minocycline and Acne-Vulgaris

Tetracyclines are a class of broad-spectrum bacteriostatic antibiotics used to treat many infections, including methicillin-resistant Staphylococcus aureus (MRSA), acne, pelvic inflammatory disease, chlamydial infections, and a host of zoonotic infections. These drugs work by inhibiting protein synthesis in bacterial ribosomes, specifically by disallowing aminoacyl-tRNA molecules from binding to the ribosomal acceptor sites. While rare, tetracycline antibiotics, particularly minocycline and doxycycline, are associated with an increased risk of developing esophageal perforation and pseudotumor cerebri (PTC, or idiopathic intracranial hypertension). Since tetracyclines are a commonly prescribed class of medications, especially in adolescents for acne treatment, it is important for clinicians to appreciate significant side effects that can result in morbidity and mortality. This paper aims to consolidate and to emphasize current research on the association between tetracycline antibiotics and the development of esophageal perforation, and PTC. PTC is a neurological syndrome consisting of increased intracranial pressure, headache, and vision changes without evidence of the contributing source, such as mass lesion, infection, stroke, or malignancy. Esophageal perforation, while rare, can be the result of pill esophagitis. Pill-induced injuries occur when caustic medicinal pills dissolve in the esophagus rather than in the stomach. Most patients experience only self-limited pain (retrosternal burning discomfort, heartburn, dysphagia, or odynophagia), but hemorrhage, stricture, and perforation may occur. Tetracycline use can lead to pill esophagitis. In summary, clinicians should appreciate the potential risks of tetracycline compounds in clinical practice.

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Doxycycline; Esophageal Perforation; Esophagitis; Humans; Methicillin-Resistant Staphylococcus aureus; Minocycline; Pain; Pseudotumor Cerebri; Tetracycline

In this case report, we highlight minocycline-induced scleral hyperpigmentation, combined with ear and fingernail discoloration that developed after over 15 years of use for rosacea in a 78-year-old male with multiple medical comorbidities. Minocycline, a tetracycline antibiotic, is used to treat rosacea and acne as well as some orthopedic infections. It is typically used for extended periods of time; long-term use of minocycline is associated with hyperpigmentation of the sclera, conjunctiva, retina, teeth, skin, subcutaneous fat, oral mucosa, tympanic membrane, and gingiva. This case highlights that hyperpigmentation is more likely to occur in older patients than in younger patients. Scleral hyperpigmentation is not associated with vision loss; however, cosmetic concerns can prompt discontinuation of minocycline. Nonetheless, after cessation, the lesions persist in some patients. Monitoring for hyperpigmentation in patients using minocycline is important, as the hyperpigmentation is more likely to be permanent with long-term use.

Topics: Acne Vulgaris; Aged; Anti-Bacterial Agents; Humans; Hyperpigmentation; Male; Minocycline; Rosacea; Scleral Diseases; Vision Disorders

Acne vulgaris is a common chronic inflammatory disease with a multifactorial pathogenesis. Although myriad acne treatments are available, current options may not be sufficient because of a lack of efficacy, limited tolerability, or burden of cost to patients. In this review, we highlight recently approved topical acne treatments, as well as those currently in clinical trials. Novel formulations of tretinoin, tazarotene, and minocycline provide modifications of and improvements to existing products. Trifarotene, a novel fourth-generation retinoid, has demonstrated improved tolerability compared with existing topical retinoids. Clascoterone is a novel first-in-class antiandrogen that topically addresses the hormonal etiology of acne. The late-phase clinical trials pipeline consists of agents with bactericidal and anti-sebum mechanisms. Although it is evident that acne treatments continue to evolve, it is important to recognize the need for further comparative studies among new and existing agents to define optimal treatment algorithms that address not only safety and efficacy but also cost-effective care.

Topics: Acne Vulgaris; Dermatologic Agents; Humans; Minocycline; Retinoids; Treatment Outcome; Tretinoin

Tetracyclines are a broad-spectrum class of antibiotics that have unclear actions with potentially lasting effects on bone metabolism. Initially isolated from Streptomyces, tetracycline proved to be an effective treatment for Gram +/- infections. The emergence of resistant bacterial strains commanded the development of later generation agents, including minocycline, doxycycline, tigecycline, sarecycline, omadacycline, and eravacycline. In 1957, it was realized that tetracyclines act as bone fluorochrome labels due to their high affinity for the bone mineral matrix. Over the course of the next decade, researchers discerned that these compounds are retained in the bone matrix at high levels after the termination of antibiotic therapy. Studies during this period provided evidence that tetracyclines could disrupt prenatal and early postnatal skeletal development. Currently, tetracyclines are most commonly prescribed as a long-term systemic therapy for the treatment of acne in healthy adolescents and young adults. Surprisingly, the impact of tetracyclines on physiologic bone modeling/remodeling is largely unknown. This article provides an overview of the pharmacology of tetracycline drugs, summarizes current knowledge about the impact of these agents on skeletal development and homeostasis, and reviews prior work targeting tetracyclines' effects on bone cell physiology. The need for future research to elucidate unclear effects of tetracyclines on the skeleton is addressed, including drug retention/release mechanisms from the bone matrix, signaling mechanisms at bone cells, the impact of newer third generation tetracycline antibiotics, and the role of the gut-bone axis.

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Humans; Minocycline; Tetracycline

2021 is the 50th anniversary of the FDA approval of minocycline (MCN). While many other antibiotics have become obsolete during this time, MCN continues to be quite useful. In dermatology, MCN is used prominently in acne vulgaris, and is also employed in many other dermatological conditions because of its molecular and pharmacological properties. In this article, we review the history of minocycline, and outline the evolution of the drug since its inception. Based on its existing longstanding utility and continued innovations in formulation and delivery systems, we postulate that it will continue to have a prominent position in the dermatologist’s armamentarium. J Drugs Dermatol. 2021;20(10):1031-1036. doi:10.36849/JDD.6370.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Humans; Minocycline

To review the safety and efficacy of minocycline 4% topical foam for the treatment of moderate to severe acne vulgaris in adults and pediatric patients aged 9 years and older.. A literature search through PubMed and EMBASE was conducted using the following keywords:. Articles selected included those describing preclinical and clinical studies of pharmacokinetics, efficacy, or safety of topical minocycline foam.. Minocycline 4% topical foam was shown in a preclinical study to effectively deliver minocycline to the pilosebaceous unit, with little penetration beyond the stratum corneum. This was consistent with a phase 1 pharmacokinetic study of the foam, which yielded a significantly reduced systemic exposure of minocycline compared with oral minocycline. In phase 2 and phase 3 clinical trials, the foam significantly reduced acne lesion counts and Investigator's Global Assessment scores of acne severity compared with placebo. The foam has a good safety profile, with headache, mild erythema, hyperpigmentation, and mild dryness among the most common adverse effects.. Topical antibiotics have been a mainstay of acne therapy with the benefit of less systemic exposure compared with oral antibiotics. However, the development of bacterial resistance has reduced their use, thereby reducing options for many patients with acne. Minocycline 4% topical foam is a safe and effective alternative, which may help restore this important therapeutic approach for treating acne vulgaris.

Topics: Acne Vulgaris; Administration, Cutaneous; Adult; Anti-Bacterial Agents; Child; Clinical Trials as Topic; Female; Humans; Hyperpigmentation; Male; Minocycline; Treatment Outcome

Minocycline is a tetracycline antibiotic that is widely used to treat infections and is a first-line oral antibiotic in the treatment of moderate to severe inflammatory acne. Although it has high efficacy, several adverse reactions, including life-threatening ones, have been reported in association with its use.. To identify all the potential adverse reactions due to minocycline and analyze them in terms of the number of cases reported so far, salient features, severity and clinical outcome.. Comprehensive PubMed search of English and non-English literature for case reports of adverse reactions to minocycline was conducted.. A total of 550 cases were identified from over 200 publications. The major reported adverse events caused by minocycline are drug reaction with eosinophilia and systemic symptoms syndrome, autoimmune syndromes like hepatitis, lupus and vasculitis, acute eosinophilic pneumonia, pseudotumor cerebri, hyperpigmentation, serum sickness-like reaction, Sweet's syndrome and drug fever. Several other reactions involving multiple organ systems have also been reported. These show an overlap of clinical features and may be associated with multiple events causing considerable morbidity. Eight of these cases resulted in the death of the patients.. In view of the evident potential of minocycline to cause long-lasting and severe adverse effects, significant morbidity and even mortality, it should be prescribed with caution in the first-line treatment for moderate to severe acne.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Humans; Minocycline; Pulmonary Eosinophilia

Oral minocycline is a mainstay of therapy for moderate-to-severe acne; however, systemic side effects which include hepatotoxicity, lupus-like syndrome, drug hypersensitivity syndrome, autoimmune hepatitis, polyarteritis nodosa, gastrointestinal side effects and skin hyperpigmentation are of concern. Topical antibiotics commonly used in acne, such as erythromycin and clindamycin, present high P. acnes resistance rates which has opened the market for new topical antibiotics. FMX-101 is a novel topical minocycline foam that has shown promising results in phase I, II and III trials for the treatment of moderate-to-severe acne with a better safety profile than oral minocycline.. The author provides an overview FMX-101 including its clinical efficacy and safety. The author then provides their expert opinion on this treatment and its potential for the treatment option for acne.. The topical foam formulation of FMX-101 has been shown to reduce both inflammatory and non-inflammatory lesions and to improve IGA scores in patients with moderate-to-severe acne without significant systemic absorption thus limiting associated side effects. Overall, the proven efficacy and safety profile of FMX-101, together with the low systemic absorption, high skin tolerability and cosmetically acceptable foam formulations render this novel therapy an important addition to the acne treatment armamentarium.

Topics: Acne Vulgaris; Administration, Cutaneous; Anti-Bacterial Agents; Drug-Related Side Effects and Adverse Reactions; Humans; Minocycline; Randomized Controlled Trials as Topic; Skin; Treatment Outcome

The increasing crisis regarding multidrug-resistant (MDR) and extensively drug-resistant microorganisms leads to appealing therapeutic options.. During the last 30 years, minocycline, a wide-spectrum antimicrobial agent, has been effective against MDR Gram-positive and Gram-negative bacterial infections. As with other tetracyclines, the mechanism of action of minocycline involves attaching to the bacterial 30S ribosomal subunit and preventing protein synthesis.. This antimicrobial agent has been approved for the treatment of acne vulgaris, some sexually transmitted diseases and rheumatoid arthritis. Although many reports have been published, there remains limited information regarding the prevalence, mechanism of resistance and clinical effectiveness of minocycline.. Thus, we summarize here the currently available data concerning pharmacokinetics and pharmacodynamics, mechanism of action and resistance, antibacterial activity and clinical effectiveness of minocycline.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Anti-Infective Agents; Gram-Negative Bacterial Infections; Humans; Minocycline

Topical minocycline foam 4% (Amzeeq™) is approved in the USA for the treatment of inflammatory lesions of non-nodular, moderate to severe acne vulgaris (acne) in patients aged ≥ 9 years. It was developed to minimize systemic minocycline absorption and toxicity, and its high lipid content allows efficient drug movement through sebum and into affected sites. The favorable in vitro resistance profile of oral minocycline seen in Cutibacterium acnes (C. acnes) isolates was maintained with topical minocycline foam 4%. In 12-week, phase III clinical trials, once-daily topical minocycline foam 4% significantly improved both inflammatory and noninflammatory lesions relative to foam vehicle in patients aged ≥ 9 years with moderate to severe acne and was reported by most patients to be satisfactory or highly satisfactory to use. Extension trial data indicated that topical minocycline foam 4% continued to be effective for up to 52 weeks' therapy. Topical minocycline foam 4% was generally well tolerated in these patients, with most adverse events (AEs) and all serious AEs considered to be unrelated to treatment. Cutaneous AEs were uncommon, and findings from a dermal safety study showed that topical minocycline foam 4% did not have any effects related to phototoxicity, photoallergy, skin sensitization and skin irritation. Topical minocycline foam 4% is thus a useful addition to available treatment options for the management of inflammatory lesions of non-nodular, moderate to severe acne in adult and pediatric patients aged ≥ 9 years.

Topics: Acne Vulgaris; Administration, Cutaneous; Adolescent; Adult; Age Factors; Anti-Bacterial Agents; Child; Clinical Trials, Phase III as Topic; Dose-Response Relationship, Drug; Drug Resistance, Bacterial; Humans; Minocycline; Propionibacterium acnes; Severity of Illness Index; Skin; Treatment Outcome; Young Adult

Oral tetracyclines are the most widely prescribed systemic antibiotic for acne. Synthesis of efficacy and safety of traditional and novel oral tetracyclines is highly informative to clinical practice. We conducted a systematic search of PubMed to identify large interventional and observational studies utilizing oral tetracyclines as an acne treatment. We identified 13 articles meeting inclusion for this review, which represented 226,019 pediatric and adult acne patients. Oral tetracyclines that were included in this systematic review were sarecycline (a novel narrow-spectrum tetracycline), doxycycline, minocycline, and tetracycline. Based on shared and divergent outcome measures, different oral tetracyclines were variably effective against facial acne. Sarecycline also demonstrated efficacy in truncal acne. Members of the oral tetracycline class also differed in their ability to minimize antibiotic resistance and gut dysbiosis. J Drugs Dermatol. 2020;19:11(Suppl):s4-11.

Topics: Acne Vulgaris; Administration, Oral; Anti-Bacterial Agents; Clinical Trials as Topic; Dermatology; Doxycycline; Drug Resistance, Bacterial; Dysbiosis; Face; Gastrointestinal Microbiome; Humans; Minocycline; Observational Studies as Topic; Propionibacteriaceae; Skin; Tetracycline; Tetracyclines; Treatment Outcome

To some degree, acne vulgaris affects nearly every individual worldwide. Oral antibiotic therapy is routinely prescribed for the treatment of moderate to severe inflammatory acne; however, long-term use of oral antibiotics for acne may have unintended consequences.. The aim of this study was to provide a systematic evaluation of the scientific evidence on the efficacy and appropriate use of oral antibiotics in the treatment of acne.. A systematic search of MEDLINE was conducted to identify randomized controlled clinical trials, systematic reviews, and meta-analyses evaluating the efficacy of oral antibiotics for acne. Overall, 41 articles that examined oral antibiotics compared with placebo, another oral therapy, topical therapy, alternate dose, or duration were included in this study.. Tetracyclines, macrolides, and trimethoprim/sulfamethoxazole are effective and safe in the treatment of moderate to severe inflammatory acne. Superior efficacy of one type or class of antibiotic could not be determined, therefore the choice of antibiotic is generally based on the side-effect profile. Although different dosing regimens have been studied, there is a lack of standardized comparator trials to determine optimal dosing and duration of each oral antibiotic used in acne. The combination of oral antibiotics with a topical therapy is superior to oral antibiotics alone.. This article provides a systematic evaluation of the scientific evidence of the efficacy of oral antibiotics for acne. Due to heterogeneity in the design of the trials, there is insufficient evidence to support one type, dose, or duration of oral antibiotic over another in terms of efficacy; however, due to increasing resistance to antibiotics, dermatologists should heed consensus guidelines for their appropriate use.

Topics: Acne Vulgaris; Administration, Oral; Anti-Bacterial Agents; Clinical Trials as Topic; Doxycycline; Evidence-Based Medicine; Guidelines as Topic; Humans; Meta-Analysis as Topic; Minocycline; Practice Guidelines as Topic; Randomized Controlled Trials as Topic; Tetracyclines; Treatment Outcome

Minocycline is a synthetic tetracycline-derived antibiotic with significant anti-inflammatory properties that may benefit patients with rheumatoid arthritis. Surprisingly, chronic exposure to minocycline can also cause a breach in immunologic tolerance resulting in a variety of autoimmune syndromes such as drug-induced lupus or autoimmune hepatitis. Vasculitis, most commonly resembling cutaneous polyarteritis nodosa, has also been seen in patients taking this drug. Herein, we present a case of biopsy-proven systemic vasculitis presenting as an ANA (+) ANCA (+) polyarteritis nodosa-like syndrome in a male patient who was taking minocycline for his acne for approximately 2 years. Patient initially presented with constitutional symptoms such as profound weight loss and fatigue, along with myalgias, oligoarticular arthritis, and livedo reticularis. About 2 months later, he developed a severe left testicular pain. Biopsy showed vasculitis complicated with the infarction of the left testis. Angiography revealed microaneurysms in the renal and splenic circulation. Stopping the offending drug, along with the short course of prednisone and hydroxychloroquine, resulted in prompt resolution of his symptoms. We additionally present a comprehensive review of biopsy-proven cases of vasculitis associated with chronic minocycline treatment focusing on its pathogenesis and clinical manifestations.

Topics: Acne Vulgaris; Angiography; Antibodies, Antineutrophil Cytoplasmic; Autoimmunity; Biopsy; Diagnosis, Differential; Humans; Hydroxychloroquine; Inflammation; Male; Minocycline; Neutrophils; Polyarteritis Nodosa; Prednisone; Systemic Vasculitis; Testis; Young Adult

Minocycline is an oral antibiotic used for acne vulgaris. Its use has lessened due to safety concerns (including potentially irreversible pigmentation), a relatively high cost, and no evidence of any greater benefit than other acne treatments. A modified-release version of minocycline is being promoted as having fewer side-effects.. To assess new evidence on the effects of minocycline for acne vulgaris.. Searches were updated in the following databases to November 2011: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library, MEDLINE (from 1946), EMBASE (from 1974), and LILACS (from 1982). We also searched trials registers and checked reference lists for further references to relevant randomised controlled trials (RCTs).The Cochrane Skin Group's Trials Search Co-ordinator undertook searches exploring minocycline's adverse effects in EMBASE and MEDLINE in February 2012.. We selected randomised controlled trials (RCTs) comparing minocycline, at any dose, to an active or a placebo control, in participants with inflammatory acne vulgaris. For adverse effects, we selected additional studies that reported the number of adverse effects and the number of participants treated.. Outcome measures used in the trials included lesion counts, acne grades/severity scores, doctors' and participants' global assessments, adverse effects, and dropout rates. Two authors independently assessed the quality of each study. Effect sizes were calculated, and meta-analyses were undertaken where possible.Sixteen studies met the inclusion criteria for the review of adverse effects.. We included 12 new RCTs for this update, giving a total of 39 RCTs (6013 participants). These additional 12 RCTs have not changed the original conclusions about the clinical efficacy of minocycline.The identified RCTs were generally small and poor quality. Meta-analysis was rarely possible because of the lack of data and different outcome measures and trial durations. Although minocycline was shown to be an effective treatment for moderate to moderately-severe acne vulgaris, there was no evidence that it is better than any of the other commonly-used acne treatments. One company-sponsored RCT found minocycline to be less effective than combination treatment with topical erythromycin and zinc. No trials have been conducted using minocycline in those participants whose acne is resistant to other therapies. Also, there is no evidence to guide what dose should be used.The adverse effects studies must be interpreted with caution. The evidence suggests that minocycline is associated with more severe adverse effects than doxycycline. Minocycline, but not other tetracyclines, is associated with lupus erythematosus, but the risk is small: 8.8 cases per 100,000 person-years. The risk of autoimmune reactions increases with duration of use. The evidence does not support the conclusion that the more expensive extended-release preparation is safer than standard minocycline preparations.. Minocycline is an effective treatment for moderate to moderately-severe inflammatory acne vulgaris, but there is still no evidence that it is superior to other commonly-used therapies. This review found no reliable evidence to justify the reinstatement of its first-line use, even though the price-differential is less than it was 10 years ago. Concerns remain about its safety compared to other tetracyclines.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Humans; Minocycline; Randomized Controlled Trials as Topic

Acne vulgaris affects over 80% of teenagers, and persists beyond the age of 25 years in 3% of men and 12% of women. Typical lesions of acne include comedones, inflammatory papules, and pustules. Nodules and cysts occur in more severe acne and can cause scarring and psychological distress.. We conducted a systematic review and aimed to answer the following clinical question: What are the effects of topical and oral treatments in people with acne vulgaris? We searched: Medline, Embase, The Cochrane Library, and other important databases up to February 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).. We found 69 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.. In this systematic review we present information relating to the effectiveness and safety of the following interventions: topical treatments (adapalene, azelaic acid, benzoyl peroxide, clindamycin, erythromycin [alone or plus zinc]; isotretinoin, tetracycline, tretinoin); and oral treatments (doxycycline, isotretinoin, lymecycline, minocycline, oxytetracycline, tetracycline).

