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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