Minocycline for Acne: How It Works, Dosage, Side Effects and More

• Minocycline is a tetracycline antibiotic with antibacterial and anti-inflammatory effects.
• It is an alternative to other antibiotics like doxycycline.
• Minocycline is taken in combination with other acne treatments.
• It can take weeks to one or two months for minocycline to produce improvements.

Millions of people all over the world suffer from acne vulgaris, a skin condition that can cause permanent facial scarring and significant distress. Minocycline is an antibiotic that can help treat acne and prevent its complications. 

What Is Minocycline?

Minocycline is an antibiotic from the tetracycline family, a group of antibiotics that work against bacteria by blocking bacterial protein synthesis.

Minocycline is effective against a broad range of infections such as pneumonia and other respiratory infections, skin infections, and meningitis.

Minocycline is most commonly available in the form of an extended-release tablet or capsule. This means that the pill remains in your body and releases minocycline over a prolonged period to keep a relatively steady concentration of it in your bloodstream.

How Minocycline Works to Treat Acne

Minocycline is effective against Cutibacterium acnes (C. acnes; previously called Propionibacterium acnes or P. acnes), a type of bacteria implicated in acne. 

C. acnes is normally present on the skin and is usually harmless. However, if there is an imbalance in your skin microbiome or if you have an aggressive strain of C. acnes, it can play a role in the development of acne.

In addition to its activity against C. acnes, the anti-inflammatory effects of minocycline help it target the inflammatory components of acne.

Minocycline for cystic acne

Cystic acne is a severe form of acne in which pores are clogged, allowing pus and debris to accumulate under the skin and form a cyst. The presence of cysts indicates severe acne.

Since acne cysts contain inflammatory debris and C. acnes bacteria, Minocycline is an appropriate and effective treatment for cystic acne.

How to Use Minocycline for Acne

The extended-release form of minocycline (Ximino, Minolira, CoreMino, Solodyn) is usually taken once daily at any time of the day. 

You can take minocycline with or without food but it is recommended to take it with a full glass of water and some food to reduce the risk of irritation of the esophagus.

Dosage 

Accurate dosing of minocycline depends on your body weight. The appropriate dosage generally follows this formula: 1 mg of minocycline per kilogram of your body weight each day.

For example, if you weigh 65 kilograms (143 lbs), your daily minocycline dose should be 65 mg.

A wide range of dosage forms is available to make it easier to accurately dose minocycline. If the exact dose you need is not available, it is acceptable to approximate to the nearest available dosage form (e.g., if your estimated dose is 62 mg/day, it is ok to take a 65 mg pill instead).

How to deal with the purging stage

When you first start taking minocycline, there is a chance that your acne may appear to be getting worse at first. This is called the purging stage and is a result of deep acne lesions coming to the surface at a higher rate before resolving. Not everyone experiences a purging stage.

The purging stage usually resolves within four to six weeks, after which your acne should begin to improve. If it lasts longer or if it causes you significant distress, you should consult your dermatologist. You should not discontinue minocycline on your own.

During the purging stage, you should focus on skin hygiene by using protective skincare products such as cleansers, moisturizers, and sunscreen.

Wearing heavy makeup, sun exposure without sunscreen, and diets high in sugars, saturated fats, and dairy products can make your acne worse, particularly during the purging stage.

Results 

Minocycline can produce significant improvements in the number and severity of inflamed acne lesions. It does not work on non-inflamed lesions (whiteheads or blackheads) or acne scars.

In the past, minocycline was believed to be more effective than other tetracyclines and other acne treatments. However, more recent studies concluded that while it is effective, it is not better than other treatments. 

Concerns over side effects and the lack of advantages over other treatments have made minocycline a less attractive option for acne treatments. The use of minocycline is now reserved for people who did not respond to other treatments or who are unable to take them.

A new form of topical minocycline foam showed effectiveness in treating both inflamed and noninflamed acne lesions in people with moderate to severe acne. Minocycline foam is expected to become available in 2020.

How long does it take to work? 

Some people can begin to see improvements in as little as two weeks after starting the treatment. In others, improvements can take up to eight weeks or longer, particularly if they experience a purging stage.

When to stop taking minocycline for acne

The American Academy of Dermatology recommends that minocycline be taken for three to four months. Your doctor will then reevaluate whether you need to continue taking it.

Systemic antibiotics, including minocycline, should be taken for the shortest possible duration as bacteria can become resistant to the antibiotic with long-term use. Antibiotic-resistant bacteria are more difficult to kill.

Minocycline is usually combined with one or more other acne treatments like retinoids or benzoyl peroxide. Your physician may ask you to continue taking these treatments after completing your minocycline treatment course to improve on the results.

Minocycline Safety and Side Effects

Minocycline can cause some adverse effects ranging from mildly inconvenient to potentially serious. Common side effects include:

• Nausea and vomiting
• Diarrhea
• Dizziness or a spinning sensation
• Feeling tired
• Headache
• Ringing in your ears
• Joint or muscle pains
• Rash and/or itching
• Color changes or pigmentation of the teeth, nails, or skin

More serious side effects are rare and include:

• A condition that resembles lupus erythematosus (an autoimmune disease)
• Liver or kidney dysfunction
• Increased pressure in the brain
• Increased susceptibility for sunburns

Additional safety considerations include:

• Children under eight years of age should avoid minocycline. Minocycline can cause weakening and discoloration of teeth and bone in young children or infants whose mothers used it during pregnancy.
• People who are taking oral retinoids like isotretinoin with minocycline may experience increased pressure inside the skull.
• People with preexisting liver or kidney disorders may be at increased risk for liver and kidney problems with minocycline.

Alternatives

Systemic antibiotics are an important component in the treatment of acne. Minocycline is usually used when other acne-specific antibiotics have failed to produce improvements or when they cannot be taken. 

Systemic antibiotics should always be combined with other acne treatments such as benzoyl peroxide.

Doxycycline

Doxycycline is another member of the tetracycline family of antibiotics. It is considered a first-line medication for moderate to severe acne. 

Doxycycline is generally safer and cheaper than minocycline.

Macrolides

Macrolides are another class of systemic antibiotics that can be prescribed in people who cannot take tetracyclines. Macrolides that have shown effectiveness in acne include erythromycin and azithromycin.

Compared to tetracyclines, macrolides have less anti-inflammatory effects and a higher risk of antibiotic resistance.

Clindamycin

Topical clindamycin is available in the form of gels, solutions, lotions, or foams. It is often combined with benzoyl peroxide and is effective at treating mild to moderate inflammatory acne.

Oral clindamycin is not recommended for acne due to the risk of causing pseudomembranous colitis, an inflammation of the colon that occurs with some antibiotics.

Takeaway

Minocycline is an oral antibiotic with demonstrated activity against moderate to severe acne vulgaris. It is used when safer antibiotic options are not effective or when the person is unable to take them. 

Minocycline can reduce the number of acne-causing bacteria and reduce the inflammation associated with acne. It is prescribed with another acne treatment such as benzoyl peroxide and taken once daily for three to four months.