Topics: Acne Vulgaris; Anti-Bacterial Agents; Benzoyl Peroxide; Humans; Isotretinoin; Lymecycline; Minocycline; Tretinoin

Topics: Acne Vulgaris; Administration, Oral; Anti-Bacterial Agents; Azithromycin; Drug Costs; Drug-Related Side Effects and Adverse Reactions; Erythromycin; Evidence-Based Medicine; Humans; Minocycline

Minocycline is a semi-synthetic tetracycline antibiotic effective against a wide range of aerobic and anaerobic Gram-positive and Gram-negative bacteria. It is highly active in the pilosebaceous complex, due to its great lipophilicity, and therefore it has been used in the treatment of moderate to severe papulo-pustular acne for a long time. It has an optimal therapeutic range and the percentage of P. acnes resistant strains are still inferior to 5%. Besides the antimicrobial activity, minocycline has an anti-inflammatory action, due to the reduction in neutrophilic chemotaxis, the inhibitory effect on pro-inflammatory cytokines, and the reduction in sebum free fatty acids and bacterial lipases. In 2006 the Food and Drug Administration (FDA) approved a new extended-release formulation of minocycline. This formulation allowed the reduction of some dose-related adverse events, such as those affecting the vestibular system. Besides the dose-related events (nausea, vomiting, and dizziness), minocycline is also known to induce hyperpigmentation, even if less frequently than doxycycline, and is rarely responsible for autoimmune disorders, hypersensitivity reactions, and serum sickness-like reactions. The latest guidelines in the treatment of acne recommend a dose of 50-100 mg, once or twice a daily for the non-modified release minocycline, and 1 mg/kg daily for the new extended-release formulation. This agent is most appropriately used in combination with a topical regimen containing benzoyl peroxide and/or retinoid.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Humans; Minocycline

Minocycline is a semi-synthetic, second-generation tetracycline. It was introduced in 1972 and has both antibacterial and anti-inflammatory properties. Minocycline is used for a variety of infectious diseases and in acne. Even today, new indications beyond the antibacterial indications are being investigated such as its use in neurologic diseases. Formerly, minocycline was thought to have a superior efficacy in the treatment of inflammatory acne, especially with respect to antibacterial-resistant Propionibacterium acnes. A thorough review of the literature, however, shows that minocycline is not more effective in acne than other tetracyclines. Compared with first-generation tetracyclines, minocycline has a better pharmacokinetic profile, and compared with doxycycline it is not phototoxic. However, minocycline has an increased risk of severe adverse effects compared with other tetracyclines. It may induce hypersensitivity reactions affecting the liver, lung, kidneys, or multiple organs (Drug Reaction with Eosinophilia and Systemic Symptoms [DRESS] syndrome) in the first weeks of treatment and, with long-term treatment, may cause autoimmune reactions (systemic lupus erythematosus, autoimmune hepatitis). In addition, CNS symptoms, such as dizziness, are more frequent compared with other tetracyclines. Long-term treatment may induce hyperpigmentation of the skin or other organs. Resistance of P. acnes to minocycline also occurs, dependent on the prescribing behavior. Considering the aspects of efficacy, its adverse effect profile, resistance, price, and alternatives, minocycline is no longer considered the first-line antibacterial in the treatment of acne.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Humans; Minocycline; Risk Assessment; Tetracycline Resistance; Treatment Outcome

A significant number of patients with moderate-to-severe inflammatory acne are candidates for oral antibiotic therapy. Use of tetracycline for acne has yielded to second-generation molecules doxycycline and minocycline, which are associated with numerous benefits over their predecessor, especially less frequent dosing and improved safety. Nonetheless, these agents are associated with certain potential side effects, including gastrointestinal (GI) concerns, staining of developing teeth in children, candidiasis, vestibular concerns and, somewhat more controversially, photosensitivity. Additionally, minocycline may be associated with the development of autoantibodies, including anti-nuclear antibody (ANA), anti-neutrophil cytoplasmic antibody (ANCA) and anti-phospholipid antibodies with or without associated clinical symptoms. Given their similar efficacy for the management of moderate-to-severe acne vulgaris, the choice of doxycycline or minocycline may depend on specific clinical considerations, including patient satisfaction with therapy, compliance and convenience. Data and clinical experience suggest that enteric-coated doxycycline, with its low rate of GI symptoms, may represent a more tolerable treatment option for many acne patients and therefore be associated with better likelihood of compliance.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Doxycycline; Humans; Minocycline

Minocycline is a commonly used antibiotic for long-term treatment of acne vulgaris. A well-documented and cosmetically dis-pleasing side effect is skin pigmentation. Three distinct types occur: Type I, blue-black/grey pigment on the face in areas of scarring or inflammation associated with acne; type II, blue-grey pigment on normal skin on the shins and forearms; type III, diffuse muddy-brown discoloration in areas of sun exposure. Types I and II stain for iron and melanin extracellularly and within macrophages in the dermis. Type III shows nonspecific increased melanin in basal keratinocytes and dermal melanophages staining for melanin only. The etiology of this pigmentation is unknown, but may be related to polymerized reactive metabolites, insoluble chelation products, and lengthy treatment durations of minocycline compared to other tetracyclines. Types I and II tend to resolve slowly over time, whereas type III persists indefinitely. Treatment involves early recognition, discontinuation of the drug, sun protection, and laser for persistent pigmentation.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Humans; Hyperpigmentation; Minocycline

Topics: Acne Vulgaris; Administration, Oral; Anti-Bacterial Agents; Humans; Minocycline; Practice Patterns, Physicians'; Treatment Outcome

Until recently, with the exception of oral isotretinoin for the treatment of severe recalcitrant nodular acne, systemic therapy for acne vulgaris and rosacea has been based on anecdotal support, clinical experience, and small clinical trials. Tetracycline derivatives are the predominant systemic agents that have been used for both disease states, prescribed in dose ranges that produce antibiotic activity. Anti-inflammatory dose doxycycline, a controlled-release (CR) 40-mg capsule formulation of doxycycline that is devoid of antibiotic activity when administered once daily, was US Food and Drug Administration (FDA)-approved for the treatment of inflammatory lesions (papules and pustules) of rosacea, based on large-scale phase 3 pivotal trials and long-term microbiologic and safety data. Also, an extended-release (ER) tablet formulation of minocycline was approved by the FDA for the treatment of inflammatory lesions of moderate to severe acne vulgaris in patients 12 years and older based on large-scale phase 3 clinical trials that evaluated efficacy and safety, dose-response analysis, and long-term data. This article discusses the studies and clinical applications related to the use of these agents.

Topics: Acne Vulgaris; Administration, Oral; Anti-Inflammatory Agents; Delayed-Action Preparations; Dose-Response Relationship, Drug; Doxycycline; Humans; Minocycline; Rosacea

Tetracyclines are broad-spectrum antibiotics that act as such at the ribosomal level where they interfere with protein synthesis. They were first widely prescribed by dermatologists in the early 1950s when it was discovered that they were effective as a treatment for acne. More recently, biologic actions affecting inflammation, proteolysis, angiogenesis, apoptosis, metal chelation, ionophoresis, and bone metabolism have been researched. The therapeutic effects of tetracycline and its analogues in various diseases have also been investigated. These include rosacea, bullous dermatoses, neutrophilic diseases, pyoderma gangrenosum, sarcoidosis, aortic aneurysms, cancer metastasis, periodontitis, and autoimmune disorders such as rheumatoid arthritis and scleroderma. We review the nonantibiotic properties of tetracycline and its analogues and their potential for clinical application.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Anti-Inflammatory Agents; Aortic Aneurysm, Abdominal; Apoptosis; Arthritis, Rheumatoid; Doxycycline; Humans; Matrix Metalloproteinases; Minocycline; Neoplasms; Neovascularization, Physiologic; Periodontitis; Rosacea; Sarcoma, Kaposi; Skin Diseases; Skin Diseases, Vesiculobullous; Tetracyclines

Minocycline is an oral antibiotic widely prescribed throughout the world, primarily for the treatment of acne vulgaris; other uses include the treatment of rosacea and perioral dermatitis. In the United States, Propionibacterium acnes resistance is lowest with minocycline compared with other tetracyclines and with erythromycin. The availability of generic formulations of minocycline has created confusion regarding the clinical significance of brand versus generic minocycline products. This article reviews available data on minocycline use for acne vulgaris and discusses a patented brand of minocycline versus generic formulations, including evaluations of pharmacologic activity and safety.

Topics: Acne Vulgaris; Administration, Oral; Anti-Bacterial Agents; Biological Availability; Chemistry, Pharmaceutical; Drugs, Generic; Humans; Minocycline

Patients with moderate or severe acne vulgaris, or an inadequate response to topical treatments, are often treated with oral antibacterials, in particular, tetracyclines. Minocycline is one of the most commonly prescribed tetracyclines in acne, the predominant use for this drug. In 2005, around 2.5 million prescriptions for oral tetracyclines were dispensed in England at a cost to the NHS of over pound 21 million, and minocycline accounted for 40% of this expenditure. The drug is often recommended with claims that it is more effective, less likely to cause bacterial resistance, and easier to take than other tetracyclines. Here we consider the use of minocycline for acne.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Drug Costs; Drug Resistance, Microbial; Female; Health Services Misuse; Humans; Male; Meta-Analysis as Topic; Minocycline; Treatment Outcome

Topics: Acne Vulgaris; Adapalene; Anti-Bacterial Agents; Benzoyl Peroxide; Clindamycin; Dermatologic Agents; Dicarboxylic Acids; Doxycycline; Erythromycin; Humans; Isotretinoin; Minocycline; Naphthalenes; Tetracycline; Tretinoin; Zinc

For a long time, minocycline has been recognized as highly efficacious for the treatment of acne vulgaris but with use-limiting acute vestibular adverse events (AVAEs). Based on the concept that lowered overall systemic exposure to minocycline should reduce unwanted side effects, a program was initiated to develop a modified-release formulation for clinical testing. An extended-release (ER) minocycline hydrochloride tablet formulation was developed that demonstrated delayed time of maximum concentration (tmax, 3 1/2 - 4 hours) compared with a nonmodified-release minocycline (tmax, 2 1/4 - 3 hours), and a lower maximum concentration of drug (cmax) in the blood (90%) compared with nonmodified-release formulations. At steady state (day 6), the ER-minocycline formulation had a 0- to 24-hour area under the curve (AUC(0-24)) and cmax of 33.32 microg x h/mL and 2.63 microg/mL, respectively, compared with 46.35 micro x h/mL and 2.92 microg/mL, respectively, for the nonmodified-release minocycline. These studies demonstrated that the new ER-minocycline hydrochloride formulation is not bioequivalent to the immediate-release (IR) minocycline hydrochloride formulation currently on the market. The favorable pharmacokinetic profile of ER minocycline also was not affected by concomitantly ingested food, including dairy products.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Biological Availability; Delayed-Action Preparations; Humans; Minocycline

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Female; Humans; Minocycline; Polyarteritis Nodosa; Skin Diseases

The goal of this review was to summarize the available literature covering the safety profiles of oral doxycycline and minocycline.. Scientific literature published between 1966 and August 2003 was searched using the MEDLINE, EMBASE, and Biosis databases (search terms: minocycline or doxycycline, each paired with adverse reaction, adverse event, and side effect, and doxycycline or minocycline with the limits English language, human, and clinical trials). Safety information was collected from case reports and clinical trials. Adverse event (AE) rates in the United States were calculated by comparing data from the MedWatch AE reporting program used by the US Food and Drug Administration (FDA) with the number of new prescriptions dispensed for each drug from January 1998 to August 2003.. Between 1966 and 2003, a total of 130 and 333 AEs were published in case reports of doxycycline and minocycline, respectively. In 24 doxycycline clinical trials (n = 3833) and 11 minocycline trials (n = 788), the ranges in incidence of AEs were 0% to 61% and 11.7% to 83.3%, respectively. Gastrointestinal AEs were most common with doxycycline; central nervous system and gastrointestinal AEs were most common with minocycline. From January 1998 to August 2003, the FDA MedWatch data contained 628 events for doxycycline and 1099 events for minocycline reported in the United States. Approximately 47,630,000 doxycycline and 15,234,000 minocycline new prescriptions were dispensed in the United States during that period, yielding event rates of 13 per million for doxycycline and 72 per million for minocycline, based on FDA data.. Between 1998 and 2003, doxycycline was prescribed 3 times as often as minocycline. The incidence of AEs with either drug is very low, but doxycycline had fewer reported AEs. Although more head-to-head clinical trials are needed for a direct comparison of AE frequency, these preliminary data from separate reports suggest the possibility that AEs may be less likely with doxycycline than minocycline.

Topics: Acne Vulgaris; Adverse Drug Reaction Reporting Systems; Anti-Bacterial Agents; Central Nervous System Diseases; Clinical Trials as Topic; Doxycycline; Drug Prescriptions; Gastrointestinal Diseases; Humans; Incidence; MEDLINE; Minocycline; Skin Diseases; United States; United States Food and Drug Administration

Topics: Acne Vulgaris; Administration, Oral; Adolescent; Adult; Androgen Antagonists; Anti-Bacterial Agents; Anti-Inflammatory Agents; Cyproterone Acetate; Dermatologic Agents; Diagnosis, Differential; Doxycycline; Female; Humans; Isotretinoin; Keratolytic Agents; Male; Minocycline; Ointments; Prednisolone; Retinoids; Tetracycline; Time Factors

Minocycline is a tetracycline antibiotic that is commonly used in the treatment of moderate to severe acne vulgaris. Although it is more convenient for patients to take than first-generation tetracyclines, as it only needs to be taken once or twice a day and can be taken with food, it is more expensive. Concerns have also been expressed over its safety following the deaths of two patients taking the drug. There is a lack of consensus among dermatologists over the relative risks and benefits of minocycline. As most acne prescribing is undertaken by general practitioners, it is important that guidelines issued to them are based on the best available evidence rather than personal judgements.. To collate and evaluate the evidence on the clinical efficacy of minocycline in the treatment of inflammatory acne vulgaris. Specific objectives were to compare the efficacy of minocycline with other drug treatments for acne and to collate information on the incidence of adverse drug reactions.. Randomised controlled trials (RCTs) of minocycline for acne vulgaris were identified by searching the following electronic databases; MEDLINE, EMBASE, Biosis, Biological Abstracts, International Pharmaceutical Abstracts, Cochrane Skin Group's Trial Register, Theses Online, BIDS ISI Science Citation Index, National Research Register, Current Controlled Trials and Bids Index to Scientific and Technical Proceedings. Other strategies used were scanning the references of articles retrieved, hand-searching of major dermatology journals and personal communication with trialists and drug companies.. To be eligible for the review, studies had to be RCTs comparing the efficacy of minocycline at any dose to active or placebo control, in subjects with inflammatory acne vulgaris. Diagnoses of papulo-pustular, polymorphic and nodular acne were also accepted. Trials were not excluded on the basis of language.. 27 randomised controlled trials met the inclusion criteria and were included in this review. The comparators used were placebo (2 studies), oxytetracycline (1), tetracycline (6), doxycycline (7), lymecycline (2), topical clindamycin (3), topical erythromycin/zinc (1), cyproterone acetate/ ethinyloestradiol (1), oral isotretinoin (2), topical fusidic acid (1) and there was one dose response study. Two studies are ongoing and it remains to be clarified whether one further study is a RCT. Major outcome measures used in the trials included lesion counts, acne grades/severity scores, doctors' and patients' global assessments, adverse drug reactions and drop out rates. The quality of each study was assessed independently by two assessors and an effect size calculated where possible. An additional three RCTs and three safety studies were identified by searches conducted in November 2002; these will be reviewed for a major update in early 2003 when it is anticipated that the results of the two ongoing studies will be available.. The trials were generally small and of poor quality and in many cases the published reports were inadequate for our purpose. Pooling of the studies was not attempted due to the lack of common outcome measures and endpoints and the unavailability of some primary data. Although minocycline was shown to be an effective treatment for acne vulgaris, in only two studies was it found to be superior to other tetracyclines. Both of these were conducted under open conditions and had serious methodological problems. A third study showed it to be more effective than 2% fusidic acid, applied topically, against inflammatory lesions in mild to moderate acne. Differences in the way adverse drug reactions were identified could have accounted for the wide variation between studies in numbers of events reported. This meant that no overall evaluation could be made of incidence rates of adverse events associated with minocycline therapy. No RCT evidence was found to support the benefits of minocycline in acne resistant to other therapies and the dose response has only been evaluated up to eight weeks of therapy.. Minocycline is likely to be an effective treatment for moderate acne vulgaris, but this review found no reliable RCT evidence to justify its continued use first-line, especially given the price differential and the concerns that still remain about its safety. Its efficacy relative to other acne therapies could not be reliably determined due to the poor methodological quality of the trials and lack of consistent choice of outcome measures. Similarly the relative risk of adverse drug reactions could not be ascertained reliably and no recommendations can be made concerning the appropriate dose that should be used. It is hoped that this review will highlight the inadequacy of acne trials in general and encourage improvements in methodological quality and standards of reporting.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Humans; Minocycline; Randomized Controlled Trials as Topic

Acne vulgaris is a very common disorder, affecting virtually every adolescent at some point in time. Systemic antibacterials have been used in the treatment of acne for many years, and there are several commonly used antibacterials which have established efficacy and safety records. In recent years, the issue of antibacterials resistance has become more prominent, especially with concerns that Propionibacterium acnes can transfer antibacterials resistance to other bacteria within the resident skin flora. Commonly used antibacterials include tetracycline, doxycycline, minocycline, erythromycin (and other macrolides) and trimethoprim/sulfamethoxazole (cotrimoxazole). The choice of antibacterial should take into account efficacy, cost-effectiveness, benefit-risk ratios, patient acceptability and the potential for the development of resistance. Poor clinical response can be the result of poor compliance, inadequate duration of therapy, development of gram-negative folliculitis, resistance of P. acnes to the antibacterial(s) administered, or a high sebum excretion rate. In order to help prevent the development of resistance a number of measures should be undertaken: antibacterials are prescribed for an average of 6 months; if retreatment is required, utilize the same antibacterial; generally, antibacterials should be given for at least 2 months before considering switching due to poor therapeutic response; concomitant use of oral and topical chemically-dissimilar antibacterials should be avoided (try benzoyl peroxide and/or retinoids instead) and systemic isotretinoin should be considered if several antibacterials have been tried without success.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Doxycycline; Drug Resistance, Microbial; Erythromycin; Humans; Minocycline; Practice Guidelines as Topic; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

Minocycline is the treatment of choice for acne vulgaris, the most common form of inflammatory acne, despite the increase in awareness of rare but significant side-effects. This paper discusses the undesirable side-effect of minocycline staining in permanent teeth.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Humans; Minocycline; Tooth Discoloration

Cutaneous pigmentation associated with minocycline ingestion is an unusual adverse effect for which few treatments have been described. Within the past few years, treatment with different Q-switched lasers has been reported in the literature. The purpose of this therapeutic intervention was to determine whether the Q-switched Alexandrite laser could clinically and histologically improve pigmentation associated with minocycline ingestion. A patient with type II minocycline pigmentation was treated with the Q-switched Alexandrite (755 nm) laser and then evaluated clinically and histologically to determine the outcome of this intervention. Treatment with the Q-switched Alexandrite (755 nm) laser provided excellent clinical and histologic clearing of minocycline pigmentation. One year after completion of laser treatment, the skin has remained clinically clear with no recurrence. The Q-switched Alexandrite laser (755 nm) should be considered for treatment of type II minocycline pigmentation.

