- Doxycycline is an antibiotic that is typically prescribed for moderate to severe acne
- It is also used to treat mild forms of inflammatory acne that fails to respond to other treatments
- To increase effectiveness and safety, doxycycline is usually combined with other acne treatments
- Doxycycline is usually taken for three to four months
Acne is a common skin condition that can cause significant distress and long-lasting skin damage if left untreated. Symptoms can range from mild (pimples, blackheads and whiteheads) to severe (papules, pustules and nodules). While effective treatment can be a challenging and lengthy undertaking, doxycycline for acne has earned the reputation as one of the most effective acne medications available.
What Is Doxycycline?
Doxycycline is an oral antibiotic that belongs to a class of medications called tetracyclines which are broad-spectrum antibiotics. This means they can destroy a wide range of bacteria, making them effective against infections such as pneumonia and chlamydia.
This antibiotic can also effectively kill infections caused by gram-positive and gram-negative bacteria.
How Doxycycline Works to Treat Acne
Doxycycline helps treat acne in several ways. It prevents the bacteria associated with acne, Cutibacterium acnes (formerly Propionibacterium acnes) from multiplying. By inhibiting the multiplication of C. acnes, doxycycline helps to restore the balance of the skin microbiome. The microbiome refers to trillions of microorganisms that are invisible on the skin that support skin health.
Doxycycline also has anti-inflammatory properties. By inhibiting certain proinflammatory enzymes and acting as an antioxidant, it can reduce the inflammation associated with acne.
How to Use Doxycycline for Acne
Doxycycline should not be taken as a standalone therapy for acne for several reasons.
While it is effective against inflammation and bacteria, it can do little to address oil, debris and dead skin cells – the material that blocks pores and causes blemishes to form.
Adding other medications such as topical retinoids and benzoyl peroxide can work alongside doxycycline to clear blocked pores. Lastly, using doxycycline with a nonantibiotic medication reduces the risk of developing antibiotic resistance.
You will likely be prescribed doxycycline for 3 months and then your dermatologist will re-evaluate your treatment based on the severity of your acne and your skin’s response. Some patients may need a longer course of doxycycline.
The typical dose of doxycycline for acne is 50–100 mg twice daily or 100 mg once daily. Because it can cause an upset stomach and digestive problems, it should be taken with food.
Concerns over the emergence of antibiotic-resistant strains of bacteria have led some experts to suggest smaller doses of 20 mg twice daily or 40 mg once daily. At this range, doxycycline retains its anti-inflammatory effects and is proven effective against moderate inflammatory acne.
How to deal with the purging stage
As with other acne medications, for the first 4–6 weeks of treatment your symptoms are likely to worsen before they improve. This is known as purging, and is due to increased skin cell turnover and accelerated release of deep-seated comedones.
During this stage, be especially gentle with your skin so that you don’t irritate it further. Avoid all abrasive topical skin care products and opt for a sulfate-free cleanser and a light moisturizer.
You should not stop taking doxycycline without professional advice. If symptoms persist or worsen, consult with your dermatologist.
Follow a few simple rules to ensure you don’t further irritate your skin during this time:
- Do not pick or pop any lesions; avoid touching the face altogether to practice good hygiene
- Avoid heavy makeup and oily skin care products which could exacerbate your acne
- Change your pillowcase regularly to prevent the transfer of oil and debris to your face
- Stay consistent with your skin care regimen to clear your pores of oil buildup
As part of the tetracycline class, it may be superior to other antibiotics because of its antibacterial and anti-inflammatory properties.
Doxycycline is not an effective treatment against acne scars as they are no longer actively inflamed.
How long does it take to work?
The optimal combination therapy of doxycycline, benzoyl peroxide and a topical retinoid can produce improvements in as little as 2 weeks. However, it can take some people up to 12 weeks to see improvements.
Acne before and after doxycycline
Interactions and Side Effects
It is particularly important to avoid the sun and apply a protective layer of sunscreen, as doxycycline can cause skin sensitivity resulting in rash, itchiness, redness and sunburn.
