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There's no shortage of acne treatments and products formulated for those with acne-prone skin. Patches, washes, scrubs, peels—take your pick. Still, as anyone who has ever dealt with severe acne (we're not talking about the occasional breakout here and there) will tell you, sometimes over-the-counter skincare products don't cut it. In that case, dermatologists will try combating the condition from the inside out, where oral medications like doxycycline come into play.
There are several different options skin docs commonly rely on, ranging from hormonal therapies (birth control pills, spironolactone) to antibiotics. Among the latter, doxycycline—or doxy, as it's often referred to—is one of the most popular, often-prescribed pills out there, as it works to reduce inflammation and lower levels of acne-causing bacteria. But before you head to the pharmacy, we tapped expert dermatologists Joshua Zeichner, MD, and Jordan Carqueville, MD, to answer all your questions about taking doxycycline for acne.
Ahead, discover how doxycycline works as well as its benefits and potential side effects.
Meet the Expert
- Joshua Zeichner, MD, is a board-certified dermatologist and assistant clinical professor of dermatology at Mount Sinai Hospital in New York City.
- Jordan Carqueville, MD, is a board-certified dermatologist and dermatopathologist in Chicago, specializing in general, surgical, and cosmetic dermatology.
Doxycycline
Type of ingredient: Anti-inflammatory
Main benefits: Commonly used for bacterial infections and treatment of moderate to severe acne
Who should use it: Those dealing with inflammatory acne on larger areas of the body
How often can you use it: Varies from patient to patient
Works well with: Oral doxy works well in tandem with products containing benzoyl peroxide, but consult a doctor first before use.
Don’t use with: N/A
What Is Doxycycline?
Doxycycline is an antibiotic in the tetracycline family commonly used to treat various bacterial infections and moderate to severe acne. The 'moderate to severe' part is key here, according to Zeichner, as this is not (nor is any oral antibiotic) a go-to treatment for a few clogged pores or acne types like blackheads. It should only be considered for those suffering from inflammatory acne; in other words, widespread, red, angry pimples, notes Zeichner. It's also beneficial for those dealing with acne on larger areas of the body—think chest and back acne—and for patients who aren't responding to topical medications alone, he adds.
Its mechanism of action against acne is similar to that of other tetracycline antibiotics, the most common being minocycline. That being said, "doxycycline is the most commonly used oral antibiotic for acne due to its low side effect profile and efficacy in treating inflammatory acne," says Carqueville. Zeichner agrees: "It's an effective drug that has been used in dermatology for decades and has a proven safety record." Doxycycline is the generic name of the drug, by the way, and name brands include Vibramycin, Mondox, Atridox, and Doryx, to name a few.
How It Treats Acne
So, how exactly does it help combat blemishes? "Doxycycline treats acne in both direct and indirect ways," says Zeichner:
Lowers levels of acne-causing bacteria: The medication directly lowers the levels of acne-causing bacteria (p.acnes) on the skin. Like the other tetracyclines, it does this by inhibiting the protein synthesis of this bacteria, explains Carqueville. The additional benefit of this? Zeichner points out that reduced bacterial levels also reduce subsequent inflammation in the skin.
Impacts the immune system: Doxy also reduces inflammation more directly via its effects on the immune system. "It blocks the recruitment of inflammatory blood cells and enzymes and messengers that drive skin inflammation," Zeichner explains. This double-whammy of anti-inflammatory benefits is why this drug reduces the redness and tenderness of active pimples, adds Carqueville.
How to Use
You'll first have to get a prescription from your dermatologist. It's crucial only to take this medication under the direct guidance of a dermatologist, as it can have some serious side effects (more on that below).
"The dosage and duration of treatment may vary from patient to patient, but typically, you can expect to be on the medication for at least six to eight weeks. The dosage is usually 50 to 100 milligrams, taken once or twice daily," says Carqueville. Doxycycline can have some gastrointestinal side effects, so both dermatologists we spoke with also advise taking the medication with a full glass of water. Also important: Take it at least 30 minutes, if not an hour, before lying down to minimize the risk of developing heartburn. It's a no-no if you're pregnant or breastfeeding, as well as for anyone who is allergic to tetracyclines.
Zeichner also suggests talking to your dermatologist about combining oral doxy with a product that contains benzoyl peroxide, a topical ingredient that also has antibacterial activity against p.acnes—this can help limit the development of bacterial resistance, he adds. And to that point, keep in mind that this isn't going to be a long-term treatment. While you need to be on it for several weeks to see effects, "it should be limited to three or four months of use and discontinued as soon as possible," cautions Zeichner. This is the general rule of thumb for any oral antibiotic being used as an acne treatment, again, to minimize the likelihood of bacterial resistance. Once you're off of it, topical treatments should be enough to maintain the results achieved. If not, your dermatologist will likely suggest an alternative oral drug, such as hormonal therapy or a heavy-duty medication called isotretinoin, Zeichner says.
Potential Side Effects
Acid reflux (aka heartburn) is one of the most significant potential side effects. "Doxycycline can cause inflammation of the esophagus and, in severe cases, even lead to ulcers," says Zeichner. Nausea and vomiting are also possible side effects, as is increased sun sensitivity, so be extra diligent about your sun protection practices, advises Carqueville. Still, it's worth noting that even though studies found both doxycycline and minocycline to be effective acne treatments, the side effect profile is theoretically safer and more tolerable with doxy, according to Carqueville. (She adds that while there tend to be fewer GI symptoms that come with minocycline, it may be associated with rare hypersensitivity reactions and ringing in the ears, which aren't side effects of doxycycline.) In other words, while this may sound like a long list of potentially unpleasant side effects, at the end of the day, doxycycline is still considered to be a top-notch, safe, and effective oral antibiotic for acne.
