Doxycycline for Acne: Everything to Know

Doxycycline is an antibiotic that can be used to treat acne. As part of a group of antibiotics called tetracyclines, it helps treat acne by reducing bacteria on pores and by calming inflammation.

Doxycycline is commonly prescribed in pill or capsule form either as a generic medication or under the brand names Doryx, Vibramycin, Oracea, Adoxa, and others. When prescribed for acne, healthcare providers usually recommend taking it for about three to four months.

This article explains what doxycycline can (and cannot) do, how it should be used, and what side effects you might expect while taking it.

Doxycycline Uses

Doxycycline is an oral antibiotic taken by mouth that is used to treat moderate to severe inflammatory acne. It can also be used to treat mild inflammatory acne that isn’t getting better with other treatments.

Inflammatory acne is the type in which bacteria inside a pore cause a red, swollen, pus-filled bump (pustule) on the skin. Cystic acne and nodular acne are two types of inflammatory acne.

Doxycycline works by reducing the amount of bacteria, most commonly Cutibacterium acnes, in skin pores. By controlling the infection, doxycycline also eases inflammation, including signs of redness and swelling.

As an oral drug, doxycycline is a good choice if you have an acne breakout on the back or other parts of the body that are difficult to reach with topical drugs.

Doxycycline is far less effective in treating non-inflammatory acne conditions like whiteheads (closed comedones), blackheads (open comedones), or milia (subdermal cysts).

Doxycycline Dosage and How to Use

You'll need a prescription from your healthcare provider to take doxycycline. Doses vary from as low as 40 milligrams (mg) once daily to 100 mg twice daily.

Doxycycline is typically prescribed alongside topical retinoids and benzoyl peroxide. As doxycycline treats the underlying infection, the other drugs inhibit processes that contribute to pimples. Topical retinoids like Differin (adapalene) are especially good at unblocking clogged pores, while benzoyl peroxide helps shed dead skin cells that contribute to pore blockages.

Using doxycycline alongside these topical drugs also reduces the risk of antibiotic resistance as less doxycycline is used over a shorter period of time to achieve skin clearance.

Duration of Use

When indicated, doxycycline is typically used for three to four months. Your healthcare provider will take you off the drug once your skin has improved. You’ll then stay on topical treatments long-term to keep breakouts away.

People with especially severe cystic or nodular acne may need to use doxycycline for longer periods of time. Each case is assessed individually, weighing the benefits against the risks.

Regular follow-up appointments will be scheduled to check if the drug is working or if you need a different type of treatment.

Who Should Not Take Doxycycline

Doxycycline is not a one-size-fits-all solution for acne and may not be suitable for certain groups. This includes:

• Pregnant people: Doxycycline can affect bone growth in a developing fetus and is not recommended if you are pregnant or breastfeeding.
• Younger children: Doxycycline shouldn't be used by children under 8 years of age as it may affect bone growth and cause permanent tooth staining.
• People with an allergy: You need to avoid doxycycline if you are allergic to other tetracycline antibiotics like chlortetracycline, oxytetracycline, demeclocycline, lymecycline, methacycline, minocycline, or rolitetracycline.

If doxycycline cannot be used, other oral or topical antibiotics like erythromycin can be prescribed.

Doxycycline Side Effects

Like all medications, doxycycline can cause side effects. While most are relatively mild and manageable, some people may experience profound or intolerable symptoms.

Possible side effects of doxycycline include:

• Nausea or vomiting
• Diarrhea
• Loss of appetite
• Rectal itching
• Vaginal redness, burning, or itching
• Vaginal discharge
  
• Painful urination
• Difficulty urinating
• Sore throat or nose
• Swollen tongue
• Dry mouth
• Anxiety
• Back pain
• Changes in skin or nail color

Call your healthcare provider if you experience any unusual side effects or if side effects are becoming intolerable.

Upset Stomach and Diarrhea

Doxycycline can cause nausea and stomach upset. Taking the pill with food can help, but avoid dairy which can interfere with the absorption of doxycycline and make it less effective. When taking doxycycline, wait at least an hour before drinking or eating any dairy product.

Dairy may also cause acne because of hormones in milk products. One theory is that dairy foods increase inflammation in the body, leading to worse breakouts.

Esophagus Pain

Doxycycline can irritate your esophagus (the tube connecting your throat to your stomach). This can not only make it harder to swallow but also trigger acid reflux and heartburn.

You can reduce the risk by taking the pill with a big glass of water. Also, avoid lying down for about an hour after taking a dose.

Sensitivity to Sunlight

Doxycycline can make the skin more sensitive to the sun, referred to as photosensitivity. Symptoms include a skin rash, itching, and redness as well as an increased risk of sunburn. It can also cause photophobia in which your eyes are extra-sensitive to sunlight.

If prescribed doxycycline, always use sunscreen and reapply it often when spending time outdoors. You should also protect your eyes with sunglasses.

Doxycycline Interactions

Doxycycline can interact with many drugs and supplements and affect how they work. These include:

• Accutane (isotretinoin): used to treat nodular acne
• Antacids containing magnesium, aluminum, or calcium
  
• Anticoagulants ("blood thinners") like Coumadin (warfarin)
• Bismuth subsalicylate such as Pepto-Bismol or Kaopectate
• Calcium supplements
• Dilantin (phenytoin): used to treat epilepsy
  
• Iron supplements
• Lamictal (phenobarbital): used to treat epilepsy
  
• Laxatives containing magnesium
  
• Penicillin
  
• Proton pump inhibitors (PPIs) like Nexium (esomeprazole), Prilosec (omeprazole), or Protonix (pantoprazole)
• Soriatane (acitretin): used to treat psoriasis
• Tegretol (carbamazepine): used to treat seizures and chronic pain

Some interactions can be overcome by separating doses by two to three hours, particularly those containing calcium, magnesium, iron, or aluminum. Other drugs may need to be substituted or require a dose adjustment.

Let your healthcare provider know about any prescription or over-the-counter medications or supplements you take. This can help reduce the risk of a drug interaction.

Alternative Antibiotics for Acne

If you cannot take doxycycline for any reason, your dermatologist might prescribe an alternative antibiotic. According to the American Academy of Dermatology, effective alternatives include:

• Azithromycin
  
• Erythromycin
• Minocycline
• Tetracycline

Your dermatologist will work with you to determine the best option for you based on your symptoms and medication history.

Summary

Doxycycline is an oral antibiotic that can be used to treat inflammatory acne when other treatments fail. It is taken by mouth for a short period of time to clear the underlying bacterial infection and help reduce inflammation. It is typically used in combination with other topical acne treatments.

Common side effects include nausea, diarrhea, sore throat, and changes in skin or nail color.