Downside to Doxycycline Treatment for Acne

The antibiotic doxycycline is considered to be a kinder, gentler alternative to minocycline, an antibiotic more often used to treat acne in the United States. Canadian and European doctors often prescribe doxycycline for their teenage and young adult patients because it is less likely to leave black or blue stains on the teeth at the gum line, a problem that has been known to occur in users of minocycline up to 22 years old. The use of doxycycline for acne is being called into question, however, with an upsurge in cases of inflammatory bowel disease connected to the drug.

Why Doctors Choose Doxycycline

Doxycycline, which is dispensed under the trade names Doryx, Bio-Tab, and Vibramycin, has many advantages over other antibiotics for acne. It’s better absorbed into the bloodstream than the older antibiotics for acne such as tetracycline and oxytetracycline, and it’s equally well absorbed as minocycline. It can be taken with food, even with milk. It gets into the bloodstream twice as fast as other antibiotics, and stays in the bloodstream three times as long. It does not interfere with oral contactives (at least the brands most commonly prescribed in the United States), and in much of the world it only costs about US $10 a month or the equivalent.

Doxycycline usually gets rid of about 2/3 of blemishes in 2 to 3 months. That is not as much anti-acne action as many over-the-counter products claim, but it is better than most prescription medications or over-the-counter products deliver. Just about the only known downside to using doxycycline until recently has been a problem with skin discoloration when users go out into the sun, especially if they have Asian skin tones. The specter of inflammatory bowel disease, however, puts doxycyline use in a new light.

Doxycycline and Inflammatory Bowel Disease

Inflammatory bowel disease includes a variety of conditions of intestinal inflammation including ulcerative colitis and Crohn’s disease. These conditions tend to be insidious. They cause severe fatigue and vague pain until they present a crisis, sometimes a life-threatening crisis, as severe inflammation of the bowel closes the lower digestive tract to the passage of food and sometimes even stops circulation of blood.

The concern about doxycycline and inflammatory bowel disease arises from a recently released study of 99,487 acne patients in the United Kingdom. Doxycycline is a popular treatment for acne in the UK, and about 1/5 of these patients, who were tracked for 5 years, received doxycycline. Researchers were alarmed when they noticed that acne patients who got doxycycline were 225% more likely to develop inflammatory bowel disease than those who did not.

Since some kinds of acne are made worse by bacterial overgrowth in the small intestine, it is possible that the people who most need antibiotics are also those at greatest risk for developing bowel problems. It is even possible that the FD and C blue No.1, FD and C yellow No. 6, and D and C yellow No. 1 dyes used to color the capsule contribute to bowel inflammation, or the sodium laureth sulfate used to help the medication break up in the stomach causes severe inflammation in the bowel in some susceptible users. But it appears that doctors need to be on the lookout for early signs of Crohn’s disease in their acne patients who use doxycycline for one month or more.

Doxycycline Not the Only Acne Medication Linked to Bowel Disease

Doxycycline, it turns out, is not the only acne medication that has been linked to bowel disease. The use of Accutane has been linked to another kind of inflammatory bowel disease known as ulcerative colitis.

Ulcerative colitis is an autoimmune disease that causes severe inflammation to the lining of the colon. Open sores in the colon can bleed into the stool. The blood tends to be dry and black rather than fresn and red. Ulcerative colitis causes severe diarrhea and severe pain, but it tends to come and go. It is not related to diet, but it can be relieved by changes in diet.

Crohn’s disease is also an autoimmune disease that can cause severe inflammation to the lining of the colon, but unlike ulcerative colitis, it can cause sores to break out anywhere in the digestive tract from the mouth to the anus. It can also cause joint pain and rashes on the face that look a little like especially red spots of rosacea.

Either condition has life-altering and life-threatening consequences. And they are caused by the two medications most often used to treat acne in Europe, doxycycline and isotretinoin. So what can acne sufferers who use these treatments do to minimize their risk of digestive complications?

