Acne and Rosacea Charity Training Manual
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
Systemic Antibiotics<br />
Tetracyclines<br />
The tetracyclines are the most commonly used antibiotics in acne. They have good activity against P acnes <strong>and</strong> have<br />
potent ant-inflammatory activity. All tetracyclines can photosenitise but in practice, this is only a problem with<br />
doxycycline, where 25% of patients can develop a significant photosensitization. A rare side effect of tetracyclines is<br />
benign intracranial hypertension – this presents with severe headaches <strong>and</strong> the drug should be stopped immediately.<br />
Tetracycline will colour developing secondary dentition <strong>and</strong> should be avoided in children under the age of 13 years.<br />
Oxytetracycline –dose 250mg QDS. This is the most commonly used tetracycline as it is the cheapest. It has a half-life of 8 hours <strong>and</strong> thus should be used<br />
QDS <strong>and</strong> it is inhibited by food in the stomach, so should be taken on an empty stomach <strong>and</strong> the patient instructed not to eat for 1 hours after taking it. In<br />
my experience, this makes it almost impossible to take properly.<br />
Lymecycline – dose 408mg OD or BD. This tetracycline is has a long half-life <strong>and</strong> is not affected by food in the stomach. The manufacturer suggests a once<br />
daily dose but I find a BD dose more effective. Once clearance has been achieved, the dose can be reduced.<br />
Doxycycline – dose 100mg OD. This drug has a long half-life <strong>and</strong> is not affected by food in the stomach. 25% of patients may develop significant<br />
photosensitivity. The capsule of Doxycycline is very sticky <strong>and</strong> patients must be warned to take it with food <strong>and</strong> not just with a swallow of water. It can<br />
adhere to the lining of the esophagus <strong>and</strong> cause a painful burn. One of my patients was hospitalized for 3 days following esophageal ulceration caused by<br />
doxycycline.<br />
Minocycline – dose 100mg OD. Minocycline was a very popular drug in acne as it had a long half-life <strong>and</strong> was not<br />
inhibited by food in the stomach. There have been reports of a rare side effect – lupus like syndrome with severe<br />
arthropathy <strong>and</strong> hepatotoxicity has now limited its use. It is still a very effective drug but if used long term, patients<br />
should be tested for ANA. If used long term, minocycline can be deposited as a complex with melanin in scarred areas<br />
leaving a bluish pigmentation. If this occurs the drug should be stopped immediately otherwise the pigmentation may<br />
become permanent.<br />
Minocycline pigmentation
Change language