Topics: Acne Vulgaris; Adult; Beryllium; Biopsy, Needle; Disease Progression; Female; Follow-Up Studies; Humans; Hyperpigmentation; Laser Therapy; Leg Dermatoses; Minocycline; Treatment Outcome

Minocycline belongs to the second generation class of cyclines. It was synthesized in 1967 and marketed in 1972. Minocycline has an antiinfectious activity with a spectrum similar to that of other cyclines, notably against Chlamydias, Treonema and Proprionibacterium acenes. The antiinflammatory activity is associated with this antiinfectious action is greater than that of first generation cyclines with specifically a modulator effect on epidermal cytokines. The pharmokinetics of minocycline is characterized by an excellent absorption, a long half-life and an important lipophilic property inducing good tissue distribution. Clinical trials of minocycline have mainly been performed in sexually transmissible diseases and in acne, a field where randomized studies are the most frequent. These trials show that the effect of minocycline is not stronger than first generation cyclines or doxycycline, but that the action is quicker than that of tetracycline at the dose of 500 mg a day. Minocycline is also efficient in nocardiasis, mycobacteriosis, leprosy, Lyme disease, pyoderma gangrenosum, autoimmune bullous dermatitis, Carteaud disease, and prurigo. However, the effect of minocycline in these different conditions has always been evaluated in open trials with a small number of patients. The usual side effects of cyclines, i.e. digestive problems, fungal infections, are less frequent than with first generation cyclines. No photosensitivity has been demonstrated although pigmentations have been described. Dizziness is a specific side effect of minocycline. Furthermore, rare but severe side effects have been reported, including hypersensitivity syndrome, autoimmune hepatitis, and lupus. Regular indications for minocycline in dermatology are acne and three sexually transmissible diseases (mycoplasm, chlamydia, treponema). Proposed dosage is 100 mg per day in sexually transmissible disease with a reduction to 50 mg per day after 15 days in acne.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Autoimmune Diseases; Cytokines; Drug Administration Schedule; Humans; Leprosy; Lyme Disease; Minocycline; Mycobacterium Infections; Nocardia Infections; Prurigo; Pyoderma Gangrenosum; Research Design; Sexually Transmitted Diseases; Skin Diseases, Vesiculobullous; Treatment Outcome

Several classes of medications successfully treat acne. Systemic and topical retinoids, systemic and topical antimicrobials, and systemic hormonal therapy are the major categories. Failure of therapy may result from drug interactions, antibiotic resistance, or coexisting conditions; therefore, a detailed history including these points should be used to decide which therapy is appropriate for each patient. Furthermore, one must consider the potential side effects of each treatment and make sure that (1) the benefits outweigh the risks of the treatment, (2) the side effects can be avoided by adding another agent, or (3) the side effects can be safely treated.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Drug Interactions; Drug Resistance, Microbial; Estrogens; Female; Humans; Isotretinoin; Minocycline; Polycystic Ovary Syndrome; Retinoids

Minocycline is a tetracycline antibiotic that is commonly used in the treatment of moderate to severe acne vulgaris. Although it is more convenient for patients to take than first-generation tetracyclines, as it only needs to be taken once or twice a day and can be taken with food, it is more expensive. Concerns have also been expressed over its safety following the deaths of two patients taking the drug. There is a lack of consensus among dermatologists over the relative risks and benefits of minocycline. As most acne prescribing is undertaken by general practitioners, it is important that guidelines issued to them are based on the best available evidence rather than personal judgements.. To collate and evaluate the evidence on the clinical efficacy of minocycline in the treatment of inflammatory acne vulgaris. Specific objectives were to compare the efficacy of minocycline with other drug treatments for acne and to collate information on the incidence of adverse drug reactions.. Randomised controlled trials (RCTs) of minocycline for acne vulgaris were identified by searching the following electronic databases; MEDLINE, EMBASE, Biosis, Biological Abstracts, International Pharmaceutical Abstracts, Cochrane Skin Group's Trial Register, Theses Online, BIDS ISI Science Citation Index and Bids Index to Scientific and Technical Proceedings. Other strategies used were scanning the references of articles retrieved, hand-searching of major dermatology journals and personal communication with trialists and drug companies.. To be eligible for the review, studies had to be RCTs comparing the efficacy of minocycline at any dose to active or placebo control, in subjects with inflammatory acne vulgaris. Diagnoses of papulo-pustular, polymorphic and nodular acne were also accepted. Trials were not excluded on the basis of language.. 27 randomised controlled trials met the inclusion criteria and were included in this review. The comparators used were placebo (2 studies), oxytetracycline (1), tetracycline (6), doxycycline (7), lymecycline (2), topical clindamycin (3), topical erythromycin/zinc (1), cyproterone acetate/ ethinyloestradiol (1), oral isotretinoin (2), topical fusidic acid (1) and there was one dose response study. One study is ongoing and it remains to be clarified whether one further study is a RCT. Major outcome measures used in the trials included lesion counts, acne grades/severity scores, doctors' and patients' global assessments, adverse drug reactions and drop out rates. The quality of each study was assessed independently by two assessors and an effect size calculated where possible.. The trials were generally small and of poor quality and in many cases the published reports were inadequate for our purpose. Pooling of the studies was not attempted due to the lack of common outcome measures and endpoints and the unavailability of some primary data. Although minocycline was shown to be an effective treatment for acne vulgaris, in only two studies was it found to be superior to other tetracyclines. Both of these were conducted under open conditions and had serious methodological problems. A third study showed it to be more effective than 2% fusidic acid, applied topically, against inflammatory lesions in mild to moderate acne. Differences in the way adverse drug reactions were identified could have accounted for the wide variation between studies in numbers of events reported. This meant that no overall evaluation could be made of incidence rates of adverse events associated with minocycline therapy. No RCT evidence was found to support the benefits of minocycline in acne resistant to other therapies and the dose response has only been evaluated up to eight weeks of therapy. (ABSTRACT TRUNCATED)

Topics: Acne Vulgaris; Anti-Bacterial Agents; Humans; Minocycline

A 22-year-old woman with a "hot" thyroid nodule who was being treated with minocycline for severe acne vulgaris is presented. A partial thyroidectomy specimen revealed a black adenoma. Microscopically, the black pigment was found in the follicular cells and the colloid of the adenoma. The pigment was bleached with potassium permanganate and was Fontana-Masson stain positive. It was negative for iron, periodic acid-Schiff, and acid-fast Ziehl-Neelsen stains. All these feature suggest a melanin-like pigment. However, electron microscopic examination revealed a dense osmophilic material present within the lysosomes of the follicular cells. No melanosomes were present. Twenty-six previously reported cases are reviewed, and the possible mechanisms for the deposition of the pigment in the adenoma and its relation to minocycline degradation products are discussed.

Topics: Acne Vulgaris; Adenoma; Adult; Anti-Bacterial Agents; Female; Histocytochemistry; Humans; Microscopy, Electron; Minocycline; Pigmentation; Thyroid Neoplasms

Topics: Acne Vulgaris; Administration, Topical; Anti-Bacterial Agents; Doxycycline; Estrogens; Female; Humans; Isotretinoin; Male; Mineralocorticoid Receptor Antagonists; Minocycline; Retinoids; Risk Factors; Spironolactone

Minocycline is an antibacterial drug used in the treatment of acne. Concern has been expressed over the possibility of severe adverse reactions to minocycline, including hepatitis. This study set out to identify and characterise reported cases of hepatotoxicity associated with the use of minocycline.. A systematic review of the literature including a search of computerised databases and analysis of data from the Uppsala Monitoring Centre (WHO Collaborating Centre for International Drug Monitoring) was conducted. The review involved a search for original case reports involving liver damage in people using minocycline. Patients taking minocycline for reasons other than acne or those given intravenous minocycline were excluded. The search strategy involved an enquiry of computerised databases and a search for secondary references. Cases were then classified appropriately.. 65 reported cases of hepatitis or liver damage in association with minocycline from either case reports or case series were identified from the literature review. 58% of cases occurred in females and 94% were aged under 40 years. For 20 case reports there was insufficient information to classify the type of event, but for the remaining 45, 2 types of hepatic reaction were recognised: autoimmune hepatitis associated with lupus-like symptoms occurring after a median duration of exposure to minocycline of 365 days in females (n = 20) and 730 days in males (n = 9), hypersensitivity reaction associated with eosinophilia and exfoliative dermatitis occurring within 35 days of therapy (n = 16). Reports to the WHO of hepatic adverse drug reactions associated with minocycline accounted for 6% (493) of all minocycline-related adverse drug reactions (8025). The pattern of distribution in relation to exposure demonstrated 2 groups, similar to that described by the case reports.. Severe cases of minocycline-associated hepatotoxicity appear to be a hypersensitivity reaction and occur within a few weeks of commencing therapy. An autoimmune hepatitis usually presents after exposure to minocycline of a year or more, is more common in women and is sometimes associated with lupus-like symptoms.

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Chemical and Drug Induced Liver Injury; Fatal Outcome; Female; Humans; Male; Minocycline; Product Surveillance, Postmarketing; World Health Organization

Topics: Acne Vulgaris; Anti-Bacterial Agents; Chemical and Drug Induced Liver Injury; Humans; Minocycline

Minocycline is the most widely prescribed systemic antibiotic for the management of acne. In the past several years, increasing attention has been paid to the drug, both for its potential use as a disease-modifying antirheumatic agent and for its propensity to engender untoward autoimmune reactions, including serum sickness-like disease, drug-induced lupus, and autoimmune hepatitis. This paper reviews the evidence for minocycline as an anti-inflammatory and immunomodulatory agent, its utility in the treatment of rheumatoid arthritis, and the spectrum of adverse reactions that have been ascribed to the drug in the past 5 years.

Topics: Acne Vulgaris; Animals; Anti-Bacterial Agents; Arthritis; Arthritis, Rheumatoid; Autoimmune Diseases; Chemical and Drug Induced Liver Injury; Drug Hypersensitivity; Female; Humans; Lupus Erythematosus, Systemic; Male; Minocycline; Vasculitis

Minocycline is a semisynthetic tetracycline used in the treatment of inflammatory acne because of its broad spectrum of activity, less common development of resistant organisms, and its anti-inflammatory effects. A number of adverse reactions are reported, including skin and oral pigmentation. This paper details the pharmacology of minocycline and describes the pigmentation and likely mechanisms active in both hard and soft tissues. Oral pigmentation usually involves the hard tissues only and presents typically as a discrete band occupying the central zone of the alveolar mucosa and palate. As with other sites, it may persist following withdrawal of the drug. Early recognition by the dental practitioner may allow an alternative form of therapy to be sought, minimizing the likelihood of a long-term aesthetic problem.

Topics: Acne Vulgaris; Adult; Alveolar Process; Anti-Bacterial Agents; Anti-Inflammatory Agents; Esthetics, Dental; Humans; Minocycline; Mouth Diseases; Mouth Mucosa; Palate; Pigmentation Disorders; Skin Pigmentation

Minocycline is an antibiotic commonly used in the treatment of adolescent acne.. To describe the clinical, laboratory, and histological features in 3 cases of minocycline-related autoimmune hepatitis and to review the literature of similar cases in the adolescent population.. Case series.. Patients were cared for in the Division of Gastroenterology, Children's Hospital, Boston, Mass.. Three adolescents (age, 15-16 years), while being treated with therapeutic doses of minocycline for periods of 12 to 20 months, met the 1993 International Autoimmune Hepatitis Group criteria for autoimmune hepatitis. All had a positive antinuclear antibody titer. Other features included hypergammaglobulinemia and a positive anti-smooth muscle antibody titer. Two patients underwent liver biopsy that revealed severe chronic lymphoplasmacytic inflammation, necrosis, and fibrosis. All other causes of liver disease were excluded. One patient had resolution of symptoms with withdrawal of the drug, while 2 required immunosuppression therapy. A review of the literature yielded only 18 similar cases, none in the pediatric literature, the majority of which contained incomplete pertinent data.. Minocycline is related to the development of autoimmune hepatitis in some adolescents. Pediatricians who use this drug for treatment of acne should be aware of this serious potential relation and stop the drug immediately when suspicion is raised.

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Chemical and Drug Induced Liver Injury, Chronic; Female; Hepatitis, Autoimmune; Humans; Male; Minocycline

Minocycline, a semi-synthetic tetracycline antibiotic, is well documented as being associated with pharmacogenic pigmentation of various tissues in humans and other mammals. The most obvious of these are skin pigmentation, but intraorally include "green" roots of erupted teeth, "black" roots of extracted teeth, a dark stain of the crowns of fully developed teeth, and "black" alveolar bone. This article presents five cases of "black" alveolar bone with photographic documentation of its progress. It also reviews the available English language literature on this phenomenon. The incidence of minocycline staining of alveolar bone is probably 2% of that population taking the drug for 2 months or longer. Presently, minocycline is most widely used in the young adult population for the treatment of acne. With the recent interest in minocycline as a palliative treatment for rheumatiod arthritis, an entirely different population could be experiencing this effect. If minocycline use becomes widespread as a treatment for rheumatoid arthritis, it is likely that more practitioners will be asked to diagnose this sometimes striking, though apparently benign, condition. Recognition of this condition will save the practitioner and the patient from unnecessary concern and surgery.

Topics: Acne Vulgaris; Adolescent; Adult; Alveolar Process; Anti-Bacterial Agents; Diagnosis, Differential; Female; Humans; Jaw Diseases; Middle Aged; Minocycline; Palate; Pigmentation Disorders

Minocycline is the most commonly used systemic antibiotic in the long-term treatment (weeks to months) of severe acne vulgaris. Currently much attention is being paid in the Dutch and international literature to the safety of minocycline, after several reports on serious adverse events. The clinical efficacy of minocycline in the treatment of acne vulgaris is better than that of tetracycline and equal to that of doxycycline. The serious adverse events of minocycline therapy described consist of hyperpigmentation of various tissues, autoimmune disorders (systemic lupus erythematosus, autoimmune hepatitis) and serious hypersensitivity reactions (hypersensitivity syndrome reaction, pneumonitis and eosinophilia, and serum sickness-like syndrome). In relation to the number of prescriptions, the number of serious adverse events of minocycline described is small. However, it is very important that prescribing doctors should be aware of the possibility of these adverse events occurring during long-term minocycline therapy and able to recognize the characteristic symptoms at an early stage.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Drug Hypersensitivity; Hepatitis, Autoimmune; Humans; Lupus Erythematosus, Systemic; Minocycline; Pigmentation Disorders; Pulmonary Eosinophilia; Serum Sickness; Syndrome

The determination of a factor triggering lupus-like symptoms could yield new insights into the management of rheumatic disease. We describe a case of minocycline related lupus in a young patient positive for HLA-DR2 who was prescribed minocycline 4 times for mild acne and developed rheumatic symptoms each time. We review 8 other cases.

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Female; Humans; Lupus Vulgaris; Minocycline

Topics: Acne Vulgaris; Adult; Drug Hypersensitivity; Female; Humans; Minocycline; Pulmonary Eosinophilia

The role of laboratory monitoring in patients receiving long-term oral antibiotics for acne vulgaris has not been clearly defined.. The purpose of our study was (1) to evaluate the literature for objective evidence on the value of routine laboratory monitoring of the asymptomatic patient receiving oral antibiotics for acne and (2) to determine the utilization of laboratory monitoring of these patients by Connecticut dermatologists.. We surveyed Connecticut dermatologists by phone and inquired about the laboratory monitoring performed in patients receiving long-term oral tetracycline, minocycline, or erythromycin for acne.. Eight published studies reported a total of 777 patients who had laboratory monitoring at various frequencies while receiving oral antibiotics for acne. Only one adverse drug reaction (ADR) was detected in a patient in whom mild hyperbilirubinemia developed. Of the 75 Connecticut dermatologists who participated in our survey, 48 (64%) perform some laboratory monitoring; 29% do so routinely, and 35% under special circumstances.. Our literature review does not support routine laboratory monitoring in all patients who receive long-term oral antibiotics for acne; rarely does such screening detect an ADR and thus does not justify the cost of such testing. A relatively small proportion of Connecticut dermatologists check laboratory tests more frequently than appears necessary; in our opinion, laboratory monitoring should be limited to patients who may be at higher risk for an ADR.

Topics: Acne Vulgaris; Dermatology; Disease; Drug Monitoring; Erythromycin; Gastrointestinal Diseases; Hematopoietic System; Humans; Kidney; Liver; Long-Term Care; Minocycline; Tetracycline; Time Factors

An 18-year-old man with left-lobe thyroid hemiagenesis underwent isthmectomy for management of a nodule that failed to take up radioactive iodine during a nuclear scan. The resected tissue, which demonstrated nodular hyperplasia, and the remaining right lobe, were black. The association between deep staining and chronic minocycline ingestion was subsequently recognized. Twelve years later, the patient remained asymptomatic, suggesting that complete resection of tetracycline-stained thyroid tissue is unnecessary.

Topics: Acne Vulgaris; Adolescent; Hemosiderin; Humans; Hyperplasia; Male; Microscopy, Electron; Minocycline; Pigmentation Disorders; Thyroid Gland; Thyroid Nodule

Topics: Acne Vulgaris; Adult; Humans; Male; Minocycline; Pigmentation Disorders; Suicide; Thyroid Diseases; Thyroid Gland; Time Factors; Wounds, Gunshot

During a surgical procedure, black vertebrae were observed in a 42-year-old white woman. An undecalcified iliac crest bone biopsy specimen revealed intense fluorescence compatible with tetracycline labeling and osteoporosis. A urinary screening test was negative for amino acids. The patient had been treated with minocycline hydrochloride (100 to 300 mg/d) for at least 6 years. Since minocycline is known to discolor many body tissues, it is likely that the black discoloration of bone in our patient was caused by the long-term intake of the antibiotic.

Topics: Acne Vulgaris; Adult; Biopsy; Bone and Bones; Calcification, Physiologic; Female; Humans; Ilium; Minocycline; Staining and Labeling; Time Factors

Postacne osteoma cutis is a rare complication of acne vulgaris. If it occurs during a course of tetracycline or minocycline therapy, pigmented osteomas can occur as a result of tetracycline or minocycline bone complexes. We report a case of pigmented postacne osteoma cutis that developed after extensive acne surgery and a 2- to 3-month course of minocycline. Previously reported cases have been treated surgically, but our patient responded to 0.05% tretinoin cream, with transepidermal elimination of some osteomas.

Topics: Acne Vulgaris; Adult; Facial Dermatoses; Facial Neoplasms; Female; Humans; Minocycline; Osteoma; Pigmentation Disorders; Skin Neoplasms

Minocycline has an established place in the oral therapy of acne. Prolonged courses of therapy have an acceptable safety profile. Where therapy with oxytetracycline has failed, minocycline is still likely to prove effective. The twice-daily dosage and ease of absorption from the gastrointestinal tract offer significant advantages over other tetracyclines. The simpler minocycline regime and early onset of clinical improvement are likely to result in better patient compliance, and hence optimise therapeutic response. There is therefore justification for the use of minocycline as first-line oral therapy, but, whether as a first- or second-line therapy, minocycline is a valuable drug in the treatment of this very distressing disorder. The earlier effective therapy is used in a patient with acne, the less physical and psychological scarring will remain thereafter.