Taking Steps to Minimize Drug Side Effects

If you are 15 years of age or older, ask your doctor about alternatives to doxycycline treatment for acne. In Canada and Europe, dermatologists prescribe doxycycline to be especially sure that antibiotic treatment does not cause tooth discoloration, and they usually prescribe it to patients up to the age of 22. Your doctor may not give you minocycline, but limocycline may help keep acne under control without risk of tooth discoloration.

It also helps to use topical retinoids rather than oral retinoids, that is, using tretinoin on your skin rather than taking an isotretinoin pill. The tretinoin creams and gels do not cause bowel problems and they do not cause birth defects when taken by mothers in the first trimester of pregnancy. They require a little more effort than downing a doxycycline capsule once a day, but they don’t carry the risk of inducing inflammatory bowel disease and many other complications.

Even if you have been taking these medications, there is still no need to panic. In a 5-year period, about 2/10 of 1% of the population is diagnosed with either ulcerative colitis or Crohn’s disease. Among people who have taken these medications for acne, about 1/2 of 1% will get an inflammatory bowel disease diagnosis. The conditions are severe enough that it is important to take care to avoid them, but over 99% of people who don’t take precautions will not develop the disease.

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Doxycycline

Doxycycline Basics:

Doxycyline belongs to a group of antibiotics called tetracyclines. Doxycycline is used to treat acne and rosacea, as well as many other bacterial infections.

Doxycycline is an option for people with moderate to severe inflammatory acne, or mild inflammatory acne that will not respond to other treatments. It’s taken orally and is available only with a prescription.

Also Known As:
Adoxya, Doryx, Monodox, Vibramycin

How Doxycycline Works:

Doxycycline works by hindering the growth of the bacteria — in this case, Propionibacterium acnes, which is responsible for inflamed acne breakouts.

Oral antibiotics like doxycyline are especially useful in helping to clear back and body acne. Doxycycline is often used along with other with topical treatment, such as benzoyl peroxide or Retin-A.

Doxycycline is best for those with inflamed breakouts. It won’t clear up blackheads, whiteheads, or comedonal acne.

How Doxycycline Is Used:

Doxycycline is taken orally once or twice a day. Your doctor will probably suggest taking it with food if the medication upsets your stomach. (Don’t take doxycycline with dairy, though, because it can make it less effective.)

Short-term use of doxycycline is the goal. Once your skin has improved noticeably, your doctor will start to taper off use of the medication. For some people, though, longer use may be needed to keep acne under control.

Low-dose doxycycline may be another option for you. Doxycycline used at a dosage too low to inhibit bacterial growth has been used successfully to treat rosacea and inflammatory acne.

Possible Side Effects of Doxycycline:

Side effects you may experience with doxycycline treatment include:

*Upset stomach
*Diarrhea
*Vaginal yeast infections in women
*Photosensitivity

Doxycycline is a FDA Pregnancy Category D drug. It may cause harm to a fetus, so tell your doctor if you’re pregnant or you get pregnant while using doxycycline. Also, tell your doctor if you’re breastfeeding, because this medication may pass into breast milk.

Doxycycline shouldn’t be used by young children because it can affect growth and cause permanent tooth discoloration.

Tips for Using Doxycycline:

*Wear sunscreen. Taking doxycycline can make you more sensitive to the sun.
*The use of oral antibiotics can cause antibiotic-resistant bacteria. It’s important to take your medication exactly as directed, and tell your doctor if you aren’t noticing improvement after several weeks of use.
*To keep doxycycline from irritating your throat, take with a full glass of water.

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Doxycycline for Severe Acne

Doxycycline, a derivative of tetracycline, is a common prescription medication for inflammatory acne. This antibiotic is effective in lessening the impact of the bacteria responsible for clogging skin pores and causing acne.

Body hormones increase secretions of sebaceous glands. Increased oil secretions clog skin pores leading to an overgrowth of normal skin bacteria-Propionibacterium acnes. This bacterium destroys the inner lining of your skin pore. This destruction allows dead skin cells to accumulate within the skin pore. The inflammatory response is acne.

How Does Doxycycline prevent Acne?