Some drugs can decrease the absorption of doxycycline into the body, rendering it less effective including:
- Certain antibiotics such as rifampin
- Iron supplements and multivitamins with iron
- Minerals and vitamins such as calcium, iron and zinc
- Seizure medications such as barbiturates, carbamazepine and phenytoin
Special care and monitoring should be exercised when combining doxycycline with the following drugs:
- Aminolevulinic acid (ALA) can cause an increased risk of skin reactions
- Blood thinners such as warfarin can increase the risk of bleeding
- Some retinoids such as isotretinoin can cause elevated pressure in the brain
Other medications may also interact with doxycycline; ensure your dermatologist is aware of all prescription and over-the-counter drugs you are taking.
Some common side effects can occur and include:
- Esophagitis (inflammation of the esophagus) which can manifest as heartburn or chest discomfort; as a preventative, take doxycycline with a full glass of water and avoid lying down for 30 minutes afterward
- Loss of appetite, diarrhea, nausea or vomiting
- Photosensitivity (increased susceptibility to sunburns)
Other side effects
Rare, but more serious adverse effects include:
- Permanent damage to teeth and bones in children and infants when doxycycline is ingested during pregnancy
- Stevens-Johnson syndrome and toxic epidermal necrolysis (TEM), severe skin reactions that cause the skin to blister and peel off
Antibiotic therapy is a cornerstone in the management of acne. Other antibiotics shown to be effective in fighting acne include macrolides, trimethoprim and other members of the tetracycline family.
Just like doxycycline, minocycline and tetracycline (named after the group) are all effective acne treatments. (Doxycycline and minocycline have replaced the older tetracycline as the drugs of choice in severe and moderate acne.)
Macrolide antibiotics such as erythromycin and azithromycin are effective acne treatments and have significant anti-inflammatory effects. Macrolides are prescribed as alternatives for people who cannot take doxycycline due to allergies or severe side effects, pregnancy or young age.
While trimethoprim-sulfamethoxazole (TMP-SMX) is an effective antibiotic for acne, the potential for severe side effects such as suppression of bone marrow function and TEN limit its use.
With that in mind, TMP-SMX is recommended as a third-line antibiotic for treatment-resistant acne or for those who cannot take tetracycline antibiotics.
Doxycycline is a very effective antibiotic with anti-inflammatory properties that is prescribed as a first-line treatment for moderate to severe inflammatory acne. It is also prescribed for mild forms of acne when conventional treatments are ineffective.
For maximum results and safety, doxycycline is typically combined with other acne treatments such as topical retinoids and benzoyl peroxide, another mainstay in acne treatment.
Doxycycline is usually taken once or twice daily for 3–4 months and it can take several weeks to see improvements. Should you experience side effects, contact your doctor to discuss alternative treatments.
- Cunha BA, Sibley CM, Ristuccia AM. Doxycycline. Therapeutic Drug Monitoring. 1982 ;4(2):115-135. doi:10.1097/00007691-198206000-00001
- Klein NC, Cunha BA. Tetracyclines. The Medical Clinics of North America. 1995 Jul;79(4):789-801. doi:10.1016/s0025-7125(16)30039-6
- Valentín S, Morales A, Sánchez JL, Rivera A. Safety and efficacy of doxycycline in the treatment of rosacea. Clin Cosmet Investig Dermatol. 2009 Aug 12;2:129-40. doi:10.2147/ccid.s4296
- Dréno, B., Pécastaings, S., Corvec, S., Veraldi, S., Khammari, A. and Roques, C. (2018), Cutibacterium acnes (Propionibacterium acnes) and acne vulgaris: a brief look at the latest updates. J Eur Acad Dermatol Venereol, 32: 5-14. doi:10.1111/jdv.15043
