Acne vulgaris is a common chronic skin condition that can affect individuals at any stage of life. It occurs when pores become clogged with sebum (oil) and dead skin cells. This blockage can result in various types of acne lesions including blackheads, whiteheads, papules, pustules, nodules and cysts. Several factors contribute to acne forming the main ones being hormones, genetics, lifestyle and overgrowth of Propionibacterium acnes (P. acnes) bacteria. Acne lesions can cause physical discomfort and emotional distress. There are thankfully a number of treatments available for acne and the best one depends on the type of lesions and severity of acne. Amongst these, Doxycycline is a popular and powerful antibiotic for treating acne. In this article, we take a deep dive into the effects of Doxycycline on the skin, doses and how long it takes to work for acne, side effects and alternatives.
What is Doxycycline?
Doxycycline is a broad-spectrum antibiotic belonging to the tetracycline class of medications. It has been widely used in the medical field since its introduction in the early 1960s. It is effective against a variety of bacterial infections across a multiple organ systems including:
- Respiratory Tract Infections such as pneumonia, bronchitis and sinusitis.
- Urinary Tract Infections like bladder infections and kidney infections.
- Sexually Transmitted Infections such as chlamydia and syphilis.
- Skin Infections including severe acne, rosacea and perioral dermatitis.
- Tick-Borne Diseases like Lyme disease and Rocky Mountain spotted fever.
The main way Doxycycline works is by inhibiting the production of proteins that bacteria need to grow and multiply. Specifically, it binds to the bacterial ribosome, blocking the attachment of aminoacyl-tRNA to the RNA-ribosome complex. This action prevents the incorporation of amino acids into the peptide chains necessary for bacterial survival. As a result, this inhibits bacterial protein synthesis which leads to the death of the bacteria. It also has anti-inflammatory properties which further contribute to its effectiveness especially in treating conditions where inflammation is a key component like acne and rosacea.
Doxycycline for Acne
In dermatology, Doxycycline is most commonly used to treat acne and Rosacea. Doxycycline is particularly effective for moderate to severe inflammatory acne, including cystic and nodular acne. It has the dual action of targeting P. acnes and reducing inflammation which means it addresses two primary causes of acne. Since Doxycycline is delivered through the blood stream, it offers a systemic approach to skin problems. This ensures that the medication reaches deeper layers of the skin where severe acne often originates. It is also really beneficial for individuals with widespread acne on the face, chest and back where topical treatments might be impractical.
For acne, Doxycycline is normally taken orally in tablet or capsule form. Typically the dose of Doxycycline for acne treatment ranges from 50 to 100 mg taken once or twice daily. That being said, the specific Doxycycline dose depends on the severity of the acne as well as the patient’s weight, medical fitness, age and their skin’s response to treatment. Regardless of dose, a typical course of Doxycycline for acne treatment lasts three to six months. Some patients however may require longer therapy for optimal results.
How Long Doxycycline Treatment Takes to Work for Acne
We know that Doxycycline’s is effective for moderate to severe acne withs some studies showing a 50-70% reduction in inflammatory lesions after 12 weeks. The time it takes for Doxycycline acne treatment to work and when you’ll see results varies between person to person. It depends on a number of factors including the severity of acne, adherence to the prescribed medicine and individual response to the medication.
Some patients may notice improvements within as little as two weeks. Other people might require as much as two months to see start seeing any changes. For these reasons, it’s really important to use your Doxycycline consistently for the however long the treatment course your doctor gives you in order for it to work properly. Even if you see improvement quickly, it is vital to complete the entire course of treatment to sustain results. If you stop the medication prematurely, you’re at risk of a recurrence of acne and developing of antibiotic resistance.
Risks & Side Effects
Although Doxycycline has been a round for a long time and is generally well-tolerated for skin problems, it can potentially cause side effects in some people. The most common side effect is gastrointestinal problems such as gastritis, nausea, vomiting and diarrhoea. One of the reasons for this is that Doxycycline, like other antibiotic treatments can disrupt the natural balance of gut flora and balance of the microbiome. You can help reduce the effect of Doxycycline on the stomach by taking it with food and plenty of water. Additionally, probiotics like Lactobacillus are beneficial bacteria that support gut health. Combining Doxycycline with probiotics can help restore this balance and mitigate some of the adverse effects on the gut microbiome. Moreover, research suggests that probiotics may have a positive impact on skin health by enhancing the skin’s barrier function and reducing inflammation.
Another potential risk if photosensitivity, or increased sensitivity to sunlight. This is why It is important to use sunscreen and wear protective clothing when exposed to sunlight while taking Doxycycline. Less common but important to note is that long-term use of Doxycycline can affect bone and teeth development in children. For this reason you should avoid taking it during pregnancy and breastfeeding. It’s also best to avoid using Tretinoin alongside Doxycycline. This is because combining these two medications can increase the risk of a rare but potentially serious condition called pseudotumor cerebri.
Alternatives to Doxycycline for Acne
Whilst Doxycycline is a popular and effective skin treatment for acne, it might not work or be suitable for everyone. Depending on your health, type and severity of your acne as well as goals, these may be potential alternative treatments:
- Topical Retinoids like Tretinoin, Adapalene and Tazarotene are prescription treatments that help to unclog pores and reduce inflammation. They can also help fade post acne scars and hyperpigmentation.
- Benzoyl Peroxide is a topical treatment that kills acne-causing bacteria and helps to remove dead skin cells. It is available in various strengths and formulations both over the counter and as a prescription medicine. You can use Benzoyl peroxide alone or in combination with other acne treatments like in Epiduo.
- Oral Contraceptives such as combination pills containing both oestrogen and progestin are often prescribed for women with hormonal acne. They help to regulate hormones that can contribute to acne flare-ups.
- Spironolactone is an oral medication that reduces androgen levels which can help control hormonal acne in women. It is particularly effective for adult women with persistent acne or PCOS.
- Topical Antibiotics can also reduce the presence of Propionibacterium acnes on the skin. Common examples include Clindamycin and Erythromycin which are often used in combination with benzoyl peroxide to prevent antibiotic resistance.
- Azelaic Acid is a a naturally occurring acid that helps to reduce inflammation and kill bacteria. It is effective in treating mild to moderate acne and can also help with post-inflammatory hyperpigmentation.
- Isotretinoin (Accutane or Roaccutane) is a powerful oral medication for severe, treatment-resistant or wide-spread acne. It works by reducing oil production, shrinking sebaceous glands and preventing clogged pores. Isotretinoin does potentially have a number of side effects and so it requires close monitoring.
Doxycycline remains a powerful option for the management of moderate to severe inflammatory acne. It’s advantage is the ability to target both the bacterial and inflammatory components of acne. However, its efficacy varies from person to person and it does have potential side effects. The best way to introduce Doxycycline is by taking into account patient health and skin factors, type and severity of acne, correct dose and giving it enough time to work. There are also a number of alternative acne treatments for those who are not suitable or for whom Doxycycline did not work. Ultimately, it’s best to seek help from a Dermatologist or other specialist to determine the most appropriate treatment for your individual needs.
At City Skin Clinic, we are fanatical about personalised skincare. Through our online skin clinic, our doctors offer safe and effective treatments like Tretinoin and Hydroquinone. We treat a range of skin conditions including acne, hyperpigmentation, melasma and skin ageing. To start your personalised skincare plan, book a virtual video consultation or use our online consultation form. The journey towards great skin starts here.
