Have you tried every cream, birth control, and urban legend for clear skin, all to no effect?
If other methods have failed, antibiotics such as doxycycline may help to clear up recurring acne vulgaris.
Doxycycline is an antibiotic used to treat inflammatory acne with pustules and red bumps after other treatments have failed. Unlike topical acne treatments, doxycycline is an oral medication taken in capsule or pill form.
Here’s everything you need to know, from how doxycycline works to dosage to common side effects.
What is doxycycline?
Doxycycline is the most commonly prescribed oral antibiotic acne treatment. It’s also used to treat rosacea and skin infections.
As an oral antibiotic, doxycycline is taken in pill form. It’s not available over-the-counter, only through a prescription for your dermatologist or doctor.
Doxycycline belongs to a larger group of bacteria-fighting drugs called tetracycline antibiotics, which also includes minocycline and oxytetracycline. These are often prescribed for the management of acne.
Common brand names of doxycycline include Doryx, and Vibramycin, though there are others on the market. Due to the strength and effectiveness of this treatment option, it is usually reserved for moderate to severe acne.
How Doxycycline Treats Acne
Cutibacterium acnes (previously known as Propionibacterium acnes) is the bacteria that causes acne breakouts on the skin. Acne is not the result of a skin infection; however, the more C. acnes that sits on your skin, the more likely you are to get pimples.
Doxycycline (also called doxycycline hyclate) kills C. acnes, which lives in the oil-producing glands of your skin. Doxycycline may also reduce existing inflammation, another feature of acne.
Dermatology is still learning more about the anti-inflammatory properties of how doxycycline treats acne.
Treatment of acne with doxycycline is best indicated for pustules and red bumps seen in inflammatory acne. Blackheads and whiteheads respond better to other treatments.
How long should you take doxycycline for acne? You should take doxycycline for acne until your symptoms visibly improve. This antibiotic is not a permanent prescription but rather a temporary fix as you work with your dermatologist on ways to manage your skincare.
Dosage of Doxycycline for Acne
The dosage of doxycycline for acne varies by patient, but I typically recommend starting at a low dosage. Some doctors recommend 100mg a day or even twice a day, but I find that the side effects and impact on your microbiome are much more severe with this larger dose.
A doxycycline dosage of between 20-50 mg daily is a good place to start. Since this acne medication can wipe out your natural bacteria levels, continue to take a probiotic for acne to retain some of your body’s helpful microorganisms.
What to Expect When Taking Doxycycline
Picture this: you walk into your dermatologist’s office, having just read this inspiring article about how doxycycline might work for you. After explaining any other conditions or medications, and assessing the severity of your acne, they decide that doxycycline for acne is a good fit for you.
You’ll start taking your low dose right away, being sure to pair it with a meal and a large glass of water to avoid adverse effects. You’ll need to buy some chic hats and stay in the shade to keep your skin safe, so choose a shady spot for your weekly brunch catchup with the girls.
Some say that their acne got worse before it got better on doxycycline, but for most, this stage is short if it happens at all. In 4-6 weeks, you’ll head back to your dermatologist to check your skin’s progress at the halfway point in your medication.
Your dermatologist will check how your skin is reacting to the prescription and re-evaluate your dosage. It’s worth asking if you can lower your dose at this stage. From there, you can work with your doctor on long-term solutions to keep acne breakouts away.
How long does it usually take for doxycycline to work?
How long does it take for antibiotics to clear up acne? It takes antibiotics like doxycycline in between 2 weeks and 3 months to clear up acne.
How long does it usually take for doxycycline to work? Doxycycline takes 4-6 weeks to show a visible difference on severe or moderate acne. Around this time, your dermatologist will check in on your progress using the prescription.
Doxycycline Side Effects
Doxycycline can have many side effects, some common or mild and some quite severe.
A study published in the Journal of the American Academy of Dermatology found that doxycycline had less harsh adverse effects than its counterpart, minocycline. However, there are still some issues to look out for.
Some of the most common side effects of doxycycline include:
- Photosensitivity (sensitivity to light). This can cause sunburns and sun damage to the skin. You’ll need to be careful to wear adequate sunscreen and avoid long periods of sun exposure while taking doxycycline.
