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Why You Should Think Twice Before Using Doxycycline for Acne Treatment

By Dr. Jaggi Rao, MD, FRCPC, Double board-certified dermatologist

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.

The use of doxycycline is being questioned, with an upsurge in cases of inflammatory bowel disease connected to the drug.

Why Doctors Choose Doxycycline

Doxycycline is an antibiotic that falls under the tetracycline group of antibiotics. It is used to treat a number of conditions, including cholera, UTI, gum disease, bacterial infections, acne and rosacea. 👩‍⚕️👨‍⚕️ It is a favorite among some of the best dermatologists when it comes to treating mild to moderate cases of acne or acne that doesn’t seem to be getting any better after using other treatments. It is also used to treat breakouts on the back and body.

Doxycycline, is dispensed under many names including Doryx, Bio-Tab, Adoxa, Alodox, Adoxa CK, Adoxa TT, Adoxa Pak, Doryx, Oracea, Monodox, Periostat, Vibramycin Hyclate, Vibramycin Calcium, Vibra-Tabs and Vibramycin. Your prescription may come in the form of pills, tablets or most often – capsules.

Doxycycline 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 contraceptives (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 doxycycline 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. 🩸 They can even stop the 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 fresh 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.

Both ulcerative colitis and Crohn’s disease 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.

Smile! Unlike minocycline, it doesn’t stain teeth in young people.

Do not use doxycycline if you are pregnant since it can harm the developing fetus. Consider using other acne treatment medications that will not pose any risk to your unborn baby. 🤰👶 Adequate research has not yet been done on the effect it has on breastfeeding women, so use your own discretion to determine whether you should use the medication or not.

Also, do not use this option if you are allergic to tetracycline or if you have other allergies, such as allergy to certain foods, dyes, animals or preservatives. Some of the side effects of using this medication are diarrhea, stomach upset, irritation of the esophagus, and increased sensitivity to the sun. To prevent the medication from being too hard on your tummy, consider taking it with a meal. To reduce esophagitis, take it with a lot of water and don’t lie down for at least half an hour after taking the pill. Use sunscreen to help deal with the sensitivity to the sun.

If you have any other medical conditions, make sure to inform your doctor since these conditions may affect the effectiveness of this medication. This includes medical conditions, such as asthma, diarrhea, kidney problems and vaginal candidiasis. Let your doctor also know if you are on any other medication since the interaction of this drug and other drugs may cause a reaction in your body. If you are on other medication, rather than taking you completely off doxycycline, the doctor may choose to change your dosage or take any other precautions. Drinking alcohol while using this drug may result in increased risk of getting stomach upsets, so talk to your doctor about the risks involved if you consume alcohol.

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.

According to research that was published in 2015 by MedPage Today, using a facial gel that is antibiotic free will give you better results than using doxycycline.

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.

Most acne can be cleared with a good skin care regimen if you stick to it. Kits you can buy, like Exposed Skin Care, offer everything needed to clear acne in most cases without all the potential danger of stronger treatments and medications.

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rosan Reply

hi thank you for the heads up. I cant find when this article was written, so are they're any changes or improvements on this drug since then? Also how is it in the case of taking erythromycin?

March 7, 2012 at 7:53 am Reply
Former Doryx User Reply

I used to take Doryx for my acne. I used it for a year so from 16-17 years old. I am now 18 years old and suffering from Ulcerative Colitis. It's been the worst experience of my life and I would never want to wish this upon anyone else. I highly suggest that you do not take any Doryx acne medicine. My doctor said I may never fully overcome this illness.

April 3, 2012 at 10:00 pm Reply
Martin Reply

I'm really sorry to hear it. That is just terrible. You may already have done research, but I'd like to share what I know about treating Ulcerative Colitis. Just know that I'm not a doctor and what I tell you now should not be considered medical advice. You see, the wife of one of my friends suffered UC for a long time with the typical fatigue and bloody stools. We came to talk about it fairly recently because my mom was actually diagnosed with a type of IBD called Collagenous Colitis, which is very similar to UC, but without the bloody stools. My friends wife completely cured her Ulcerative Colitis with VSL#3. Because it's a probiotic it's considered completely safe to use. My friends wife experienced some discomfort as her stools began to return to normal. Because of some remaining inflammation, the more normal stools created some discomfort in the lower intestine and colon but as the inflammation decreased so did the discomfort. Of course, you can get a little gassy at first, but it will pass in a few days. The point is, she no longer suffers from UC. All symptoms are gone and have not returned. My mom cured her CC with probiotics (incidentally, not vsl3 ) combined with a very strict diet. She especially made an effort to stay away from gluten, milk products, and sugar, but also did not touch coffee, wine, beer, wheat flour, and citrus fruits for a period of three months. It was recommend to her that she take fish oil daily as well as slippery elm. Obviously, that's a strict diet, but alot is at stake and fortunately her efforts paid of. It worked and her symptoms have not returned either. I also really recommend you buy Healing Without Medication by Robert Rister and read the section of Inflammatory Bowel Disease. I really hope this helps.

April 4, 2012 at 8:00 am Reply
Jeremy Reply

Hi Martin, Interesting to read that your friend's wife is cured of UC. However, i do believe UC is not a curable disease only managed. I was diagnosed with UC last year. One question that I have is whether your friend's wife is also under some other form of medication (other than the VSL#3). Doctors will normal prescribe medication to suppress the immune system etc. Can you please find out and also please provide me with an update on your friend's wife's condition. Is your mum cured as well? or under management? Also was she under any form of medication? Would be great to hear back from you. I am not in the USA. Wondering how i can get my hands on some VSL#3. Thank you. Jeremy.