Topics: Acne Vulgaris; Drug Interactions; Humans; Minocycline; Tetracyclines

Benign intracranial hypertension with papilloedema developed in a 18-year-old woman following Minocycline administration. Tetracycline therapy was prescribed for acne vulgaris. One month after the beginning of the treatment, she presented with headache, nausea and vomiting; there were no visual symptoms. Visual acuity and visual field were normal, fundus examination showed bilateral papilloedema. After Minocycline was discontinued and steroid therapy was administrated, symptoms rapidly resolved and papilloedema disappeared. Minocycline is known to penetrate into the central nervous system more effectively and to have a greater lipoid solubility than the other antibiotics of the same group. However the pathogenesis of benign intracranial hypertension after Minocycline therapy remains unknown.

Topics: Acne Vulgaris; Adolescent; Female; Humans; Minocycline; Papilledema; Tetracyclines

It has been a long-term debate over the concomitant treatment of inflammatory acne vulgaris using intense pulsed light (IPL) and minocycline due to the photosensitivity of minocycline.. We aimed to evaluate the safety and efficiency of IPL combined with minocycline in treating acne vulgaris in a randomized trial.. A total of 40 patients were enrolled and randomly assigned into two groups which were either given minocycline (100 mg per day) for 8 weeks with IPL treatments three times at weeks 0, 4, and 8, or the same dosage of minocycline only. The evaluations for inflammatory lesion count, Investigator Global Assessment of Acne (IGA), erythema, and purpura indexes were taken before treatment and at weeks 4, 8, and 16.. There were significant improvements in inflammatory lesion count, IGA scores, and purpura index in both groups as compared with the baseline at week 16 (p < 0.02). The concomitant therapy, but not minocycline only, significantly improved the erythema index (p = 0.40) at the 16. IPL in combination with minocycline shows a better clinical efficacy for the treatment of inflammatory acne vulgaris than minocycline alone, and it is safe.

Topics: Acne Vulgaris; Combined Modality Therapy; Humans; Immunoglobulin A; Minocycline; Treatment Outcome

FMX101 4% topical minocycline foam has been shown to be an effective and safe treatment for acne vulgaris (AV).. To further evaluate the efficacy and safety of FMX101 4% in treating moderate to severe acne vulgaris.. A 12-week, multicenter, randomized (1:1), double-blind, vehicle-controlled study was conducted. Coprimary end points were the absolute change in inflammatory lesion count from baseline and the rate of treatment success (Investigator's Global Assessment score of 0 or 1 with a ≥2-grade improvement).. There were 1488 participants in the intent-to-treat population. The FMX101 4% group had significantly greater reductions in the number of inflammatory lesions from baseline (P < .0001) and a greater rate of treatment success based on Investigator's Global Assessment (P < .0001) versus the foam vehicle group at week 12. FMX101 4% was generally safe and well tolerated.. The efficacy and safety of FMX101 4% were not characterized in participants with mild AV.. FMX101 4% topical minocycline foam was effective and safe for the treatment of moderate to severe AV.

Topics: Acne Vulgaris; Administration, Cutaneous; Adolescent; Adult; Anti-Bacterial Agents; Anti-Inflammatory Agents; Child; Double-Blind Method; Facial Dermatoses; Female; Humans; Male; Minocycline; Treatment Outcome; Young Adult

FMX101 4% is a topical minocycline foam for the treatment of moderate-to-severe acne.. Evaluate the efficacy and safety of FMX101 4% in treating moderate-to-severe acne vulgaris.. Two identical phase 3 studies were conducted. Subjects were randomized 2:1 to once-daily FMX101 4% or foam vehicle for 12 weeks. The coprimary end points were the change in inflammatory lesion count from baseline and the rate of treatment success according to the Investigator's Global Assessment (a score of 0 or 1 for clear or almost clear, with a ≥2-grade improvement) at week 12.. A total of 961 subjects were enrolled (study 04, N = 466; study 05, N = 495). Compared with vehicle, FMX101 4% demonstrated a significantly greater reduction in inflammatory lesions in both studies (P < .05) and a greater rate of treatment success in study 05 according to the Investigator's Global Assessment (P < .05). Pooled analyses of the 2 studies demonstrated statistical significance for both coprimary end points (all P < .05). Noninflammatory lesion count was also significantly reduced with FMX101 4% versus with vehicle in both studies. FMX101 4% was generally safe and well tolerated. Skin-related adverse events were reported in less than 1% of subjects treated with FMX101 4%.. Longer-term efficacy and safety outcomes are needed (ongoing).. FMX101 4% topical minocycline foam significantly reduced both inflammatory and noninflammatory lesions and improved Investigator's Global Assessment scores in patients with moderate-to-severe acne.

Topics: Acne Vulgaris; Administration, Topical; Adolescent; Adult; Anti-Bacterial Agents; Child; Dosage Forms; Double-Blind Method; Female; Humans; Male; Middle Aged; Minocycline; Severity of Illness Index; Treatment Outcome; Young Adult

To characterize minocycline pharmacokinetics and relative bioavailability following multiple-dose topical administration of minocycline hydrochloride (HCl) foam 4% (FMX101 4%) as compared with single-dose oral administration of minocycline HCl extended-release tablets (Solodyn®) in subjects with moderate-to-severe acne.. A Phase 1, single-center, nonrandomized, open-label, active-controlled, 2-period, 2-treatment crossover clinical study. The study included 30 healthy adults (mean age, 22.6 years; 90% white, and 60% females) who had moderate-to-severe acne. Subjects were assigned to first receive a single oral dose of a minocycline HCl extended-release tablet (approximately 1 mg/kg). At 10 days after the oral minocycline dose, topical minocycline foam 4% was applied, once daily for 21 days. Serial blood samples were obtained before and after administration of oral minocycline and each topical application of minocycline foam 4% on days 1, 12, and 21.. Following oral administration of minocycline (approximately 1 mg/kg), plasma minocycline concentration increased until 3 hours, followed by a log-linear decrease over the remainder of the 96-hour sampling period. Following topical application of a 4-g maximal-use dose of minocycline foam 4% for 21 days, plasma minocycline concentration was very low, with geometric mean Cmax values ranging from 1.1 ng/mL to 1.5 ng/mL. Steady state was achieved by day 6. Overall, minocycline exposure with topical minocycline foam 4% was 730 to 765 times lower than that with oral minocycline. There was no evidence of minocycline accumulation over the 21 days of topical application of minocycline foam 4%. Topical minocycline foam 4% appeared to be safe and well tolerated, with no serious treatment-emergent adverse events (TEAEs), treatment-related TEAEs, or TEAEs that led to treatment discontinuation.. Once-daily topical application of minocycline foam 4% did not lead to significant systemic exposure to minocycline. It appears to be a well-tolerated treatment option for individuals with moderate-to-severe acne.

J Drugs Dermatol. 2017;16(10):1022-1028.

Topics: Acne Vulgaris; Administration, Cutaneous; Administration, Oral; Anti-Bacterial Agents; Cross-Over Studies; Delayed-Action Preparations; Drug Administration Schedule; Female; Humans; Male; Minocycline; Severity of Illness Index; Tablets; Treatment Outcome; Young Adult

Acne vulgaris is a prevalent skin disorder impairing both physical and psychosocial health. This study was designed to investigate the effectiveness of photodynamic therapy (PDT) combined with minocycline in moderate to severe facial acne and influence on quality of life (QOL).. Ninety-five patients with moderate to severe facial acne (Investigator Global Assessment [IGA] score 3-4) were randomly treated with PDT and minocycline (n = 48) or minocycline alone (n = 47). All patients took minocycline hydrochloride 100 mg/d for 4 weeks, whereas patients in the minocycline plus PDT group also received 4 times PDT treatment 1 week apart. IGA score, lesion counts, Dermatology Life Quality Index (DLQI), and safety evaluation were performed before treatment and at 2, 4, 6, and 8 weeks after enrolment.. There were no statistically significant differences in characteristics between 2 treatment groups at baseline. Minocycline plus PDT treatment led to a greater mean percentage reduction from baseline in lesion counts versus minocycline alone at 8 weeks for both inflammatory (-74.4% vs -53.3%; P < .001) and noninflammatory lesions (-61.7% vs -42.4%; P < .001). More patients treated with minocycline plus PDT achieved IGA score <2 at study end (week 8: 30/48 vs 20/47; P < .05). Patients treated with minocycline plus PDT got significant lower DLQI at 8 weeks (4.4 vs 6.3; P < .001). Adverse events were mild and manageable.. Compared with minocycline alone, the combination of PDT with minocycline significantly improved clinical efficacy and QOL in moderate to severe facial acne patients.

Topics: Acne Vulgaris; Adolescent; Adult; Chi-Square Distribution; Combined Modality Therapy; Facial Dermatoses; Female; Follow-Up Studies; Humans; Male; Minocycline; Photochemotherapy; Prospective Studies; Quality of Life; Severity of Illness Index; Treatment Outcome; Young Adult

Objective To comparatively observe clinical efficacies of Fusidic Acid Cream (FAC) , Longzhu Ointment (LO) , and their combination of minocycline hydrochloride for treating facial acne vulgaris. Methods Totally 186 patients with acne vulgaris were randomly assigned to the FAC group (103 cases) and the LO group (83 cases). Each group was further divided into two subgroups ac- cording to the severity of acne: single treatment group and united treatment group. Patients with mild ac- ne vulgaris in the FAC group received FAC alone (39 cases) , and those with severe acne vulgaris in the FAC group received FAC and minocycline hydrochloride (64 cases). Patients with mild acne vulgaris in the LO group received LO alone (27 cases) , and those with severe acne vulgaris in the LO group received LO and minocycline hydrochloride. The therapeutic course for all was 4 weeks, with one return vis- it once per week. Grading of skin lesions was assessed by global acne grading system (GAGS). Clinical improvement was evaluated. Skin spots, red areas, and other data were statistically analyzed by VISIA skin analyzer. Results GAGS score was statistically different between before and after treatment in the FAC group and the LO group (P <0. 05). The total effective rate was 64. 1% (25)39) in single treatment group of the FAC group and 66. 7% (18/27) in single treatment group of the LO group, but with no statisti- cal difference between the two groups (Χ² =0. 09, P >0. 05). The total effective rate was 70. 3% (45/64) in united treatment group of the FAC group and 62. 5% (35/56) in united treatment group of the LO group, but with no statistical difference between the two groups (Χ² =0. 04, P >0. 05). Results of VISIA showed, compared with before treatment, statistical difference existed in red area of single treatment group of the FAC group and the LO group (P <0. 05). Statistical difference existed in ultraviolet rays, red area, sclererythrin of united treatment group of the FAC group and the LO group (P <0. 05). Conclusions FAC and LO could effectively control the inflammation of acne. LO had a rapid onset. Combined with minocy- cline hydrochloride, FAC could significantly reduce the secretion of fats, and LO could defense against ultraviolet more significantly.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Humans; Medicine, East Asian Traditional; Minocycline; Treatment Outcome

Topics: Acne Vulgaris; Administration, Cutaneous; Adolescent; Adult; Anti-Bacterial Agents; Double-Blind Method; Facial Dermatoses; Female; Humans; Male; Minocycline; Prospective Studies; Severity of Illness Index; Young Adult

Minocycline and lymecycline are used in the treatment of acne, but there is not enough evidence to support superior efficacy of one of them.. 170 participants from 14 to 34 years old with mild to moderate facial acne vulgaris were recruited. 84 had 100 mg of minocycline in a single daily dose for 8 weeks and 86 had 300 mg of lymecycline in a single daily dose for 8 weeks. Participants were evaluated at baseline, week 4 and week 8.. 65 minocycline and 60 lymecycline patients were evaluable. The last observation carried forward for the count of non-inflammatory lesions changed from 37.5 ± 17.8 to 37.7 ± 17.8 in the minocycline group and from 36.9 ± 15.5 to 33.4 ± 19.3 in the lymecycline group (no significant changes); corresponding changes in inflammatory lesions were from 19.4 ± 12.4 to 12.2 ± 10.0 in the minocycline group and from 20.1 ± 11.3 to 12.6 ± 8.4 in lymecycline group (P< 0.05 comparing baseline vs. final in both groups). Porphyrin counts varied from 899.5 ± 613.9 to 233.5 ± 219.5 in the minocycline group and from 956.9 ± 661.8 to 411.8 ± 411.5 in the lymecycline group (P<0.05 between the groups at study end). 36 (42.9%) patients receiving minocycline suffered 55 adverse events (22 of them gastrointestinal), while 28 (33.3%) lymecycline patients had 37 adverse events (15 of them gastrointestinal). One patient in the lymecycline group withdrew the study due to gastritis, and one more patient in the same group experienced eosinophilia.. There were no differences between the groups in non-inflammatory and inflammatory lesion counts, and in the safety profile. Treatment with minocycline induced statistically significant decrease in facial porphyrin counts compared to the group treated with lymecycline (ClinicalTrials.gov number, NCT00988026).

Topics: Acne Vulgaris; Adolescent; Adult; Anti-Bacterial Agents; Female; Follow-Up Studies; Humans; Lymecycline; Male; Minocycline; Prospective Studies; Severity of Illness Index; Single-Blind Method; Treatment Outcome; Young Adult

Moderate to severe acne vulgaris is often treated with a combination of an oral antibiotic, topical antibiotic/retinoid, and benzoyl peroxide (BP), but data are limited on the efficacy of this and other combination regimens that incorporate both oral and topical therapies.
. Patients were required to be aged 12-30 years with moderate to severe acne (grades 3-4 acne on the Investigator's Global Assessment [IGA]) and deemed potential candidates for treatment with isotretinoin. Enrolled patients were given triple-combination therapy, defined in this study as oral minocycline HCl extended release 1 mg/kg QD, 6% BP foaming cloths used QD, and clindamycin phosphate 1.2%/tretinoin 0.025% gel applied QD, and were evaluated at baseline and weeks 2, 4, 8, and 12.
. A total of 97 patients were enrolled in the study. At week 12, 89% of patients had at least a one-grade improvement from baseline IGA and 96% had at least a one-grade improvement from baseline Global Aesthetic Improvement Scale score. Mean ± SD in- flammatory, non-inflammatory, and total lesion counts decreased from baseline by 61.8% ± 38.3%, 48.8% ± 34.5%, and 56.5% ± 29.9%, respectively. The percentage of patients evaluated as candidates for isotretinoin by independent photographic review was 77% (69/90) at baseline and only 16% (14/90) at week 12. Treatment-related adverse events (AEs) occurred in eight of 97 (8%) patients. Triplecombination therapy was not associated with any serious AEs or AEs leading to discontinuation.
. Triple-combination therapy was well tolerated and substantially reduced facial acne lesion counts, with 84% of patients judged to no longer be candidates for isotretinoin therapy by study end. These data support the clinical observation that a triple-combination regimen incorporating oral minocycline (dosed by patient weight), BP foaming cloths 6% QD, and clindamycin phosphate 1.2%/ tretinoin 0.025% gel QD can substantially improve moderate to severe acne vulgaris.

Topics: Acne Vulgaris; Administration, Cutaneous; Administration, Oral; Adolescent; Adult; Anti-Bacterial Agents; Benzoyl Peroxide; Child; Clindamycin; Delayed-Action Preparations; Dermatologic Agents; Drug Combinations; Drug Therapy, Combination; Female; Gels; Humans; Inflammation; Male; Minocycline; Severity of Illness Index; Tablets; Treatment Outcome; Tretinoin; Young Adult

There are few clinical studies which compare the efficacy and patient satisfaction for oral antibiotics to treat inflammatory acne. To clarify the difference between oral antibiotics, acne patients with moderate to severe inflammatory eruptions were randomized into three groups, and each patient was given minocycline (MINO), roxithromycin (RXM) or faropenem (FRPM) for 4 weeks, followed by 4 weeks of observation without any oral antibiotics. We estimated the reduction rate of inflammatory lesion counts, the scale of Skindex-16 which represents patient quality of life (QOL), and minimum inhibitory concentrations required to inhibit the growth of 90% of Propionibacterium acnes isolated from acne patients (MIC(90) ). In all three groups, inflammatory lesion counts, and emotional and total score of Skindex-16 were significantly improved (P<0.05) after 4 weeks treatment, and these effects were maintained for the following 4 weeks. Dizziness/nausea in two patients (4.1%) of the MINO group and diarrhea in three patients (5.9%) of the FRPM group were observed. There was no significant difference of percentage reduction in inflammatory lesion counts and incident rates of side-effects between these three oral antibiotics. MIC(90) of MINO was 0.25 μg/mL before and after treatment, but MIC(90) of RXM had increased from 0.25 μg/mL to more than 32 μg/mL after treatment. MIC(90) of FRPM was 0.06 μg/mL or less for all strains before and after treatment. Our randomized controlled clinical trial suggested that MINO, RXM and FRPM were efficient to improve inflammatory acne and patient QOL, and there was no significant difference between them.

Topics: Acne Vulgaris; Administration, Oral; Adolescent; Adult; Anti-Bacterial Agents; beta-Lactams; Female; Humans; Male; Microbial Sensitivity Tests; Minocycline; Patient Satisfaction; Propionibacterium acnes; Quality of Life; Roxithromycin; Treatment Outcome; Young Adult

To evaluate the efficacy of 3 maintenance regimens (topical tazarotene, oral minocycline hydrochloride, or both) in sustaining improvement in acne.. Multicenter, open-label treatment phase followed by double-blind, randomized, parallel-group maintenance phase.. Ambulatory patients in research or referral centers.. Volunteer sample of 189 patients with moderately severe to severe acne vulgaris (110 entered maintenance phase, 90 completed, and 2 discontinued because of adverse events).. All patients were treated with 0.1% tazarotene gel (each evening) and a 100-mg capsule (twice daily) of minocycline hydrochloride for up to 12 weeks. Patients with 75% or greater global improvement at week 12 were randomly assigned to 12 weeks of maintenance therapy with tazarotene gel plus placebo capsules, vehicle gel plus minocycline capsules, or tazarotene gel plus minocycline capsules.. Overall disease severity, global improvement, and lesion counts.. All regimens were effective in sustaining improvements in acne. After 12 weeks of maintenance therapy, the mean reductions from baseline in noninflammatory and inflammatory lesion count, respectively, were 60% and 54% with tazarotene, 52% and 66% with minocycline, and 64% and 66% with tazarotene plus minocycline. At week 24, more than 80% of patients in each group had maintained a 50% or greater global improvement from baseline, and more than 50% had maintained a 75% or greater global improvement.. A high percentage of patients with moderately severe to severe acne can maintain improvement in their condition with topical retinoid monotherapy. Maintenance with combination tazarotene and minocycline therapy showed a trend for greater efficacy but no statistical significance vs tazarotene alone. Topical retinoid monotherapy should be considered for maintenance to help minimize antibiotic exposure.

