Skin in the News: Oral Tetracyclines in the Treatment of Acne:
What is Acne?
Acne Vulgaris is a common skin disease affecting up to 70% of the population during their LIFETIME. Acne happens when hair follicles under the skin become clogged with oil, dead skin cells, or bacteria. This results in lesions which we call pimples or zits. Most of the time these painful and frustrating break outs appear on the face but they can also appear on the back, chest, and shoulders.
For some people acne is just a skin problem during their teenage years, for others this skin disease continues into their thirties, forties and fifties.
There is also Fungal Acne or Pityrosporum Folliculitis or Malassezia Folliculitis. This is different than acne vulgarisms! This type of acne is not caused by oil, dead skin cells, or bacteria. It is caused by the overgrowth of yeast, a type of fungus. Therefore, it won’t respond to the same treatments used for acne vulgaris. It is important to know the difference between these two skin diseases, how fungal acne looks and develops. This way, you can insure that you are treating it correctly and not making it worse by using treatments for the other type of acne!
What is Tetracycline?
Tetracycline is an antibiotic that fights infection caused by bacteria. It is used to treat many different bacterial infections in the skin, intestines, respiratory tract, urinary tract, genitals, lymph nodes and other body systems.
It is the most prescribed antibiotic in the treatment of severe acne! It also provides an anti-inflammatory effect against acne. The different kinds of oral tetracyclines used for acne are sarecycline, doxycycline, minocycline, and tetracycline.
How does it work?
Oral tetracyclines demonstrate (and here comes a big fancy word) bacteriostatic effects against acne. What does this mean?! Basically, this drug inhibits bacterial growth. This is something we want since acne can develop from bacterial growth in the follicles underneath the skin.
BUT some tetracyclines also exhibit (let's continue to use this word since we know what it means now) bacteriostatic effects on beneficial organisms in the gut. What? In our gut microbiome there are good bacteria and bad bacteria. The good bacteria do more than help us with digestion , they help keep bad bacteria at low numbers. The good bacteria multiply so often that the bad bacteria don’t have room to grow. This creates a healthy balance of bacteria in your gut, called equilibrium.
So, back to the point. Some tetracyclines can inhibit the bacterial growth of the good bacteria in our gut, which leads to a less diverse gut microbiome, causing chronic diseases such as obesity, and inflammatory bowel disease (IBD). Why is it important to have greater microbial diversity in our gut? Why is it bad for tetracyclines to disrupt this microbiome diversity? Because the greater the microbial diversity, the more protection we acquire from pathogens, the more nutrient supply and the more vitamin production.
What class of antibiotic is Tetracycline?
A “Broad-Spectrum” antibiotic!
Who shouldn’t use tetracyclines?
Pregnant or Nursing Women
Children under 8 Years of Age
Precautions:
Wear a sunscreen with a minimum SPF of 15 because tetracycline can make your skin more sensitive to sunlight and sunburn can result.
Consider other forms of birth control (non-hormonal) if you plan to take tetracyclines because this drug can make birth control pills less effective. Have back-up protection or avoid having sexual intercourse to avoid pregnancy.
What are common Side Effects?
nausea, vomiting, diarrhea, upset stomach, loss of appetite;
white patches or sores inside your mouth or on your lips;
swollen tongue, black or "hairy" tongue, trouble swallowing;
sores or swelling in your rectal or genital area; or
vaginal itching or discharge.
Article Discussion:
Based on a recent study conducted by JDD, Journal of Drugs in Dermatology, it was determined that different oral tetracyclines were variably effective against facial acne. JDD reviled 13 articles from PubMed which represented 226, 019 pediatric and adult patients suffering from acne. The oral tetracyclines that they were treated with were sarecycline, doxycycline, minocycline, and tetracycline.
Important Findings:
Sarecycline showed to be efficient in truncal acne ( or acne that affects the chest or back) AND showed decreased activity against the normal human intestinal microflora. So out of all the tetracyclines, it is the one that does NOT present a threat to our gut microbiome. The FDA approved Sarecycline for the treatment of moderate to severe acne in patients of 9 years and older. It is also the only oral tetracycline with reported truncal acne efficacy data.
Data shows that patients treated with seracycline demonstrated a significant reduction in inflammatory and non-inflammatory lesions by week 3 and week 6 respectively.
Seracycline was overall well tolerated with the most common adverse event (AE) being a headache.
Doxycycline prescribed patients were found to be over 60% more likely to develop new-onset inflammatory bowel disease (IBD)
Minocycline has high lipophilicity. What is lipophilicity? It is the ability of a chemical compound to dissolve in fats, oils, lipids and non-polar solvents. So because of minocycline’s high lipophilicity, it can cross the blood-brain barrier and achieve high concentrations in the Central Nervous System ((CNS). Why does this matter? Because high concentrations of minocycline in the CNS can result in higher rates of vestibular side effects such as vomiting, dizziness, and vertigo. Compared to other tetracycline drugs, minocycline can lead to more of these side effects.
Tetracycline doses of 250 mg twice-daily showed significantly lower papule count at week 8 in patients 18-35 years of age. When paired with erythromycin, patients also saw significant reductions in lesions at week 12. Approximately 10% of patients treated with tetracycline reported AE, including mostly nausea, vomiting, and vaginal candidiasis. Long term ( 3 years or more) tetracycline use was generally safe. A study based on 94,487 acne patients ages 15-35 years old out of which 38,603 received tetracycline, showed that 40% were more likely to develop new-onset IBD.
If you want to read the full article, visit https://jddonline.com/articles/dermatology/ S1545961620S00s6X/6.
We know that dealing with acne can be frustrating. Sometimes it may seen like nothing works and your skin is just getting worse. This is why it is important to be well informed. Do your own research, that way when you speak to your doctor you can be knowledgeable when discussing different treatment options.
When treating your skin, even with the help of a physician it is important to inform yourself about your condition and treatment options. If you are suffering with acne vulgaris and you want to try tetracyclines, do your research and speak with your doctor. This way you can be knowledgeable when discussing treatment options.
Written by: Laura Elvira
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