectiveness: Doxycycline treatment reduces about 84-90% of acne papules and pustules7.
Recent research5 indicates that modified-release doxycycline 40 mg has comparable efficacy to regular doxycyline in reduction of the number of acne lessions. Doxycycline is better than azithromycin in patients older than 18 years11.

Dosage for Acne:

Starting doxycycline dose for treating acne is 100 mg twice daily for 3 to 6 weeks.
Maintenance dose is 50 mg once a day.

Sub-antimicrobial dose of doxycycline (20 mg twice daily) is effective in reducing both inflammatory and non-inflammatory acne lesions and does not change skin flora 7.

Doxycycline modified-release (MR) 40 mg daily has comparable efficacy and superior safety to conventional doxycycline formulatiuon5.

How long does it take for doxycycline to work for acne? Benefits develop slowly - you may expect to notice visible improvement in acne within 6 weeks. The peak benefit is usually achieved after 3-6 months12.

Doxycycline is useful in rosacea, but rosacea responds much more quickly.

Benefits

• Long favorable track record of effectiveness and safety in the treatment of acne
• Lipophilic properties allow high doxycycline levels in the pilosebaceous unit
• Direct anti-inflammatory effects2, 4
• subantimicrobial doses of doxycycline may be as effective as standard dosages.
• Blood and tissue levels are equivalent whether the drug is administered orally or intravenously 3
• Longest half-life among the tetracyclines -- about 18-22 hours
• Doxyxycline can be taken without regard to meals as its absorption is not significantly affected by food

Concerns

• Contraindicated during pregnancy (pregnancy category D)
• Photosensitivity - doxycycline is a more potent photosensitizer than other tetracyclines. Phototoxic reactions are most common with intensive sun exposure.
• Risk of esophageal ulceration if the capsules for some reason does not reach the stomach but remains in the oesophagus.

Pharmacological characteristics

• Metabolism: not hepatic; partially inactivated in GI tract by chelate formation.
• Elimination half-life: 12-15 hours (usually increases to 22-24 hours with multiple doses);
• Excretion: Feces (30%); urine (23%)

Mode of action

Doxycycline blocks protein synthesis by preventing the binding of aminoacyl-tRNA to the ribosome. Its action is bacteriostatic (preventing the growth of bacteria) rather than killing (bactericidal).

Doxycycline inhibits the nitric oxide synthesis. This activity is a possible pathway by which tetracyclines may function as anti-inflammatory compounds.

Doxycycline targets parasites Plasmodium falciparum via the apicoplast ribosomal subunits.

Doxycycline Alternatives

Alternatives to doxycycline for acne treatment:

• Minocycline
• Tertacycline

Evaluations and Reviews from Patients

• Doxycycline user reviews for Acne at Drugs.com
• Doxycycline reviews for Acne on Acne.org
• Doxycycline hyclate reviews and ratings for Acne on WebMD
• Doxycycline reviews & ratings for at Drugs.com

References

• 1. Quarterman MJ, Johnson DW, Abele DC, Lesher JL Jr, Hull DS, Davis LS. Ocular rosacea. Signs, symptoms, and tear studies before and after treatment with doxycycline. Arch Dermatol. 1997 Jan;133(1):49-54. PubMed
• 2. Borderie D, Hernvann A, Hilliquin P, Lemarchal H, Kahan A, Ekindjian OG. Tetracyclines inhibit nitrosothiol production by cytokine-stimulated osteoarthritic synovial cells. Inflamm Res. 2001 Aug;50(8):409-14.
• 3. Bocker R, Estler CJ, Maywald M, Weber D. Comparison of distribution of doxycycline in mice after oral and intravenous application measured by a high-performance liquid chromatographic method. Arzneimittelforschung. 1981;31(12):2116-7.
• 4. Krakauer T, Buckley M. Doxycycline is anti-inflammatory and inhibits staphylococcal exotoxin-induced cytokines and chemokines. Antimicrob Agents Chemother. 2003 Nov;47(11):3630-3. PubMed
• 5. Moore A, Ling M, Bucko A, Manna V, Rueda MJ. Efficacy and Safety of Subantimicrobial Dose, Modified-Release Doxycycline 40 mg Versus Doxycycline 100 mg Versus Placebo for the treatment of Inflammatory Lesions in Moderate and Severe Acne: A Randomized, Double-Blinded, Controlled Study. J Drugs Dermatol. 2015 Jun;14(6):581-6. PubMed
• 6. Borg R, Dotevall L, Hagberg L, Maraspin Vera, Lotric-Furlan S, Cimperman J, Strle F. Intravenous ceftriaxone compared with oral doxycycline for the treatment of Lyme neuroborreliosis. Scand J Infect Dis. 2005;37(6-7):449-54. PubMed
• 7. Toossi P, Farshchian M, Malekzad F, Mohtasham N, Kimyai-Asadi A. Subantimicrobial doxycycline in the treatment of moderate facial acne. J Drugs Dermatol. 2008 Dec;7(12):1149-52. PubMed
• 11. Babaeinejad S, Khodaeiani E, Fouladi RF. Comparison of therapeutic effects of oral doxycycline and azithromycin in patients with moderate acne vulgaris: What is the role of age? J Dermatolog Treat. 2011 Aug;22(4):206-10. PubMed
• 12. Comprehensive Dermatologic Drug Therapy. p.80
• 14. Leyden JJ, Bruce S, Lee CS, Ling M, Sheth PB, Stewart DM, Werschler WP, Gilbert RD, Kircik L. A randomized, phase 2, dose-ranging study in the treatment of moderate to severe inflammatory facial acne vulgaris with doxycycline calcium. J Drugs Dermatol. 2013 Jun 1 PubMed
• 15. Del Rosso JQ. Oral Doxycycline in the Management of Acne Vulgaris: Current Perspectives on Clinical Use and Recent Findings with a New Double-scored Small Tablet Formulation. J Clin Aesthet Dermatol. 2015 May;8(5):19-26 PubMed

Written by HealthyStock.net, October 2009.
Last updated: February, 2016