Topics: Acne Vulgaris; Administration, Oral; Adult; Anti-Bacterial Agents; Dermatologic Agents; Double-Blind Method; Drug Administration Schedule; Female; Humans; Male; Minocycline; Nicotinic Acids; Severity of Illness Index; Treatment Outcome; United States

A multicenter, 12-week, randomized, double-blinded, placebo-controlled, dose-ranging study was conducted in 233 subjects with moderate to severe facial acne vulgaris to determine the lowest effective once-daily oral dose of a new extended-release (ER) minocycline hydrochloride formulation with the safest adverse effect profile. Subjects randomly were assigned to treatment with daily dosages of ER-minocycline 1-, 2-, or 3-mg/kg tablets, or daily placebo tablets, for 84 days. At the end of the 12 weeks, the number of inflammatory lesions decreased approximately 50% from baseline levels in the dose groups. No dose-dependent effect was observed, with the percentage decrease in the number of inflammatory lesions in the 1-mg/kg treatment group being equal to or greater than higher doses. The pairwise difference between the ER-minocycline 1 mg/kg and placebo groups in the percentage decrease in inflammatory lesions was statistically significant (P = .015). Acute vestibular adverse events (AVAEs) appeared to be dose proportional, with the incidence being similar in the lowest (1 mg/kg) dosing group (24%) and in the placebo group (26%). Higher-dose regimens were associated with a higher incidence of central nervous system side effects and AVAEs. A 1-mg/kg daily dosage of the new ER-minocycline formulation is the lowest effective dose with the safest side effect profile, with higher-dose regimens offering no substantial therapeutic advantages.

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Body Mass Index; Delayed-Action Preparations; Dose-Response Relationship, Drug; Double-Blind Method; Female; Humans; Male; Minocycline; Treatment Outcome

The complete safety and efficacy of a new extended-release (ER) minocycline hydrochloride formulation were assessed in an analysis of a phase 2 dose-finding study and 2 phase 3 safety and efficacy studies. The studies were similar in design, subject populations, and shared common dose groups of subjects given ER minocycline 1 mg/kg daily or placebo over 12 weeks. The similar designs were prospective, multicenter, randomized, double-blinded, and placebo-controlled. A total of 1038 subjects with moderate to severe acne were available for the pooled analysis. Independently, each study showed that treatment with ER-minocycline significantly reduced (P < .001) the number of inflammatory lesions and significantly improved (P < .001) their Evaluator's Global Severity Assessment (EGSA) scores (phase 3 studies). Analysis of the pooled population confirmed the results of the individual studies. The percentage of subjects reporting acute vestibular adverse events (AVAEs) was comparable between those receiving the ER-minocycline 1-mg/kg dose and placebo (approximately 10% of subjects in each group) for both the individual studies and the pooled population. It was concluded that a novel ER-minocycline formulation that delivers consistent levels of drug at a 1-mg/kg dose reduces dose-dependent AVAEs while reducing inflammatory lesions and improving the overall appearance of patients with acne vulgaris.

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Delayed-Action Preparations; Dose-Response Relationship, Drug; Double-Blind Method; Female; Humans; Male; Minocycline; Treatment Outcome

To determine the relative efficacy and cost-effectiveness of five of the most commonly used antimicrobial preparations for treating mild to moderate facial acne in the community; the propensity of each regimen to give rise to local and systemic adverse events; whether pre-existing bacterial resistance to the prescribed antibiotic resulted in reduced efficacy; and whether some antimicrobial regimens were less likely to give rise to resistant propionibacterial strains.. This was a parallel group randomised assessor-blind controlled clinical trial. It was a pragmatic design with intention-to-treat analysis. All treatments were given for 18 weeks, after a 4-week treatment free period. Outcomes were measured at 0, 6, 12 and 18 weeks.. Primary care practices and colleges in and around Nottingham and Leeds, and one practice in Stockton-on-Tees, England.. Participants were 649 people aged 12--39 years, all with mild to moderate inflammatory acne of the face.. Study participants were randomised into one of five groups: 500 mg oral oxytetracycline (non-proprietary) twice daily (b.d.) + topical vehicle control b.d.; 100 mg oral Minocin MR (minocycline) once daily (o.d.) + topical vehicle control b.d.; topical Benzamycin (3% erythromycin + 5% benzoyl peroxide) b.d. + oral placebo o.d.; topical Stiemycin (2% erythromycin) o.d. + topical Panoxyl Aquagel (5% benzoyl peroxide) o.d. + oral placebo o.d., and topical Panoxyl Aquagel (5% benzoyl peroxide) b.d. + oral placebo o.d. (the active comparator group).. The two primary outcome measures were: (1) the proportion of patients with at least moderate self-assessed improvement as recorded on a six-point Likert scale, and (2) change in inflamed lesion count (red spots).. The best response rates were seen with two of the topical regimens (erythromycin plus benzoyl peroxide administered separately o.d. or in a combined proprietary formulation b.d.), compared with benzoyl peroxide alone, oxytetracycline (500 mg b.d.) and minocycline (100 mg o.d.), although differences were small. The percentage of participants with at least moderate improvement was 53.8% for minocycline (the least effective) and 66.1% for the combined erythromycin/benzoyl peroxide formulation (the most effective); the adjusted odds ratio for these two treatments was 1.74 [95% confidence interval (CI) 1.04 to 2.90]. Similar efficacy rankings were obtained using lesion counts, acne severity scores and global rating by assessor. Benzoyl peroxide was the most cost-effective and minocycline the least cost-effective regimen (ratio of means 12.3; difference in means -0.051 units/GBP, 95% CI -0.063 to -0.039). The efficacy of oxytetracycline was similar to that of minocycline, but at approximately one-seventh of the cost. For all regimens, the largest reductions in acne severity were recorded in the first 6 weeks. Reductions in disability scores using the Dermatology Quality of Life Scales were largest for both topical erythromycin-containing regimens and minocycline. The two topical erythromycin-containing regimens produced the largest reductions in the prevalence and population density of cutaneous propionibacteria, including antibiotic-resistant variants, and these were equally effective in participants with and without erythromycin-resistant propionibacteria. The clinical efficacy of both tetracyclines was compromised in participants colonised by tetracycline-resistant propionibacteria. None of the regimens promoted an overall increase in the prevalence of antibiotic-resistant strains. Systemic adverse events were more common with the two oral antibiotics. Local irritation was more common with the topical treatments, particularly benzoyl peroxide. Residual acne was present in most participants (95%) at the end of the study.. The response of mild to moderate inflammatory acne to antimicrobial treatment in the community is not optimal. Only around half to two-thirds of trial participants reported at least a moderate improvement over an 18-week study period; extending treatment beyond 12 weeks increased overall benefit slightly. Around one-quarter dropped out when using such treatments, and 55% sought further treatment after 18 weeks. Topical antimicrobial therapies performed at least as well as oral antibiotics in terms of clinical efficacy. Benzoyl peroxide was the most cost-effective and minocycline the least cost-effective therapy for facial acne. The efficacy of all three topical regimens was not compromised by pre-existing propionibacterial resistance. Benzoyl peroxide was associated with a greater frequency and severity of local irritant reactions. It is suggested that the use of a combination of topical benzoyl peroxide and erythromycin gives less irritation and better quality of life. There was little difference between erythromycin plus benzoyl peroxide administered separately and the combined proprietary formulation in terms of efficacy or local irritation, except that the former was nearly three times more cost-effective. The data on cost-effectiveness, and outcomes in patients with resistant propionibacterial floras, did not support the first line use of minocycline for mild to moderate inflammatory acne of the face. Three priority areas for clinical research in acne are: defining end-points in acne trials (i.e. what is a satisfactory outcome?); developing and validating better patient-based measures for assessing treatment effects on facial and truncal acne; and exploring patient characteristics that may modify treatment effects (efficacy and tolerability).

Topics: Acne Vulgaris; Administration, Oral; Administration, Topical; Adolescent; Adult; Anti-Bacterial Agents; Benzoyl Peroxide; Child; Cost-Benefit Analysis; Double-Blind Method; Drug Resistance, Bacterial; Drug Therapy, Combination; Erythromycin; Humans; Minocycline; Oxytetracycline; Propionibacterium; Quality of Life; Treatment Outcome

Excessive sebum production is a central aspect of the pathophysiology of acne vulgaris. Sebaceous gland function is under androgen control and it is hypothesized that dihydrotestosterone is formed by the action of 5 alpha-reductase. Type I is the controlling isoenzyme. This study describes a 3-month, multicenter, randomized, placebo-controlled clinical trial with a potent, selective inhibitor of type I 5 alpha-reductase used alone and in combination with systemic minocycline. Inhibition of type I 5 alpha-reductase was not associated with clinical improvement of acne when used alone and did not enhance the clinical benefit of systemic minocycline. These results indicate the need for further work at the molecular level to better understand the action of androgens on sebaceous gland function.

Topics: Acne Vulgaris; Cholestenone 5 alpha-Reductase; Double-Blind Method; Drug Therapy, Combination; Humans; Minocycline; Randomized Controlled Trials as Topic; Treatment Outcome

There have been recent concerns about the possible association between isotretinoin therapy and depressive symptoms. We conducted a prospective study to evaluate depressive symptoms and quality of life in acne patients having either isotretinoin or antibiotics/topical treatments. There were 215 patients (mean age 20 years) included in the study. Depression, quality of life and acne severity ratings were administered at baseline, 1 month, 3 months and end of treatment or 6 months, and compared between both treatment groups. The changes in the mean depression scores did not differ significantly between both groups (P = 0.62). The incidence of isotretinoin patients with moderate depressive symptoms remained relatively unchanged from baseline. The changes in the quality-of-life measures scores between treatment groups showed no significant difference. No correlation between isotretinoin dose and depression score was found. Although five isotretinoin patients were withdrawn during the study because of worsening of mood, no definite causal relationship was established. This pilot study does not appear to support any direct link between depression and isotretinoin, apart from being a rare unpredictable idiosyncratic side-effect. However, because of the study limitations, a larger study is needed to confirm the findings.

Topics: Acne Vulgaris; Adapalene; Administration, Oral; Administration, Topical; Adolescent; Adult; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Depression; Dermatologic Agents; Female; Humans; Isotretinoin; Male; Middle Aged; Minocycline; Naphthalenes; Quality of Life

In addition to tetracyclines, zinc may constitute an alternative treatment in inflammatory lesions of acne.. To evaluate the place of zinc gluconate in relation to antibiotics in the treatment of acne vulgaris.. Zinc was compared to minocycline in a multicenter randomized double-blind trial. 332 patients received either 30 mg elemental zinc or 100 mg minocycline over 3 months. The primary endpoint was defined as the percentage of the clinical success rate on day 90 (i.e. more than 2/3 decrease in inflammatory lesions, i.e. papules and pustules).. This clinical success rate was 31.2% for zinc and 63.4% for minocycline. Minocycline nevertheless showed a 9% superiority in action at 1 month and one of 17% at 3 months, with respect to the mean change in lesion count. Regarding safety, the majority of the adverse effects of zinc gluconate and of minocycline concerned the gastrointestinal system and were moderate (5 dropouts with zinc gluconate and 4 with minocycline).. Minocycline and zinc gluconate are both effective in the treatment of inflammatory acne, but minocycline has a superior effect evaluated to be 17% in our study.

Topics: Abdominal Pain; Acne Vulgaris; Adolescent; Adult; Anti-Bacterial Agents; Arthralgia; Dermatitis, Seborrheic; Double-Blind Method; Female; Gluconates; Humans; Hypersensitivity; Male; Minocycline; Nausea; Patient Compliance; Patient Dropouts; Patient Satisfaction; Skin; Treatment Outcome; Urticaria; Vomiting; Zinc

This open study was conducted in 72 outpatients with acne vulgaris, to compare the clinical efficacy and tolerability of azithromycin and minocycline. Azithromycin was administered as a single oral dose (500 mg/day) for 4 days in four cycles every 10 days and minocycline was administered 100 mg daily for 6 weeks. Improvement was assessed 6 weeks after initiation of treatment with a four-graded scale. A satisfactory clinical response was observed in 75.8% of the patients treated with azithromycin and in 70.5% of those treated with minocycline. There were no significant differences between these two acne treatments in terms of reduction of the number of lesions (p> 0.05). Both agents were well tolerated and mild side effects were reported in 10.3% of azithromycin and 11.7% of minocycline treated patients. We conclude that azithromycin is at least as clinically effective and well tolerated as minocycline as treatment of facial comedonic and papulopustular acne.

Topics: Acne Vulgaris; Administration, Oral; Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Female; Humans; Male; Minocycline; Treatment Outcome

The effects of treatment with minocycline 100 mg per day on sebaceous excretion in acne vulgaris using lipometry and Sebutape were studied in 45 patients in an open study as well as in a randomised placebo-controlled study. In both studies a subclinical increase in sebaceous excretion was noted from the 28th day of treatment. This effect continued for 1 month after the end of treatment. The increase in sebaceous excretion was concomitant with an increase in the number of excreting pilosebaceous follicles. Minocycline may cause the follicles to become unblocked by acting on the factors responsible for ostial hyperkeratosis, in addition to an antibacterial effect on retentional acne lesions.

Topics: Acne Vulgaris; Adolescent; Adult; Anti-Bacterial Agents; Double-Blind Method; Female; Humans; Male; Minocycline; Sebaceous Glands; Sebum

Minocycline is widely used as a second-line antimicrobial for acne vulgaris. Some patients require doses of up to 200 mg daily to control their acne. To assess the long-term safety of minocycline when used at higher doses, 700 patients treated with minocycline at doses of 100 mg daily, 100/200 mg on alternate days and 200 mg daily, were recruited. The mean duration of treatment was 10.5 months. Side-effects were monitored and full blood count, blood urea, electrolytes and liver function tests were carried out on 200 of the 700 patients. Side-effects were recorded in 13.6%, and included vestibular disturbance, candida infection, gastrointestinal disturbance, cutaneous symptoms (pigmentation, pruritus, photosensitive rash and urticaria) and benign intracranial hypertension. Pigmentation was the only side-effect found to be significantly increased in patients taking higher doses of minocycline, as compared with lower doses (P < 0.01). All patients with pigmentation had taken a total cumulative dose of over 70 g. No significant abnormalities were found in any of the haematological and biochemical profiles. We conclude that minocycline, at doses of up to 200 mg/day, is safe, long-term, for acne, when such doses are clinically necessary.

Topics: Acne Vulgaris; Adolescent; Adult; Anti-Bacterial Agents; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Humans; Male; Middle Aged; Minocycline

Sixty-six patients with moderate to severe facial acne vulgaris were entered in a 12-week double-blind study to compare the efficacy of topical clindamycin phosphate 1% twice daily and oral minocycline 50 mg twice daily. Both treatments gave significant overall improvements from baseline observations in acne grade and inflamed lesion counts, but not in noninflamed lesion counts. There were no significant differences between the two treatment groups in respect of acne grade, inflamed or non-inflamed lesion counts. Both treatment regimes were well tolerated. This study has shown that topical clindamycin twice daily is an effective alternative to oral minocycline 50 mg twice daily in the treatment of moderate to severe facial acne vulgaris.

Topics: Acne Vulgaris; Administration, Cutaneous; Administration, Oral; Adolescent; Adult; Clindamycin; Double-Blind Method; Female; Humans; Male; Minocycline

Twenty-five previously untreated acne patients were monitored throughout a 6-month course of therapy with either tetracycline or minocycline for changes in the numbers of staphylococci, propionibacteria and yeasts of the genus Malessezia on the skin surface. Antibiotic resistant staphylococci and propionibacteria were also counted. Minocycline (50 mg b.d.) produced a 10-fold greater reduction in propionibacterial numbers compared to tetracycline (500 mg b.d.) after 12 (P less than 0.02, t-test) and 24 weeks (P less than 0.05) of therapy. As treatment progressed, propionibacteria were replaced by yeasts, numbers of which were significantly increased by week 12 (P less than 0.02) in tetracycline-treated patients and by week 24 (P less than 0.01) in minocycline-treated patients. This suggests that yeasts have no role in the pathogenesis of acne but may compete with propionibacteria for the same niche. Overgrowth of antibiotic resistant staphylococci prevented any decrease in staphylococcal numbers in tetracycline-treated patients, but minocycline produced a significant and sustained reduction in staphylococcal numbers after 1 week of therapy (P less than 0.001). An increase in the number of multiply resistant (greater than or equal to 3 resistances) staphylococci occurred in 67% of tetracycline-treated and 33% of minocycline-treated patients by the end of the treatment period. There was no evidence of propionibacterial resistance in either treatment group. This study shows that minocycline has much greater antibacterial activity in vivo against both staphylococci and propionibacteria and produces less staphylococcal antibiotic resistance than tetracycline.

Topics: Acne Vulgaris; Adolescent; Female; Humans; Male; Minocycline; Propionibacterium; Skin; Staphylococcus; Tetracycline; Tetracycline Resistance; Tetracyclines; Time Factors; Yeasts

In the course of a randomized, comparative, clinical study, 50 patients with acne vulgaris received systemic treatment with a single daily dose of 50 mg doxycycline or two daily doses of 50 mg minocycline. At the completion of the 12-week treatment, cure or improvement of acne was found in 78% of the patients in the doxycycline group compared to 82% in the minocycline group. The rate of unsatisfactory therapeutic results was 22% in the doxycycline group and 18% in the group of patients treated with minocycline. The results showed no significant difference between the clinical efficacy of treating acne vulgaris with doxycycline at a daily dose of 50 mg and 100 mg of minocycline daily, a fact which has already been demonstrated by earlier studies.

Topics: Acne Vulgaris; Adolescent; Adult; Dose-Response Relationship, Drug; Doxycycline; Female; Humans; Male; Minocycline; Randomized Controlled Trials as Topic; Tetracyclines

Topics: Acne Vulgaris; Adolescent; Adult; Clinical Trials as Topic; Doxycycline; Female; Humans; Male; Minocycline; Random Allocation; Tetracyclines

Topics: Acne Vulgaris; Adolescent; Adult; Clinical Trials as Topic; Cyproterone; Female; Humans; Minocycline; Random Allocation; Tetracyclines

We have recently reported that patients with severe nodular cystic acne have much lower levels of HDL-cholesterol, apolipoprotein A and hepatic lipoprotein lipase than healthy controls or subjects with acne vulgaris. Since isotretinoin is very effective in the treatment of the nodular cystic acne but has been shown to increase blood lipid levels, we decided to compare its clinical effectiveness and its effects on lipid metabolism with those of minocycline in patients with nodular cystic acne. After 20 weeks, the number and mean diameter of the cysts were definitely decreased in both groups, but the improvement was more striking in the isotretinoin-treated group. At the end of the treatment, the HDL-C and hepatic lipoprotein lipase levels in this group were increased toward normal, but not in the minocycline-treated group. Our study showed a significant remission in the acne of patients treated with isotretinoin but not in that of the minocycline-treated patients. Furthermore isotretinoin can also correct the altered lipid metabolism in these patients.