July 4, 2013 at 3:24 pm Reply
susan Reply

hi,i been taking doxyciline for about 2 month 2 weeks now,and the effect is not so obvious i can said,from what i been searching i find there is a lot of side effect that might show up,right now i am thinking to stop taking it,but antibiotic can't be stop otherwise my acne will getting worse than before right,what can i do right now,please help me

March 7, 2013 at 12:53 pm Reply
Becca Reply

This is an interesting article. I was on Minocycline for 5 years on and off.. mostly on. Towards the end most of 2011-2012 I was extremely sick thought I did have Crohns or IBD of some sort. I went to numerous Drs and hospital visits I think bills were over $60,000 thank god my insurance paid for most. They found basically nothing which was good but gave me no answers. Long story short after much researching myself online I realized it may be the Mino. I stopped taking it and coincidentally at the same time I was treated for sinus infection with Levaquin and shortly after bacterial vaginosis with Metronizadole. After that I was fine after a almost two years of constant pain, nausea, diarrhea daily it was just gone. I'm convinced it was the Minocycline and found out that Metronizadole and Levaquin are the main treatment used for Bacterial Overgrowth of the Small Intestine. I'm sure it was caused by the long term use of this drug. I now also have constant yeast infections still. I believe it has also cause yeast overgrowth which the symptoms are very similar. It has now been 8 months though and my stomach is much better still working on the yeast issue. I'm now switched to Accutane which also is scary but I feel since its short term I actually feel safer on it, maybe of my friends have been on it without issue and my Dr has started me low dose and slowly increasing me carefully. Sorry for the long post but after all I have been through I really hope this post helps someone else maybe get some answers.

April 20, 2013 at 5:06 am Reply
Liam Reply

Hi there. I have just the one quick question, I've found a few sites online that back up the theory that doxycycline can cause IBD but I have been wondering if anybody knows how long you would have to be taking it for it to have a lasting impression, I took it for 9 days and then stopped as my body wasn't doing well on it, I have since been having some stomach issues and was wondering if this very short treatment would have had this effect or whether it is simply something else such as IBS. I would imagine a three year course or something similar would have this effect, any news would be appreciated. thanks

June 22, 2013 at 2:48 pm Reply
Christy Neal Reply

I just found out in Novemember that I have Chrons. I also have rosacia . I have break outs and one I got about three weeks ago had place on face that got infected. It looks like a boil . Can't see dermatolist until Feb 24, so they called me in some doxycycline at my request. It was what I took when had break out year ago. Dr actually ordered me Oracia think that name, but my insurance said too expensive so they sub the doxycycline. I just took first pill and started reading the reactions.. That when I saw the reaction and maybe cause of Chrons . I'm 65 so not a baby. Any recommendation for what I can do to clear face up.. It looks awful and embarrassing .

February 7, 2014 at 2:19 am Reply
Giorgosdil Reply

Hello, I'm doing a research about vibramycin. I go to the doctor 25days before and he told me to follow a therapy for my acne. I don't have terrible acne like cystic or anything else I just have some red scars from old pimples and sometimes i have white pimples. So my doctor said he will see me in 40days. As I said I take this pill for 25 days and I don't see big changes in my face. Can please someone tell me how many days I' m going to see results? I do want acne like everybody else... So my question is when I will see the big results... How many months? :/

June 11, 2014 at 5:05 pm Reply
Sneha Reply

Hi. M using doxycycline from 2 months n my skin has become dark. Is this bcoz of the antibiotics. Pls help

July 21, 2014 at 6:32 am Reply
Joy Adego Reply

My skin also got darker after using it for two weeks. Has your skin improved? And if so how long did it take to improve?

June 10, 2017 at 4:58 am Reply
ranga Reply

how long to take thise effects???????

August 22, 2014 at 1:54 pm Reply
Naina Reply

I was given a 30 day supply of doxy and i think i have 10 pills left and it has done nothing for my acne :( i am thinking i wont finish this dosage. Found these pills to be a waste of time for acne.

January 3, 2015 at 5:22 am Reply
james Reply

I have had what people call a nervous stomache for years.Ive always had to know where the bathroom was. Really limits your lifestyle. About a month ago I was diagnosed with bronchitis and prescribed Doxycycline. The bronchitis cleared right up and so did the stomach trouble.strange.anyone ever heard of anything similar?

March 9, 2015 at 1:12 am Reply
john Reply

If you take another antibiotic and pain goes away then doxycy caused an overgrowth and you just killed it. I used doxycly for 5 years and got an overgrowth of cliff which was cured by metronidazole. Left me with a systemic drug resistant yeast in organs they INTENTIONLY failed to tell me about and said it was crohns. All bowel issues can be cured with chinese medicine. Poop transplants from Chinese med cure 90percent and all the herbs fix gut and kill yeast.

December 17, 2015 at 10:16 am Reply
Migezo Ramadhani Reply

Also am using doxy and its about 2 months but my skin is too dark than normal and am an african for sure my skin colour was chocolate but now am really black. I went to the Doctor and he told me its the side effect of doxy. Plz i need help to turn to my normal skin

April 13, 2017 at 11:40 am Reply
Mohammad Alimahmoodi Reply

For the longest time -- since my teens-- I was a victim of acute case of acne rosacea with multiple chalazia. Moreover, this skin condition caused infections in my eyes that left me with scared corneas. I had it wrong for 30 years, as I went to an ophthalmologist to treat the infection in my eyes rather than to a dermatologist for my skin condition that caused infection in the eyes. The ophthalmologists put me on tetracycline to no avail. For 30 years I had more 30 chalazia that had to be operated on. Ten years ago for once, I consulted Dr. Balbul, a dermatologist. He put me under Minocycline for a month and that put a stop to my skin condition and consequent infection in my eyes. I thought sharing my experience would help others in similar conditions.

October 6, 2017 at 3:05 pm Reply