Doxycycline stops production of protein necessary for the growth and development of Propionibacterium acnes, bacteria responsible for causing acne. Lack of protein disables this bacteria and it slowly dies.

Dosage of Doxycycline

Take 50 to 100 mg of Doxycycline twice a day with your food. Acne response to doxycycline treatment is visible within three to six weeks. Some patients experience increased acne before it starts subduing.

Side Effects of Doxycycline

Mild side effects of Doxycycline include nausea, diarrhea, vomiting, dark, or swollen tongue. Doxycycline increases your sensitivity to sun causing sunburns if exposed to sunrays. You can continue with doxycycline medication but inform your physician about these side effects.

Serious side effects of Doxycycline include severe headache, changes in vision, genital sores and itching, sense of confusion, allergic reactions like swelling of lips, face, and difficulty in breathing, liver damage causing abdominal discomfort, severe fatigue, and unusual bleeding, blood problems like easy bruising, fever, etc. Discontinue doxycycline immediately and consult your physician for alternative treatment.

Who Should Avoid Doxycycline?

No one under the age of eight should take this medicine as it adversely affects growth of bones and teeth. Nursing women should avoid it for the same reason. Pregnant women should also avoid this drug as it could cause birth defects. Liver and kidney patients should avoid this drug as it could cause severe adverse reactions.

Effectiveness of Doxycycline Treatment

Doxycycline is among the many oral antibiotics effective in treating moderate to severe acne. There have been numerous studies and research over the last two decades to analyze effectiveness of this antibiotic. Results prove its effectiveness among patients with severe and moderate acne.

A study took place at the University of Florida over a period of six months and results reported in 2003. Twice a day treatments of doxycycline significantly reduced the number of inflammatory and noninflammatory lesions in the patients with moderate facial acne.

Sometimes, continuous usage of the drug makes your body immune to doxycycline and hence, effectiveness reduces or becomes nil. Therefore, you can have doxycycline with benzoyl peroxide to reduce such drug resistance.

Does Doxycycline Interact with Other Drugs?

Yes. Doxycycline reacts adversely with other antibiotics like cefixime, antiviral drugs, and antacids like sodium bicarbonate, bismuth salicylate, etc. Oral contraceptives, calcium and mineral supplements, also react with doxycycline. Other drugs interacting with doxycycline include warfarin, tiopronin, lithium carbonate, etretinate, desmopressin, cholestyramine, etc. Laxatives and vitamin supplements containing calcium, iron, or magnesium reduce the effectiveness of doxycycline.

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How to Use Doxycycline to Get Rid of Acne

Doxycycline is an antibiotic that treats bacterial infection. The drug can also be used to get rid of acne and acne-like rashes that are associated with rosacea. Doxycycline is not for everyone; consult your physician to determine if you are an ideal candidate for using doxycycline or other systemic medications to treat moderate to severe acne.

Step 1

Make an appointment with your dermatologist or primary care physician to determine if doxycycline can help clear up your acne. The American Academy of Dermatology reports that oral medications such as doxycycline are usually reserved for cases of acne that cover a large area of your body, not just your face. However, you may be an ideal candidate for the medication if you have tried topical creams and ointments on facial acne and have failed to see an improvement in your condition.

Step 2

Take your medication as directed by your doctor, will a full glass of water to avoid throat irritation. You may take doxycycline with a small snack or milk to prevent an upset stomach. The March 2003 issue of Journal Watch Dermatology reports that 100 to 200 mg of doxycycline, split into two daily doses, has a positive effect on acne when taken for several months at a time.

Step 3

Get blood drawn routinely while you take doxycycline, to check your kidney function. MayoClinic.com explains that some people, especially those with a history of kidney disease, may develop impaired kidney function as a side effect of the drug.

Step 4

Protect yourself from the sun while taking doxycycline, as the medication can increase your risk of sunburn. Wear sunscreen and other protective gear and limit yourself to direct sun exposure.

Step 5

Continue to use doxycycline and any topical treatments your doctor has prescribed, even as you see your skin begin to improve. Systemic drugs used to get rid of acne may take up to six months to clear your skin as fully as possible.

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