Topics: Acne Vulgaris; Adult; Cholesterol; Cholesterol, HDL; Humans; Isotretinoin; Lipid Metabolism; Lipoprotein Lipase; Male; Minocycline; Tetracyclines; Tretinoin; Triglycerides

In a multicentre general practice open study, 338 acne sufferers were treated with Minocin 50 mg b.d. (254 for 12 weeks). A highly significant improvement trend (p less than 0.0001) was found following analysis of visual analogue scales measuring (i) severity of acne, (ii) area covered by acne, (iii) number of inflamed lesions, (iv) density of acne lesions. Over all, 79% of patients thought the therapy to be effective or very effective; 70% of patients continued on the same therapy after the study period. Mean first improvement was noted by the patients after 4 1/2 weeks of treatment. One hundred and twenty-two patients had taken prior oxytetracycline therapy, of these, ninety-four (77%) stopped oxytetracycline therapy because of lack of efficacy. After treatment of these oxytetracycline failures with Minocin, a highly significant improvement trend (p less than 0.0001) of acne was again seen. In this group, 75% of patients thought the Minocin therapy to be effective or very effective; 69% continued Minocin therapy after the study period. In all, 74% of patients having received prior oxytetracycline thought that Minocin therapy was better than their previous therapy. Ninety-three patients had received either no previous therapy or topical therapy alone. Once again Minocin treatment resulted in a highly significant improvement trend (p less than 0.0001) in the severity of acne. Seventy six (82%) of these patients thought that Minocin therapy was effective or very effective. A total of 73% of patients continued with Minocin therapy following the study period. Adverse events were noted in 6% of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acne Vulgaris; Adolescent; Adult; Clinical Trials as Topic; Family Practice; Female; Humans; Male; Minocycline; Oxytetracycline; Tetracyclines; Time Factors

This investigation utilized an accurate photographic method and grading scale for evaluating acne in sixty-two patients. During a randomized double-blind clinical study in which half of the patients received minocycline and half, tetracycline, photographs of facial or body acne were taken at baseline and every 2 weeks over a 12-week period of therapy. In addition to on-site blinded gradings by both the investigator and the patients, separate assessments were made by two independent dermatologists utilizing the scale and the transparencies taken during the study. A reasonable agreement was found between the investigator, the patients, and the independent dermatologists, indicating the usefulness of this method. The investigator's rating of acne severity disclosed a significantly (p less than or equal to 0.05) more rapid clinical response at weeks 2 and 8 in the patients who received minocycline than in those who received tetracycline. Also, the assessment of one of the independent dermatologists showed a significantly (p = 0.024) better response to minocycline than to tetracycline at week 8 of therapy. The incidence of adverse clinical experiences was lower in the minocycline-treated group (10%) than in the tetracycline-treated group (22%).

Topics: Acne Vulgaris; Adolescent; Adult; Clinical Trials as Topic; Double-Blind Method; Female; Humans; Male; Minocycline; Photography; Tetracycline; Tetracyclines

A double-blind evaluation of the efficacy and safety of minocycline hydrochloride and tetracycline hydrochloride was conducted and completed using 49 patients with Pillsbury grade 2 or grade 3 acne. For six months, half of the patients received minocycline and half received tetracycline. Although the differences between treatment groups were not statistically significant at any evaluation, more patients treated with minocycline reached and maintained a noninflammatory acne status in less time than did patients treated with tetracycline. After six weeks, twice as many patients in the group treated with minocycline had reached noninflammatory status. Side effects reported by 7 patients were equally distributed between treatment groups. No notable abnormalities were observed in the results of blood chemistry studies, hematologic tests, quantitative serum immunoglobulin determinations, or thyroid function tests in 20 of the patients examined.

Topics: Acne Vulgaris; Adolescent; Adult; Clinical Trials as Topic; Double-Blind Method; Female; Humans; Male; Middle Aged; Minocycline; Tetracyclines

The effect of 1,000 mg of tetracycline hydrochloride and 200 mg of minocycline hydrochloride on Propionibacterium acnes levels and skin-surface lipid levels was measured in 15 patients with acne. Minocycline produced a significantly greater reduction in the P acnes counts that persisted even up to three weeks after discontinuation of the minocycline therapy, in contrast to the return of P acnes to baseline counts within three weeks after discontinuation of tetracycline therapy. A similar persistence of effect for reduction of skin-surface free fatty acid levels and clinical lesions was also seen with minocycline therapy.

Topics: Acne Vulgaris; Fatty Acids, Nonesterified; Female; Humans; Lipid Metabolism; Male; Minocycline; Propionibacterium acnes; Skin; Tetracycline; Tetracyclines

Topics: Acne Vulgaris; Clinical Trials as Topic; Double-Blind Method; Doxycycline; Drug Evaluation; Humans; Minocycline; Tetracyclines

Topics: Acne Vulgaris; Adolescent; Adult; Clinical Trials as Topic; Female; Humans; Male; Minocycline; Placebos; Tetracyclines

A double-blind, random distribution study showed that a lower than recommended dose of minocycline--50 mg twice daily--was as effective as a dose of 250 mg twice daily of tetracycline for treatment of acne vulgaris in comparable patient groups, and that minocycline produced no vestibular side effects at the lower dosage. Like tetracycline, minocycline did not produce the phototoxicity associated with demeclocycline or the life-threatening colitis associated with clindamycin. Patients in this study did not develop a resistance either to minocycline or to tetracycline. Studies of the use of minocycline in patients who have developed tetracycline resistance and long-range studies of patients on the new lower dose of minocycline are now underway.

Topics: Acne Vulgaris; Adolescent; Adult; Candidiasis, Vulvovaginal; Clinical Trials as Topic; Female; Humans; Male; Minocycline; Tetracycline; Tetracyclines; Time Factors

Various tetracyclines and erythromycins have been used rather empirically for the systemic treatment of acne vulgaris for more than a decade. It has been impossible to accurately evaluate clinically the numerous derivatives and to compare their effectiveness with other antibiotics such as clindamycin. As a substitute for this approach, this present study ranks these antibiotics, when given orally, as to their effectivensss in suppressing the fatty acids in sebum in normal volunteers. As a group, the tetracyclines were more effective than the erythromycins in decreasing the fatty acids, but clindamycin was significantly more potent than either.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Chlortetracycline; Clindamycin; Clinical Trials as Topic; Demeclocycline; Erythromycin; Esters; Fatty Acids; Humans; Minocycline; Sebum; Spectrophotometry, Infrared; Tetracycline

Topics: Acne Vulgaris; Anti-Bacterial Agents; Ethnicity; Humans; Hyperpigmentation; Minocycline; Retrospective Studies; Tetracycline

Antibiotic resistance related to prolonged antibiotic use is an emerging threat to public health.. To evaluate recent trends in oral antibiotic use for acne treatment.. A retrospective study was conducted from January 2014 through September 2016 using the IBM MarketScan® claims database. Patients were aged ≥9 years, prescribed an oral antibiotic, and diagnosed with acne vulgaris on 2 separate occasions. The primary outcome was the duration of oral antibiotic treatment over 12 months; continuous use was defined as ≤30-day gap between prescriptions.. The most commonly prescribed antibiotic treatments (N=46,267) were doxycycline (36.7%) and minocycline (36.5%). Overall, 36%, 18%, 10%, and 5% of patients continuously used any oral antibiotic at 3, 6, 9, and 12 months, respectively. Among patients who continuously used tetracyclines, a similar percentage was prescribed minocycline (40.2%, 18.6%, 10.5%, and 5.1%) vs doxycycline (34.7%, 14.6%, 7.7%, and 3.9%) at 3, 6, 9, and 12 months, respectively. A greater percentage of patients continued use of tetracyclineclass antibiotics than other therapeutic classes.. Retrospective analysis of health-care claims data. Relatively short study duration.. Nearly 20% of patients continuously used oral antibiotics for ≥6 months, exceeding American Academy of Dermatology guideline recommendations of 3 to 4 months. J Drugs Dermatol. 2023;22(3):265-270. doi:10.36849/JDD.7345.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Doxycycline; Humans; Minocycline; Retrospective Studies; United States

Symptomatic dermographism (SD) is the most common form of chronic inducible urticarias. The etiology of this disease has rarely been reported in the literature. Minocycline is widely used in the treatment of acne, rosacea, and other inflammatory skin diseases. Herein we report four cases of SD onset during minocycline administration. These were young women in their 20s to 30s who were taking minocycline orally for acne vulgaris or rosacea. They all experienced the onset of SD 2-3 weeks after taking the drug, and then the complete disappearance of SD 1 month after stopping the drug. Minocycline was thought to be the culprit drug in these cases as other drugs were ruled out on clinical grounds. Our small series suggests that oral minocycline may induce SD, thus raising the awareness of this association in clinical practice. More research is needed to further confirm this association and reveal the underlying mechanism(s).

Topics: Acne Vulgaris; Anti-Bacterial Agents; Chronic Inducible Urticaria; Female; Humans; Minocycline; Rosacea; Urticaria

To evaluate the efficacy of topical 30% salicylic acid plus minocycline in moderate to severe acne. One hundred patients with moderate to severe acne from February 2020 to February 2021 were retrospectively analyzed. They were assigned (1:1) to receive either topical 30% salicylic acid plus minocycline (combination group) or minocycline (mono therapy group). The acne scores, physician subjective and objective scores, efficacy, quality of life, incidence of adverse reactions, recurrence and satisfaction in both groups were compared. The combination group had lower Global Acne Grading System (GAGS) scores, erythema scores and papulopustular scores than the mono therapy group. Combined therapy was associated with lower erythema absolute value and erythema index, more skin water content and less transcutaneous water loss versus minocycline. Higher efficacy, acne symptoms scores, and quality of life were observed with combination therapy versus mono therapy (P<0.05). The two groups had a similar incidence of adverse reactions and recurrence. Combination therapy showed a higher appearance satisfaction versus mono therapy. The efficacy of topical 30% salicylic acid plus minocycline for moderate to severe acne was better versus minocycline.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Humans; Minocycline; Quality of Life; Retrospective Studies; Salicylic Acid; Treatment Outcome

Oral tetracyclines (TCNs) are commonly prescribed for acne, but they have been shown to increase the risk of hyperpigmentation, particularly in the setting of sun exposure.. We evaluated seasonal trends in TCN-associated hyperpigmentation incidence in addition to Google search trends for hyperpigmentation-related terms.. We performed a retrospective review of acne patients seen at Massachusetts General Brigham and Women’s Hospital between 1992 and 2022. We calculated the incidence of new hyperpigmentation diagnoses for each drug cohort. We also analyzed search volume of hyperpigmentation-related terms extracted from Google Trends.. Seasonal differences in new hyperpigmentation diagnoses were identified among acne patients prescribed doxycycline (P=0.016), with peak incidence in April. In the control group of patients who had never received a TCN, diagnoses peaked in May. There were no significant seasonal differences among patients prescribed minocycline (P=0.885). There was greater search volume for hyperpigmentation-related terms in spring and summer compared to fall and winter (P<0.001). Limitations of this study include its retrospective nature and reliance on prescription and diagnosis coding data.. Our findings support the seasonal periodicity of acne-related hyperpigmentation, underscoring the importance of photoprotection counseling for patients with acne. Additionally, doxycycline may be associated with an earlier onset of hyperpigmentation, suggesting a potential benefit of considering minocycline or other alternatives to doxycycline. J Drugs Dermatol. 2023;22(11):e9-e11    doi:10.36849/JDD.7409e.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Doxycycline; Female; Humans; Hyperpigmentation; Minocycline; Retrospective Studies; Seasons; Tetracycline

Tetracycline-class antibiotics are frequently prescribed by dermatologists, commonly for acne vulgaris. Gastrointestinal absorption of first and second-generation tetracycline-class antibiotics, including doxycycline and minocycline, may be reduced by co-administration with food, resulting in potentially lower clinical efficacy. Development of novel compounds and formulations that are not impacted by diet could improve compliance, absorption, and effectiveness among patients. The objective of this study is to investigate weight-based dosing protocols and the impact of food intake, including high-fat meals, on the absorption, and clinical efficacy of sarecycline, a novel oral narrow-spectrum third-generation tetracycline-class antibiotic approved by the Food and Drug Administration for acne vulgaris treatment. Data from 12 clinical studies were analyzed using population pharmacokinetic modeling, exposure-response modeling and pharmacodynamics to evaluate sarecycline dosing recommendations. The extent of exposure is estimated to decrease by 21.7% following co-administration of a sarecycline tablet with a high-fat meal. Based on the PopPK-PD model, this is equivalent to a decrease in efficacy of 0.9 inflammatory lesions, which is not clinically meaningful. Sarecycline can be administered using weight-based dosing with or without food. Co-administration with high-fat food has a limited impact on clinical efficacy. The pharmacokinetics of oral sarecycline may provide added convenience and support ease of use and improved compliance for acne vulgaris patients.

Topics: Acne Vulgaris; Administration, Oral; Anti-Bacterial Agents; Eating; Humans; Minocycline; Tetracyclines; Treatment Outcome

Minocycline is a second-generation tetracycline drug, which is widely used to treat diverse infectious and inflammatory diseases such as acne vulgaris. The effects of minocycline on acne vulgaris have been mainly attributed to its anti-inflammatory effect; however, its sebum-regulating effect and the relevance to epigenetic regulation in human sebaceous glands remain uninvestigated.. To identify the potential underlying epigenetic mechanism of sebum-inhibitory effects of minocycline in human SZ95 sebocytes.. The quantity of lipid droplets and the expression of key lipogenic genes were analysed in minocycline-treated SZ95 sebocytes. To examine whether the sebum-inhibitory effects of minocycline are relevant to histone acetylation, we analysed the effects of minocycline on p300 HAT and total HDAC activity. To elucidate the functional implication of p300 HAT inhibition by minocycline in sebocytes, we assessed the effect of p300 knockdown, inhibition and overexpression on lipid accumulation in SZ95 sebocytes.. Minocycline suppressed the insulin and liver X receptor agonist-induced lipid accumulation and the expression of the key lipogenic transcription factor sterol regulatory element-binding protein 1 (SREBP1) and its downstream genes, fatty acid synthase (FAS) and acetyl-CoA carboxylase α (ACCα). Minocycline inhibited p300 HAT activity in a concentration-dependent manner, but demonstrated no effect on global HDAC activity, resulting in a significant decrease in histone acetylation. Downregulation of p300 by knockdown or inhibition significantly suppressed SREBP1 expression, histone acetylation and lipid accumulation, whereas p300 overexpression enhanced these effects. Moreover, p300 overexpression rescued minocycline-inhibited SREBP1 expression and lipid synthesis.. Our findings revealed a novel sebum-regulating effect of minocycline. Moreover, as p300 HAT is a key epigenetic regulator of sebaceous lipogenesis, its inhibitors could be used for the treatment of acne vulgaris.

Topics: Acetylation; Acne Vulgaris; Epigenesis, Genetic; Histone Acetyltransferases; Histones; Humans; Lipids; Lipogenesis; Minocycline; Sebaceous Glands

Acne vulgaris varies in clinical severity, from minimal comedonal disease to severe hemorrhagic and ulcerative lesions with scarring. While a family history confers a higher risk for developing acne, the correlation between heritability and clinical severity remains unclear.. To examine the natural history and heritability of severe acne with scarring in patients undergoing isotretinoin therapy.. A total of 101 subjects with severe acne with scarring and its variants, including acne conglobata and acne fulminans, were enrolled. All subjects and adult family members underwent an interview regarding their acne, and a corresponding "historical" Investigator's Global Assessment (hIGA) score (0 = clear, 1 = almost clear, 2 = mild, 3 = moderate, 4 = severe, 5 = very severe) was assigned. Study assessors performed an "examination" Investigator's Global Assessment (eIGA) based on the clinical examination of each subject (0 = clear, 1 = almost clear, 2 = mild, 3 = moderate, 4 = severe, 5 = very severe). A detailed family history and pedigree were documented.. Most subjects were Caucasian (44.5%) and male (79.2%) who had previously used doxycycline and/or minocycline (86.1%). The mean eIGA and hIGA scores were 2.7 and 4.4, respectively. 37.2% of subjects had one first-degree relative with a history of moderate or severe acne with scarring; of note, of the patients with hemorrhagic disease, 30% had at least one parent with moderate or severe acne.. Severe forms of acne often "cluster" in families, underscoring the heritable nature of acne and the prognostic value of a family history of moderate or severe disease.

Topics: Acne Vulgaris; Adult; Cicatrix; Doxycycline; Female; Humans; Isotretinoin; Male; Minocycline; Treatment Outcome

Minocycline HCl, a tetracycline antibiotic, commonly is prescribed to treat acne, but also has substantial antidepressant effects, possibly because inflammation plays a key role in depression. The drug has an acceptable safety profile, but more research is needed to determine how best to use it in treating patients with depression.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Antidepressive Agents; Depression; Humans; Minocycline

Topics: Acne Vulgaris; Humans; Minocycline; Severity of Illness Index

Topics: Acne Vulgaris; Anti-Bacterial Agents; Demography; Gastrointestinal Microbiome; Humans; Life Style; Minocycline

Several studies have evaluated the effects of changes in isotretinoin risk mitigation programs, but little is known about actual fetal exposure rates in the context of other acne treatments.. Our objective was to quantify fetal exposure rates during the use of common acne treatments.. Employing the insurance claims data of > 100,000 acne treatment users between 2006 and 2015, we created three user cohorts: (1) isotretinoin (strong teratogen/mandatory risk mitigation program), (2) doxycycline/minocycline (mild teratogen, label warning), and (3) topical clindamycin/erythromycin (no fetal risk). Fetal exposure rates overall and stratified by age were compared after adjusting for potential confounders.. Contraceptive use during acne treatment was < 50% in isotretinoin users and < 30% in the other study groups. Long-acting contraceptives contributed to 1% of all contraceptives used, with 90% being oral contraceptives. Isotretinoin users had 19.2 (95% confidence interval [CI] 20.3 to 17.9) fewer fetal exposures per 1000 person-years of use compared with doxycycline/minocycline users, which in turn had 28.8 (95% CI 31.2 to 26.3) fewer pregnancies compared with clindamycin/erythromycin users. Stratification by age showed attenuated differences in fetal exposure among acne treatment groups for teenagers.. Fetal exposure to acne treatments varied according to levels of teratogenicity, with reduced rates among users of isotretinoin and to a lesser extent doxycycline/minocycline. Teenagers had low pregnancy rates but less pronounced differences in fetal exposure across acne treatments.

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Clindamycin; Contraceptive Agents; Dermatologic Agents; Doxycycline; Erythromycin; Female; Humans; Isotretinoin; Minocycline; Pregnancy; Retrospective Studies; Teratogens; United States

We report a case of serum sickness-like reaction (SSLR) in a 14-year-old male taking minocycline for acne. The patient presented with urticarial rash, arthralgia/arthritis, and tender lymphadenopathy. Symptoms resolved with discontinuation of minocycline and treatment with prednisone, cetirizine, and ibuprofen. SSLR is a rare complication of minocycline treatment that may go unrecognized and underreported.

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Arthralgia; Humans; Male; Minocycline; Serum Sickness

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Diagnosis, Differential; Female; Humans; Minocycline; Mycoses; Pigmentation; Tongue Diseases; Tongue, Hairy; Treatment Outcome; Withholding Treatment

Topics: Acne Vulgaris; Administration, Oral; Anti-Bacterial Agents; Antifungal Agents; Candida albicans; Candidiasis, Cutaneous; Cefdinir; Diagnosis, Differential; Diagnostic Errors; Face; Humans; Itraconazole; Male; Minocycline; Skin; Treatment Outcome; Young Adult

Although tetracycline has been used to treat cutaneous sarcoidosis, the mechanism of action for this treatment remains unclear. This study evaluated the efficacy of minocycline treatment on cutaneous sarcoidosis and the relationship between its efficacy and the presence of Propionibacterium acnes in skin sarcoid lesions.. We retrospectively reviewed results in 13 patients with cutaneous sarcoidosis treated with minocycline at Saitama Medical Center between 2010 and 2017. To demonstrate the presence of P. acnes in the skin lesions, skin biopsy specimens from 11 of the 13 patients were evaluated with immunohistochemistry using a specific monoclonal antibody against P. acnes (PAB antibody).. Of the 13 patients treated with minocycline, six patients (46%) achieved a complete response (CR) and seven (54%) had a partial response (PR). The skin lesions regressed in 1.5-5 months (average, 3.2 months) after treatment with minocycline. No relapse had occurred during the minocycline therapy. Elevated serum angiotensin-converting enzyme levels were observed in five of the patients, and the levels reduced after treatment with minocycline. P. acnes, identified as round bodies that reacted with PAB antibody, were observed in the skin sarcoid granulomas in all patients tested. The number of PAB-positive round bodies was significantly higher in the skin lesions of patients who had CR than in those who had PR.. These results suggest the effectiveness of minocycline for the treatment of cutaneous sarcoidosis and an association of P. acnes with the efficacy of minocycline therapy for cutaneous sarcoidosis.