- Xu H, Li H. Acne, the Skin Microbiome, and Antibiotic Treatment. Am J Clin Dermatol. 2019 Jun;20(3):335-344. doi:10.1007/s40257-018-00417-3
- Kircik LH. Doxycycline and minocycline for the management of acne: a review of efficacy and safety with emphasis on clinical implications. Journal of Drugs in Dermatology : JDD. 2010 Nov;9(11):1407-1411. europepmc.org/article/med/21061764
- Akamatsu H, Asada M, Komura J, Asada Y, Niwa Y. Effect of doxycycline on the generation of reactive oxygen species: a possible mechanism of action of acne therapy with doxycycline. Acta Dermato-venereologica. 1992 ;72(3):178-179. europepmc.org/article/med/1357852
- Zaenglein AL, Pathy AL, Schlosser BJ, Alikhan A, Baldwin HE, Berson DS, Bowe WP, Graber EM, Harper JC, Kang S, Keri JE, Leyden JJ, Reynolds RV, Silverberg NB, Stein Gold LF, Tollefson MM, Weiss JS, Dolan NC, Sagan AA, Stern M, Boyer KM, Bhushan R. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016 May;74(5):945-73.e33. doi:10.1016/j.jaad.2015.12.037
- Moore A, Ling M, Bucko A, Manna V, Rueda MJ. Efficacy and Safety of Subantimicrobial Dose, Modified-Release Doxycycline 40 mg Versus Doxycycline 100 mg Versus Placebo for the treatment of Inflammatory Lesions in Moderate and Severe Acne: A Randomized, Double-Blinded, Controlled Study. Journal of Drugs in Dermatology : JDD. 2015 Jun;14(6):581-586. europepmc.org/article/med/26091383
- Toossi P, Farshchian M, Malekzad F, Mohtasham N, Kimyai-Asadi A. Subantimicrobial-dose doxycycline in the treatment of moderate facial acne. J Drugs Dermatol. 2008 Dec;7(12):1149-52. ncbi.nlm.nih.gov/pubmed/19137768
- Parish LC, Parish JL, Routh HB, Witkowski JA. The treatment of acne vulgaris with low dosage doxycycline. Acta Dermatovenerol Croat. 2005;13(3):156-9. ncbi.nlm.nih.gov/pubmed/16146617
- Simonart, T., Dramaix, M. and De Maertelaer, V. (2008), Efficacy of tetracyclines in the treatment of acne vulgaris: a review. British Journal of Dermatology, 158: 208-216. doi:10.1111/j.1365-2133.2007.08286.x
- Gold LS, Cruz A, Eichenfield L, Tan J, Jorizzo J, Kerrouche N, Dhuin JC. Effective and safe combination therapy for severe acne vulgaris: a randomized, vehicle-controlled, double-blind study of adapalene 0.1%-benzoyl peroxide 2.5% fixed-dose combination gel with doxycycline hyclate 100 mg. Cutis. 2010 Feb;85(2):94-104. ncbi.nlm.nih.gov/pubmed/20349684
- Goetze S, Hiernickel C, Elsner P. Phototoxicity of Doxycycline: A Systematic Review on Clinical Manifestations, Frequency, Cofactors, and Prevention. Skin Pharmacol Physiol. 2017;30(2):76-80. doi:10.1159/000458761
- Colmenero JD, Fernández-Gallardo LC, Agúndez JA, Sedeño J, Benítez J, Valverde E. Possible implications of doxycycline-rifampin interaction for treatment of brucellosis. Antimicrob Agents Chemother. 1994;38(12):2798-2802. doi:10.1128/AAC.38.12.2798
- Penttilå, O., Neuvonen, P. J., Aho, K., & Lehtovaara, R. (1974). Interaction between doxycycline and some antiepileptic drugs. British medical journal, 2(5917), 470–472. doi:10.1136/bmj.2.5917.470
- Ochsendorf, F. (2006), Systemic antibiotic therapy of acne vulgaris. JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 4: 828-841. https://doi.org/10.1111/j.1610-0387.2006.06053.x
- Fernandez‐Obregon, A.C. (2000), Azithromycin for the treatment of acne. International Journal of Dermatology, 39: 45-50. doi:10.1046/j.1365-4362.2000.00749.x
- Alzolibani AA, Zedan K. Macrolides in chronic inflammatory skin disorders. Mediators Inflamm. 2012;2012:159354. doi:10.1155/2012/159354
- Kim JE, Park AY, Lee SY, Park YL, Whang KU, Kim HJ. Comparison of the Efficacy of Azithromycin Versus Doxycycline in Acne Vulgaris: A Meta-Analysis of Randomized Controlled Trials. Ann Dermatol. 2018;30(4):417-426. doi:10.5021/ad.2018.30.4.417
- Michałek K, Lechowicz M, Pastuszczak M, Wojas-Pelc A. The use of trimethoprim and sulfamethoxazole (TMP-SMX) in dermatology. Folia Med Cracov. 2015;55(1):35-41. https://pubmed.ncbi.nlm.nih.gov/26774630/