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 occur1 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 is an antibiotic that falls under the tetracycline group of antibiotics. It is used to treat a number of conditions2, 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 moste often – capsules. It 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 minocycline3. 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 disease4, 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 noticed5 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 consequences6. 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.
Do not use doxycycline if you are pregnant since it can harm the developing fetus7. 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 medication8 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 retinoids9 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.
- Johnston S. Feeling blue? Minocycline-induced staining of the teeth, oral mucosa, sclerae and ears—a case report. British Dental Journal. 2013;215(2):71-3.
- Bonnetblanc J.M. Doxycycline. Annales de dermatologie et de vénéréologie. 2002;129(6-7):874-82.
- Del Rosso J.Q. Oral Doxycycline in the Management of Acne Vulgaris: Current Perspectives on Clinical Use and Recent Findings with a New Double-scored Small Tablet Formulation. The Journal of Clinical and Aesthetic Dermatology. 2015;8(5):19-26.
- Theochari N.A., Stefanopoulos A., Mylonas K.S., Economopoulos K.P. Antibiotics exposure and risk of inflammatory bowel disease: a systematic review. Scandinavian Journal of Gastroenterology. 2018;53(1):1-7.
- Margolis D.J., Fanelli M., Hoffstad O., Lewis J.D. Potential association between the oral tetracycline class of antimicrobials used to treat acne and inflammatory bowel disease. The American Journal of Gastroenterology. 2010;105(12):2610-6.
- Huber W., Herrmann G., Schuster T., Phillip V., Saugel B., Schultheiss C., Hoellthaler J., Gaa J., Hartel M., Schmid R.M., Reindl W. Life-threatening complications of Crohn’s disease and ulcerative colitis: a systematic analysis of admissions to an ICU during 18 years. Deutsche medizinische Wochenschrift. 2010;135(14):668-74.
- Doxycycline Use by Pregnant and Lactating Women. U.S. Food and Drug Administration. Accessed 2017.
- Valentín S., Morales A., Sánchez J.L., Rivera A. Safety and efficacy of doxycycline in the treatment of rosacea. Clinical, Cosmetic, and Investigational Dermatology. 2009;2:129–140.
- Leyden J., Stein-Gold L., Weiss J. Why Topical Retinoids Are Mainstay of Therapy for Acne. Dermatology and Therapy. 2017;7(3):293-304.
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