Topics: Acne Vulgaris; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Biopsy; Female; Humans; Japan; Male; Middle Aged; Minocycline; Propionibacterium acnes; Recurrence; Retrospective Studies; Sarcoidosis; Skin; Treatment Outcome

Topics: Acne Vulgaris; Administration, Cutaneous; Anti-Bacterial Agents; Humans; Minocycline

► Abdominal pain ► Lower-leg itching ► Dark urine & yellow eyes.

Topics: Abdominal Pain; Acne Vulgaris; Adolescent; Analgesics; Antipruritics; Chemical and Drug Induced Liver Injury; Female; Glucocorticoids; Humans; Immunologic Factors; Minocycline; Mycophenolic Acid; Prednisolone; Pruritus; Treatment Outcome; Urine; White People

Topics: Acne Vulgaris; Administration, Cutaneous; Anti-Bacterial Agents; Humans; Minocycline

Successful outcomes of clinical studies for acne vulgaris depend greatly on achieving statistically significant reduction in acne lesion count and improvement in Investigator's Global Assessment score of the investigational drug product against its vehicle control. To date, there has not been a validated preclinical acne model to evaluate investigational drug products in order to improve the probability of clinical success. An inflammatory acne-like lesion mouse model developed in-house has previously been used for clinical guidance in our drug development program. In this study, we aim to implement and assess the adequacy of swept-source optical coherence tomography (SS-OCT) in quantifying the dynamic changes in inflammatory acne-like lesions.. Live Propionibacterium acnes bacteria were injected intradermally resulting in inflammatory acne-like lesions. Topical 1% and 2% minocycline gels were applied to the lesions in separate groups once daily for 2 weeks and compared with vehicle and untreated control groups. The growth of these lesions was monitored and measured with a ruler (height)/microcaliper (width)-an approach previously developed, and with SS-OCT. The reliability of the two methods were assessed. Acquired OCT images across the apex of these inflammatory lesions were statistically analyzed for lesion volume reduction from baseline as well as between the treatment groups and the control groups.. The OCT technique allowed for reliable lesion volume analysis with varying conic profiles. After 14 days of topical minocycline treatments (1%, 2% minocycline), statistically significant reduction in lesion volume (P ≤ 0.05) based on OCT image analysis was observed compared with untreated and vehicle control groups as well as compared with baseline measurements. Under the right conditions, some morphological aspects of the P. acnes injection site were discernible within the skin in images captured with OCT.. We demonstrated the first use of SS-OCT in evaluating in vivo inflammatory acne-like lesions in a murine model. Our findings support the use of OCT in assessing lesion size and evolution of P. acnes injection sites non-invasively in preclinical in vivo studies, which could potentially lead to more consistent and predictable outcomes in clinical development. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

Topics: Acne Vulgaris; Administration, Topical; Animals; Disease Models, Animal; Mice; Minocycline; Reproducibility of Results; Tomography, Optical Coherence

Minocycline, a member of the tetracycline class of antibiotics, has been associated with benign thyroid pigmentation but reports of thyroid dysfunction are sparse.. Cases were selected via an inquiry of the electronic medical records for patients with thyroid dysfunction and the use of a tetracycline antibiotic. Non-autoimmune thyroiditis was defined as abnormally low or suppressed thyroid-stimulating hormone (TSH, <0.3 µIU/mL), elevated free thyroxine or total thyroxine, and undetectable antithyroid antibodies.. Nine cases of thyroiditis without autoimmunity were identified out of 423 reviewed patients. Cases of thyroiditis occurred in adolescents ages 14-17 years who had been taking minocycline for 6 months to 4 years. In all cases, minocycline was prescribed for the treatment of acne. Four of the 9 received treatment for thyrotoxicosis with a β-blocker (in 3 cases) and/or antithyroid drug (in 2 cases). Thyroiditis was symptomatic in all but one individual who presented with painless goiter. All thyroiditis was transient and resolved after a median of 4.5 months (range 2-5 months). In one case, thyroiditis was followed by transient hypothyroidism.. Minocycline is known to cause thyroid abnormalities, although it has not been definitively linked to thyroid dysfunction. Here, we report 9 cases of non-autoimmune thyroiditis in adolescents receiving minocycline for acne. We recommend that minocycline exposure be considered in the differential diagnosis for thyroiditis and that patients receiving minocycline be counseled regarding the risk of thyroid dysfunction.

Topics: Acne Vulgaris; Adolescent; Goiter; Humans; Male; Minocycline; Thyroiditis

Topics: Acne Vulgaris; Anti-Inflammatory Agents; Arthritis, Infectious; Cost-Benefit Analysis; Dapsone; Dermatologic Agents; Drug Therapy, Combination; Humans; Methotrexate; Minocycline; Pregnenediones; Pyoderma Gangrenosum; Skin

Topics: Acne Vulgaris; Female; Humans; Middle Aged; Minocycline; Pigmentation; Thyroid Cancer, Papillary; Thyroid Gland; Thyroid Neoplasms; Thyroidectomy; Time Factors

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Humans; Male; Minocycline; Oculomotor Nerve Diseases; Systemic Vasculitis; Withholding Treatment

Minocycline has neurological anti-inflammatory properties and has been hypothesised to have antipsychotic effects.. The aim of this study was to investigate, using routinely collected United Kingdom primary health care data, whether adolescent men and women are more or less likely to receive an urgent psychiatric referral during treatment for acne with minocycline compared with periods of non-treatment.. A self-controlled case series using United Kingdom Clinical Practice Research Datalink to calculate the incidence rate ratio of urgent psychiatric referrals for individuals, comparing periods during which minocycline was prescribed with unexposed periods, adjusted for age.. We found 167 individuals who were at the time exposed to minocycline for a mean of 99 days and who received an urgent psychiatric referral. There was no difference in psychiatric referral risk during periods of exposure compared with periods of non-exposure: incidence rate ratio first 6 weeks of exposure 1.96, 95% confidence interval 0.82-4.71, p=0.132; incidence rate ratio remaining exposure period=1.97, 95% confidence interval 0.86-4.47, p=0.107.. We found no evidence in support of a protective effect of minocycline against severe psychiatric symptoms in adolescence.

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Case-Control Studies; Female; Humans; Male; Mental Disorders; Minocycline; Referral and Consultation; United Kingdom

Given the widespread use of systemic antibiotics for treatment of moderate to severe acne, it is important to understand the associations of such antibiotic use with changes not only in Cutibacterium acnes (formerly Propionibacterium acnes) but also in the complete bacterial community of the skin.. To examine the composition, diversity, and resilience of skin microbiota associated with systemic antibiotic perturbation in individuals with acne.. This longitudinal cohort study conducted at an academic referral center in Maryland from February 11 to September 23, 2014, included 4 female participants who had received a recent diagnosis of acne vulgaris, showed comedonal and inflammatory acne on the face, were at least 18 years old, and had no recent use of systemic or topical treatments for acne, including antibiotics and retinoids. Data analysis was performed between July 5, 2017, and November 7, 2018.. Participants were prescribed oral minocycline, 100 mg, twice daily for 4 weeks. Skin areas on the forehead, cheek, and chin were sampled for 16S ribosomal RNA gene sequencing at baseline, 4 weeks after starting minocycline treatment, and then 1 week and 8 weeks after discontinuation of treatment.. Skin microbiota examined with respect to relative abundance of bacterial taxa, α diversity (represents within-sample microbial diversity), and β diversity (represents between-sample microbial diversity). Acne status evaluated with photography and lesion count.. Of the 4 patients included in this study, 2 were 25 years old, 1 was 29 years old, and 1 was 35 years old; 2 were white women, 1 was an African American woman, and 1 was an Asian woman. Across all 4 patients, antibiotic treatment was associated with a 1.4-fold reduction in the level of C acnes (difference, -10.3%; 95% CI, -19.9% to -0.7%; P = .04) with recovery following cessation of treatment. Distinct patterns of change were identified in multiple bacterial genera, including a transient 5.6-fold increase in the relative abundance of Pseudomonas species (difference, 2.2%; 95% CI, 0.9%-3.4%; P < .001) immediately following antibiotic treatment, as well as a persistent 1.7-fold increase in the relative abundance of Streptococcus species (difference, 5.4%; 95% CI, 0.3%-10.6%; P = .04) and a 4.7-fold decrease in the relative abundance of Lactobacillus species (difference, -0.8%; 95% CI, -1.4% to -0.2%; P = .02) 8 weeks following antibiotic treatment withdrawal. In general, antibiotic administration was associated with an initial decrease from baseline of bacterial diversity followed by recovery. Principal coordinates analysis results showed moderate clustering of samples by patient (analysis of similarity, R = 0.424; P = .001) and significant clustering of samples by time in one participant (analysis of similarity, R = 0.733; P = .001).. In this study, systemic antibiotic treatment of acne was associated with changes in the composition and diversity of skin microbiota, with variable rates of recovery across individual patients and parallel changes in specific bacterial populations. Understanding the association between systemic antibiotic use and skin microbiota may help clinicians decrease the likelihood of skin comorbidities related to microbial dysbiosis.

Topics: Acne Vulgaris; Administration, Oral; Adult; Anti-Bacterial Agents; Bacteria; Cohort Studies; Female; Humans; Longitudinal Studies; Microbiota; Minocycline; Pilot Projects; Propionibacterium acnes; Skin; Treatment Outcome

Cycline antibiotics (CAs) are commonly used to treat acne, blepharitis, and dry eye syndrome. Prescribers or patients may hesitate to use Cas because they may increase the risk of pseudotumor cerebri syndrome (PTCS).. We sought to assess whether CA use is associated with an increased risk of PTCS or papilledema and whether the risk depends upon dosage or duration of CA intake.. We studied patients 12 to 65 years of age who were diagnosed with acne, blepharitis, or dry eye syndrome, who were enrolled in a nationwide managed care network between January 1, 2001 and December 31, 2015, and who had no preexisting diagnosis of papilledema or PTCS. Multivariable Cox regression modeling was used to assess the risk of developing papilledema or PTCS from exposure to CAs.. Among the 728,811 eligible enrollees (mean age, 34.7 years; 72% female), 42.0% filled ≥1 CA prescription. Of the 305,823 CA users, 170 (0.06%) were diagnosed with papilledema or PTCS. By comparison, of the 57.0% with no record of CA use, 121 (0.03%) were diagnosed with papilledema or PTCS (P < .0001). In the unadjusted model, every additional year of CA use was associated with a 70% (doxycycline: hazard ratio, 1.70 [95% confidence interval 0.98-2.97]; P = .06) or 91% (minocycline: hazard ratio, 1.91 [95% confidence interval 1.11-3.29]; P = .02) increased hazard of papilledema/PTCS relative to nonusers of CAs. After adjustment for confounders, the increased hazard of PTCS/papilledema with CA use was no longer statistically significant (P = .06, doxycycline; P = .08, minocycline).. This study relies on claims data, which lack clinical data.. This study offers some evidence that CAs may increase the risk of PTCS/papilledema. However, after accounting for confounding factors in our multivariable models, we found no statistically significant association between CA use and the development of PTCS. Moreover, there was no dose-response effect whereby greater CA use was associated with a higher PTCS risk.

Topics: Acne Vulgaris; Administrative Claims, Healthcare; Adolescent; Adult; Anti-Bacterial Agents; Blepharitis; Doxycycline; Dry Eye Syndromes; Female; Humans; Male; Middle Aged; Minocycline; Papilledema; Pseudotumor Cerebri; Young Adult

Oral antibiotics are well established treatments for acne vulgaris but are associated with undesirable side effects. Topical antibiotics offer an improved safety profile but have led to an alarming rise in worldwide P. acnes resistance. Fortunately, a new class of topical minocycline products has been developed for the treatment of acne and rosacea that decreases the risk for antibiotic resistance while maintaining safety and efficacy. Recent clinical studies have demonstrated that a hydrophilic minocycline gel (BPX-01) and a lipophilic minocycline foam (FMX101) both reduced acne lesion counts with negligible systemic absorption. Head-to-head studies have yet to be completed, but the hydrophilic gel studies reported greater treatment efficacy than the lipophilic foam studies.\ \ J Drugs Dermatol. 2019;18(3):240-244.

Topics: Acne Vulgaris; Administration, Cutaneous; Anti-Bacterial Agents; Clinical Trials as Topic; Drug Resistance, Bacterial; Humans; Minocycline; Propionibacterium acnes; Skin; Treatment Outcome

FMX101 4% contains 4% micronized minocycline (as an HCl) formulated in a lipophilic foam vehicle for topical administration. FMX101 4% has been shown to be an effective and well-tolerated treatment for moderate-to-severe acne in three Phase 3 pivotal studies, however, skin sensitization and toxicity potential remains to be fully evaluated. Four single-center, randomized, controlled, within-subject comparison studies were conducted to evaluate the potential for phototoxicity, photoallergy, skin sensitization, and cumulative skin irritation with topical administration of FMX101 4% and the corresponding vehicle. Across the four studies, healthy male and non-pregnant female volunteers (age ≥18 years) were randomized to FMX101 4%, vehicle, or other controls. In the phototoxicity study, treated skin was irradiated at 3 and 24 hr post-application, and local tolerability was assessed pre- and post-irradiation. In the photoallergy study, the skin was treated and irradiated (post-24 hr) twice weekly for 3 wk (induction phase), rested for 10-17 d, and naive skin sites were treated and irradiated (challenge phase); skin reactions were assessed after patch removal and post-irradiation. In the sensitization study, the skin was treated for 3 wk (induction phase), then rested for 10-14 d, and naive skin sites were treated for 48 hr (challenge phase); contact sensitization was assessed for both phases. In the cumulative irritation study, treatment and vehicle were applied daily for 21 d; skin irritation was assessed after each application. In all studies, standard safety assessments were conducted. A total of 32, 56, 233, and 42 subjects were enrolled in the phototoxicity, photoallergy, sensitization, and skin irritation studies, respectively. There was no evidence of phototoxicity, photoallergy, skin sensitization, or skin irritation potential with FMX101 4%. Few adverse events, mostly mild to moderate, were reported. In conclusion, FMX101 4% appeared to be well tolerated and non-irritating, and was considered to be non-sensitizing, non-phototoxic, and non-photoallergic.

Topics: Acne Vulgaris; Administration, Cutaneous; Adolescent; Adult; Aged; Anti-Bacterial Agents; Clinical Trials, Phase I as Topic; Dermatitis, Photoallergic; Dermatitis, Phototoxic; Erythema; Female; Humans; Male; Middle Aged; Minocycline; Randomized Controlled Trials as Topic; Severity of Illness Index; Skin; Time Factors; Young Adult

Animal studies suggest that the antibiotic and microglial activation inhibitor, minocycline, is likely to have a protective effect against the emergence of psychosis but evidence from human studies is lacking. The aim of this study is to examine the effects of exposure to minocycline during adolescence on the later incidence of severe mental illness (SMI).. A historical cohort study using electronic primary care data was conducted to assess the association between exposure to minocycline during adolescence and incidence of SMI. The Incidence Rate Ratio (IRR) was measured using Poisson regression adjusted for age, gender, time of exposure, socioeconomic deprivation status, calendar year and co-medications.. Early minocycline prescription ( n=13,248) did not affect the incidence of SMI compared with non-prescription of minocycline ( n=14,393), regardless of gender or whether or not the data were filtered according to a minimum exposure period (minimum period: IRR 0.96; 95% CI 0.68-1.36; p=0.821; no minimum period: IRR 1.08; 95% CI 0.83-1.42; p=0.566).. Exposure to minocycline for acne treatment during adolescence appears to have no effect on the incidence of SMI.

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Cohort Studies; Databases, Factual; Female; Humans; Incidence; Male; Mental Disorders; Minocycline; United Kingdom; Young Adult

Topics: Acne Vulgaris; Anti-Bacterial Agents; Female; Humans; Hyperpigmentation; Middle Aged; Minocycline; Rosacea

Topics: Acne Vulgaris; Adolescent; Diagnosis, Differential; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug-Related Side Effects and Adverse Reactions; Female; Fever; Humans; Magnetic Resonance Imaging; Minocycline; Positron-Emission Tomography; Risk Factors; Sweating; Vasculitis; Weight Loss; Withholding Treatment

Topics: Acne Vulgaris; Adalimumab; Anti-Bacterial Agents; Clinical Trials as Topic; Dermatologic Agents; Drug Resistance; Evidence-Based Medicine; Hidradenitis Suppurativa; Humans; Meta-Analysis as Topic; Minocycline; Systematic Reviews as Topic

Minocycline is a derivative of tetracycline. It has been widely used in dermatology for the treatment of acne and rosacea. One of its adverse effects is pigmentation of various body tissues. Clinically, 3 main distinct types of hyperpigmentation by minocycline have been distinguished: type I, with blue-gray to black pigment on the face in areas of scarring or inflammation; type II, with blue-gray pigment on normal skin of the legs, forearms and on the shins; and type III, with a diffuse muddy-brown discoloration in areas of sun exposure. In the current report, we present the case of a 50-year old man with a history of severe acne treated with minocycline in the past, who currently complained about discoloration of his face. He had also taken colloidal silver supplements for "good health" about 16 years ago. Physical examination revealed gray-blue discoloration on the face, sclera, hard palate and back. Histologic examination showed intracellular pigment deposits in macrophages of the superficial dermis in a perivascular and an interstitial distribution. The pigment stained with Fontana-Masson and von Kossa, whereas it was Perls' iron negative. This case does not fit well into any of the previously described patterns of minocycline-related hyperpigmentation.

Topics: Acne Vulgaris; Aged; Anti-Bacterial Agents; Argyria; Dietary Supplements; Humans; Hyperpigmentation; Male; Minocycline; Mucous Membrane; Silver; Skin

Topics: Acne Vulgaris; Administration, Oral; Adult; Anti-Bacterial Agents; Cohort Studies; Delayed-Action Preparations; Drug Administration Schedule; Drugs, Generic; Female; Follow-Up Studies; Humans; Male; Minocycline; Ohio; Patient Compliance; Retrospective Studies; Severity of Illness Index; Treatment Outcome; Young Adult

Topics: Acne Vulgaris; Administration, Oral; Adolescent; Adult; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Resistance; Drug Therapy, Combination; Female; Humans; Isotretinoin; Minocycline; Pseudotumor Cerebri; Recurrence

Topics: Acne Vulgaris; Adolescent; Allergens; Anti-Bacterial Agents; Autoantibodies; Cross Reactions; Diabetes Mellitus, Type 1; Drug Hypersensitivity Syndrome; Female; Humans; Immunomodulation; Immunosuppressive Agents; Liver Transplantation; Minocycline

A 20-year-old woman underwent lacrimal gland biopsy for unilateral swelling and was unexpectedly found to have olive-green discoloration of her orbital rim. Postoperative questioning revealed that as a teenager she had been treated for acne with minocycline, a semisynthetic tetracycline antibiotic and a first-line treatment for moderate and severe acne. While hyperpigmentation is a known side effect of minocycline, reports of pigmentation changes of the periorbital bones are relatively rare and could pose a diagnostic dilemma during surgery.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Biopsy; Female; Humans; Lacrimal Apparatus; Minocycline; Orbital Diseases; Pigmentation Disorders; Visual Acuity; Young Adult

Topics: Acne Vulgaris; Alkaptonuria; Anti-Bacterial Agents; Arthroscopy; Diagnosis, Differential; Humans; Hyperpigmentation; Knee Joint; Male; Middle Aged; Minocycline; Pain

Thyroid dysfunction in adolescents treated with minocycline for acne has been previously described as transient effect and/or associated with autoimmune thyroiditis. We report nonimmune-mediated thyroid dysfunction associated with minocycline/doxycycline in 3 adolescents whose clinical courses suggest an adverse effect that may be more common, serious, and persistent than realized previously.