- Heartburn. Doxycycline sometimes causes esophagitis, or inflammation of the esophagus. This can lead to heartburn. Take your pill directly after a meal with a full glass of water to avoid unnecessary irritation. You’ll also want to avoid lying down for 30 minutes after your dose.
- Gastrointestinal issues. Nausea, vomiting, and diarrhea are all possible side effects of doxycycline (and most antibiotics). Let your dermatologist know if these are ongoing or serious. As mentioned above, be sure to take your pill with a meal to avoid these symptoms.
However, oracea is one form of doxycycline that should only be taken on an empty stomach, so chat with your prescriber if you’re concerned about how to take your medicine.
Serious, more rare side effects of doxycycline include:
- Tooth staining. When small children or pregnant women take doxycycline, it can cause serious, irreversible discoloration of teeth. Therefore, doxycycline is not prescribed for pregnant women or children who have not gotten all of their permanent teeth. After all of your permanent teeth are in (usually by age 8-10), you don’t not need to worry about potential tooth staining from tetracycline antibiotics.
- Antibiotic resistance. This is a serious condition that prevents antibiotics from working in your body in the future. Using a topical medication like benzoyl peroxide or topical retinoids may reduce the chances of developing this condition. This is also why dermatologists limit how long you can use oral antibiotics as a treatment option.
- Ulcers in the esophagus. If esophagitis persists, ulcers (painful sores) can develop in the esophagus, causing more pain and making swallowing difficult. Taking your doxycycline with food helps prevent this issue.
Drug Interactions
While doxycycline can do miracles for acne, it doesn’t always play well with others.
Doxycycline hyclate should not be taken at the same time as:
- Antacids with calcium, like Tums, can prevent your body from absorbing doxycycline appropriately.
- Iron supplements can also block optimal absorption.
- Penicillin has a known interference with doxycycline.
- Warfarin can increase the side effects of doxycycline.
If you take any of these drugs or supplements, notify your doctor before starting doxycycline for acne.
Is doxycycline right for you?
Doxycycline for acne is an effective treatment with years of documented success stories. However, there are possible risks and side effects involved and it’s not the right fit for everyone.
Pregnant women, small children, and people on medications listed above should probably not take doxycycline. It also won’t work for those with antibiotic resistance. This prescription is not a one size fits all, but it’s a great solution for a large number of acne patients.
In the end, your integrative dermatologist should be passionate about looking at the whole picture and getting you to your healthiest self. They should be able to give you the scoop on exactly what combination of medication is right for you in winning your war against acne.
Sources
- Del Rosso, J. Q. (2015). 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, 8(5), 19. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4445892/
- McLaughlin, J., Watterson, S., Layton, A. M., Bjourson, A. J., Barnard, E., & McDowell, A. (2019). Propionibacterium acnes and acne vulgaris: new insights from the integration of population genetic, multi-omic, biochemical and host-microbe studies. Microorganisms, 7(5), 128. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6560440/
- Patel, R. S., & Parmar, M. (2020). Doxycycline Hyclate. In StatPearls [Internet]. StatPearls Publishing. Full text: https://www.ncbi.nlm.nih.gov/books/NBK555888/
- Henehan, M., Montuno, M., & De Benedetto, A. (2017). Doxycycline as an anti‐inflammatory agent: updates in dermatology. Journal of the European Academy of Dermatology and Venereology, 31(11), 1800-1808. Abstract: https://pubmed.ncbi.nlm.nih.gov/28516469/
- Zaenglein, A. L., Pathy, A. L., Schlosser, B. J., Alikhan, A., Baldwin, H. E., Berson, D. S., … & Keri, J. E. (2016). Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology, 74(5), 945-973. Abstract: https://pubmed.ncbi.nlm.nih.gov/26897386/
- Cross, R., Ling, C., Day, N. P., McGready, R., & Paris, D. H. (2016). Revisiting doxycycline in pregnancy and early childhood–time to rebuild its reputation?. Expert opinion on drug safety, 15(3), 367-382. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4898140/