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Diplopia; Fatigue; Female; Headache; Humans; Hyperthyroidism; Male; Minocycline; Polydipsia; Thyrotropin; Thyroxine; Weight Loss

Pseudotumor cerebri is a syndrome characterized by an elevated intracranial pressure greater than 20 cmH2O with ventricles and cerebrospinal fluid of normal characteristics. Consumption of minocycline have been described among the causes associated with this syndrome. We present a 13-year old female patient with a history of acne treated with minocycline who began with severe headache, diplopia and blurred vision. The diagnosis of pseudotumor cerebri was made, indicating the immediate antibiotic suspension and the beginning of the treatment with acetazolamide. Although the pathogenesis of pseudotumor cerebri is not fully known, an association with minocycline has been observed. This antibiotic is often used by health professionals for the management of acne, so it is important to consider its complications before being prescribed.. El pseudotumor cerebral se caracteriza por una elevación de la presión intracraneal mayor de 20 cmH2O, con ventrículos y líquido cefalorraquídeo de características normales. El consumo de minociclina es una de las causas asociadas a este síndrome. Presentamos una paciente de 13 años de edad con antecedentes de acné tratado con minociclina. Comenzó con cefalea intensa, diplopía y visión borrosa. Se constató el diagnóstico de pseudotumor cerebral y se indicó la suspensión inmediata del antibiótico y el inicio del tratamiento con acetazolamida. Aunque la patogénesis de pseudotumor cerebral no es totalmente conocida, se ha observado una asociación con el empleo de minociclina. Este antibiótico es de uso frecuente para el manejo del acné, por lo que es importante considerar sus complicaciones antes de ser prescrito.

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Female; Humans; Minocycline; Pseudotumor Cerebri

Acne affects a large proportion of the Canadian population and has psychosocial and financial consequences.. We provide cost information for treatments recommended by the Canadian acne guidelines.. Highest level recommendations were selected for 3-month usage cost.. Three-month estimated treatment costs were as follows: topical retinoids ($14.40-$73.80), benzoyl peroxide (BPO; $6.75), fixed-dose BPO-clindamycin ($40.95-$44.10) and BPO-adapalene ($73.80), oral antibiotics ($25.20 for tetracycline 250 mg qid; $52.20 and $52.74 for doxycycline 50 mg bid and 100 mg od, respectively), and hormonal therapy ($26.46-$37.80 for ethinyl estradiol [EE] 0.030 mg/drospirenone 3mg and $75.60-108.99 for EE 0.035 mg/cyproterone acetate 2 mg). Oral isotretinoin 3-month costs ranged from $393.96 to $478.80.. Awareness of costs of recommended treatments may facilitate improved outcomes by increasing procurement and adherence.

Topics: Acne Vulgaris; Adapalene; Administration, Cutaneous; Administration, Oral; Androgen Antagonists; Androstenes; Anti-Bacterial Agents; Benzoyl Peroxide; Canada; Clindamycin; Cyproterone Acetate; Dermatologic Agents; Doxycycline; Drug Combinations; Estrogens; Ethinyl Estradiol; Humans; Isotretinoin; Mineralocorticoid Receptor Antagonists; Minocycline; Practice Guidelines as Topic; Severity of Illness Index; Tetracycline

Acne vulgaris is a multifactorial skin disease associated with the colonization of Propionibacterium acnes. Antibiotics are a mainstay of treatment for acne, yet the emergence of resistance against the currently approved antibiotics is a serious concern. In this case report, a slow responder had multiple Propionibacterium acnes isolates with varied levels of sensitivity to the conventional antibiotics. The bacterial isolates obtained from acne samples collected from the patient were analyzed for phylogeny, and was found to be largely restricted to two different lineage patterns. Propionibacterium acnes phylotype IA1, which is considered to be pathogenic, displayed clindamycin sensitivity, but phylotype IB, which is associated with commensals, exhibited high clindamycin resistance. Sensitivity analysis revealed uniform resistance to macrolides, but susceptibility to tetracycline and nadifloxacin. These results implicate Propionibacterium acnes in the pathophysiology of acne vulgaris, although the lines between commensal and pathological phylotypes may be blurred. Switching the patient to a combination of minocycline and nadifloxacin resulted in a significant improvement in the clinical lesions. Such a science-driven judicious selection of antibiotics can minimize the probability of development of resistance, and might be the way forward in the treatment of acne.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Drug Resistance, Bacterial; Drug Substitution; Drug Therapy, Combination; Fluoroquinolones; Genotype; Humans; Male; Minocycline; Phenotype; Phylogeny; Propionibacterium acnes; Quinolizines; Remission Induction; Ribotyping; Skin; Treatment Outcome; Young Adult

Topics: Acne Vulgaris; Anti-Bacterial Agents; Arizona; Chemical and Drug Induced Liver Injury; Drug Labeling; Humans; Judicial Role; Liability, Legal; Lupus Erythematosus, Discoid; Minocycline

Black bone disease has been recognised as a potential consequence of long-term treatment with tetracycline antibiotics. Largely documented affecting structures in the head and skull, there are few reported cases of black bone disease in the foot and ankle. The case of a 55 years old patient, who as a teenager, had undergone treatment with minocycline hydrochloride for chronic acne, and was found to have bone discolouration consistent with minocycline induced black bone disease (MIBBD) during the course of hallux valgus corrective surgery some 40 years later, is presented. In spite of the intraoperative findings, the patient's post-operative recovery and bone healing was uneventful. The literature on minocycline induced black bone disease is reviewed.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Bone Diseases; Female; Hallux Valgus; Humans; Intraoperative Period; Middle Aged; Minocycline

A 40-year-old woman was referred by her primary care physician for evaluation after a routine physical exam revealed bilateral brownish pigmentation of the tympanic membrane. Head and neck examination in the otolaryngology clinic revealed bluish hue of both sclera, teeth, and portions of her pinnae. A hearing test revealed bilateral mild sensorineural hearing loss. The patient had a history of taking minocycline for 14 years, and the hyperpigmentation that she had is known to be a rare complication of prolonged minocycline use. However, to our knowledge, this is the first case showing photographic evidence of minocycline-induced tympanic membrane hyperpigmentation. Minocycline-induced hyperpigmentation should be considered when a patient presents with brown or blue discoloration of the tympanic membrane.

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Ear Auricle; Ear Diseases; Female; Humans; Hyperpigmentation; Minocycline; Scleral Diseases; Tympanic Membrane

Topics: Acne Vulgaris; Acute Disease; Adult; Drug Hypersensitivity Syndrome; Early Diagnosis; Female; Giant Cells; Heart Transplantation; Humans; Methylprednisolone; Minocycline; Myocarditis; Treatment Failure; Ventricular Dysfunction, Left; Young Adult

Topics: Acanthosis Nigricans; Acne Vulgaris; Adult; Anti-Bacterial Agents; Biopsy; Diagnosis, Differential; Foot Dermatoses; Humans; Hyperpigmentation; Male; Minocycline; Neurodermatitis

Topics: Acne Vulgaris; Aged; Anti-Bacterial Agents; Humans; Incidence; Male; Minocycline; Nails; Pigmentation Disorders; Rosacea; Skin; Treatment Outcome

An 18-year-old Japanese girl had received oral minocycline 200mg daily for treatment of acne vulgaris since 16 years old. She had a fever three months before admission, followed by joint pains in her knees, elbows and several proximal interphalangeal joints one month before admission. She was referred to our hospital because of a high serum level of anti-DNA antibody. She had already discontinued oral minocycline five weeks before admission, because she missed her medication refilled. On admission, the arthralgia and fever spontaneously resolved, and there were no laboratory evidence of hypocomplementemia and cytopenia. She had neither erythema nor internal organ involvements. Because her symptoms subsided spontaneously after the cessation of minocycline, she was considered to have drug-induced lupus. Both the arthralgia and fever did not relapse, and anti-ds DNA antibody returned to normal during a follow-up period without treatment. There are few reports of drug-induced lupus caused by minocycline in Japan. This case highlights the importance of considering minocycline-induced lupus.

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Antibodies, Antinuclear; Biomarkers; Female; Humans; Lupus Erythematosus, Systemic; Minocycline; Time Factors

Topics: Acne Vulgaris; Anti-Bacterial Agents; Diagnosis, Differential; Disease Progression; Eye Color; Female; Humans; Hyperpigmentation; Hypothyroidism; Middle Aged; Minocycline; Sclera; Thyroid Hormones

Topics: Acne Vulgaris; Anti-Bacterial Agents; Benzoyl Peroxide; Dermatologic Agents; Doxycycline; Drug Resistance, Bacterial; Gram-Positive Bacterial Infections; Humans; Isotretinoin; Minocycline; Propionibacterium acnes; Zinc

Topics: Acne Vulgaris; Acute Kidney Injury; Anti-Bacterial Agents; Antibodies, Antineutrophil Cytoplasmic; Humans; Kidney Function Tests; Male; Minocycline; Polyarteritis Nodosa; Treatment Outcome; Withholding Treatment; Young Adult

Tumor necrosis factor α antagonists are potent biologics used to treat a variety of autoimmune disorders such as rheumatoid arthritis, ankylosing spondylitis, Crohn disease, psoriasis, and psoriatic arthritis. These medications are known to have many side effects (eg, infusion reactions, cytopenia, risk for infection, heart failure); however, only a few cases of acne vulgaris have been associated with the use of these biologics, particularly infliximab and adalimumab. We report a rare case of etanercept-induced cystic acne.

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Dermatologic Agents; Etanercept; Humans; Immunoglobulin G; Male; Minocycline; Psoriasis; Receptors, Tumor Necrosis Factor; Treatment Outcome

Topics: Acne Vulgaris; Anti-Bacterial Agents; Diagnosis, Differential; Humans; Lupus Erythematosus, Systemic; Lyme Disease; Male; Minocycline

Topics: Acne Vulgaris; Adolescent; Adult; Anti-Bacterial Agents; Child; Evidence-Based Medicine; Humans; Middle Aged; Minocycline; Practice Patterns, Physicians'; Young Adult

Drug-induced autoimmune hepatitis is an acute and potentially severe side effect, particularly often reported after the long-term use of minocycline. The condition's characteristic biochemical findings are highly elevated transaminase levels, only mildly increased markers of cholestasis and bilirubin levels, an elevated IgG concentration and a high antinuclear antibody (ANA) titre.. A 14-year-old girl developed autoimmune hepatitis due to the long-term use of minocycline for acne vulgaris. She presented with icterus and very high transaminase levels. The patient made a full recovery after the medication was discontinued.. This type of autoimmune hepatitis can be differentiated from 'classic' autoimmune hepatitis by the patient's quick recovery after stopping the inducing drug and no relapse of the condition after the discontinuation of glucocorticoid therapy.

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Antibodies, Antinuclear; Chemical and Drug Induced Liver Injury; Female; Hepatitis, Autoimmune; Humans; Immunoglobulin G; Minocycline

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Female; Humans; Hyperpigmentation; Laser Therapy; Minocycline; Thigh

Topics: Acne Vulgaris; Administration, Oral; Adolescent; Diagnosis, Differential; Female; Humans; Hyperpigmentation; Long-Term Care; Minocycline; Nail Diseases; Onycholysis; Photosensitivity Disorders; Sunlight

To describe the clinical features, treatment, and outcomes of polyarteritis nodosa (PAN)-like vasculitis in association with minocycline therapy.. We identified all subjects ≥18 years old with PAN-like vasculitis in the context of minocycline use seen at our institution between January 1995 and October 2010. Cases of hepatitis B-associated PAN were excluded. PAN was defined based on angiographic findings or tissue biopsy. Minocycline use was defined as medication use at the time of onset of first symptom.. We identified 9 patients (5 females; 56%) with a median age of 30 (range 18 to 55) years. Four patients (44%) had isolated cutaneous disease, while 5 cases (56%) had systemic involvement including renal artery microaneurysms (2 patients), cholecystitis (1 patient), mononeuritis multiplex (2 patients), and mesenteric vasculitis (1 patient). Median duration of minocycline use was 2 (range 1 to 4) years. Three patients had a positive antinuclear antibody with negative extractable nuclear antigen antibodies. All patients had positive antineutrophil cytoplasmic antibody in a perinuclear pattern but specificity to myeloperoxidase was observed in 2 patients (22%). Diagnosis was confirmed by histopathology in 6 patients (67%) and angiography in 3 patients (33%). Minocycline was discontinued in all cases. Further immunosuppressive therapy was added in 6 cases (67%).. Cutaneous, as well as systemic, PAN-like vasculitis may occur in association with minocycline use. Clinicians should consider the possibility of drug-induced vasculitis, especially in cases of medium-vessel vasculitis with atypical antineutrophil cytoplasmic antibody serologies or in patients with negative hepatitis B testing.

Topics: Acne Vulgaris; Adolescent; Adult; Anti-Bacterial Agents; Antibodies, Antinuclear; Female; Humans; Immunosuppressive Agents; Male; Middle Aged; Minocycline; Polyarteritis Nodosa; Young Adult

Topics: Acne Vulgaris; Humans; Male; Middle Aged; Minocycline; Parkinson Disease; Skin Diseases; Treatment Outcome

Minocycline is a bacteriostatic, long-acting, lipid-soluble tetracycline that is generally well tolerated, but has been associated with polyarteritis nodosa (PAN). This is a case report of a 21-year-old woman presented to her primary care physician with several months of fatigue, mylagias, weight loss and intermittent severe bi-temporal headaches without changes in vision. Her medications included an Ortho-Tri-Cyclen Lo and Minocycline, which she started 2 years prior for acne. On presentation, she was tachycardic and severely hypertensive. Initial laboratory evaluation showed hyponatraemia and hypokalaemia as well as elevation of inflammatory markers. Autoimmune work-up was positive for perinuclear antineutrophil cytoplasmic antibodies. Renal arteriogram was characteristic of PAN and along with her other symptoms, she fulfilled the necessary criteria of American College of Rheumatology for diagnosis of PAN. Minocycline as a possible causative agent was discontinued since it was reported to cause cutaneous PAN in the literature. Cyclophosphamide and prednisone were initiated for treatment of her vasulculitis. Her symptoms and hypertension improved over the next several months. This is the first report of the minocycline-induced renal PAN.

Topics: Acne Vulgaris; Adult; Angiography; Angiotensin-Converting Enzyme Inhibitors; Anti-Bacterial Agents; Anti-Inflammatory Agents; Arteries; Cyclophosphamide; Female; Humans; Hypertension; Kidney; Minocycline; Polyarteritis Nodosa; Prednisone; Young Adult

Erythema nodosum leprosum is defined by the appearance of tender skin nodules, which can be accompanied by fever, joint pain, neuritis, edema, malaise and/or lymphadenopathy. The authors describe the case of a 19-year-old Angolan black woman, resident in Portugal for the last 10 years, diagnosed with Hansen's disease at the age of 12, irregular with follow-up and non-compliant with treatment. She was referred to our clinic with painful nodules and pustules on the upper limbs, diffuse facial infiltration with pustules and fever, after initiating minocycline with the intention of treating acne. Diagnosis of erythema nodosum leprosum was confirmed by the presence of acid-fast bacilli in the skin smear and also in skin biopsy. Minocycline was suspended and the patient was treated with systemic steroids, with prompt clinical improvement. Our case is reported to alert clinicians to this unusual presentation of erythema nodosum leprosum in a patient treated with highly bactericidal drugs that were not intended to treat Hansen's disease.

Topics: Acne Vulgaris; Biopsy, Needle; Drug Therapy, Combination; Erythema Nodosum; Female; Follow-Up Studies; Humans; Immunohistochemistry; Leprostatic Agents; Leprosy, Lepromatous; Minocycline; Prednisolone; Risk Assessment; Treatment Outcome; Young Adult

An analytical method for the simultaneous determination of 6 antibiotics (minocycline, oxytetracycline, tetracycline hydrochloride, chlorotetracycline hydrochloride, doxycycline hydrochloride and chloramphenicol) and metronidazole in acne removal products of cosmetic was established using high performance liquid chromatography (HPLC). The drugs in the sample were extracted with methanol. The separation was performed on an Agilent ZORBAX SB-C18 column (250 mm x 4.6 mm, 5 microm) at 20 degrees C with methanol, acetonitrile and 0.002 mol/L oxalic acid solution as mobile phases with gradient elution at a flow rate of 0.8 mL/min. The detection was performed by a diode array detector (DAD) at 268 nm. The injection volume was 10 microL. The quantification was performed by external standard method. The calibration curves showed good linearity within the range of 1 - 30 mg/L with the correlation coefficients no less than 0.997 0. The detection limits were in the range of 1.1 - 1.2 microg/g. The recoveries were between 91.9% and 107.7% in three spiked levels of 5, 10 and 20 mg/L with the relative standard deviations (RSDs) of 0.13% - 1.74%. The method was used in the analysis of acne removal products, and metronidazole was found in 15% of the total test samples. The method is rapid, sensitive, accurate, effective in separation, and can be used in the determination of the six antibiotics and metronidazole in acne removal products.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Anti-Infective Agents; Chromatography, High Pressure Liquid; Cosmetics; Humans; Metronidazole; Minocycline; Oxytetracycline; Tetracycline

Propionibacterium acnes plays an important role in the development of acne, and inflammatory lesions are improved by antibiotics. Long-term use of antibiotics may result in development of resistant strains and treatment failure. The aim of the present study was to investigate the isolation rate of P. acnes and to evaluate its antibiotic susceptibility to widely used antibiotics in acne in Korea. Among 46 patients, 31 P. acnes strains were cultured. Isolated P. acnes was measured for minimum inhibitory concentration (MIC) of tetracycline, doxycycline, minocycline, erythromycin and clindamycin using an Epsilometer test. Age, disease duration and previous history of antibiotic therapy for acne were compared in relation to the MIC. The mean MIC of tetracycline, minocyclines, doxycycline, clindamycin and erythromycin were all below the breakpoint of antibiotic resistance. The patients with acne vulgaris with disease duration of more than 2 years documented higher MIC values in doxycycline, erythromycin, and clindamycin than those of less than 2 years. The patients who were previously treated with topical or systemic antibiotics showed higher MIC in doxycycline. Antibiotic resistance of P. acnes is still low in Korea, but at this point, there is an increasing trend of MIC. Caution and acknowledgement of increased risk of antibiotic resistant P. acnes should be advised in acne antibiotic treatment to minimize and avoid the emergence of the resistant strain.

Topics: Acne Vulgaris; Adolescent; Adult; Anti-Bacterial Agents; Child; Clindamycin; Doxycycline; Drug Resistance, Microbial; Erythromycin; Female; Gram-Positive Bacterial Infections; Humans; In Vitro Techniques; Male; Microbial Sensitivity Tests; Minocycline; Propionibacterium acnes; Republic of Korea; Tetracycline; Young Adult

The aim of this study was to examine whether brownish crown and root discoloration of wisdom teeth was related to treatment of acne with tetracyclines. For this purpose, 17 discolored third molars from nine patients were embedded without being decalcified, ground along the tooth axis, and examined using fluorescence microscopy. A thorough medical history served to determine the start and duration of any administration of tetracyclines. This confirmed the use of drugs against acne containing minocycline in all cases except one. The microscopic analyses of all teeth revealed intensely fluorescent bands in the dentin, which corresponded to the mineralization front at the time of tetracycline intake. More or less uniform discoloration of the entire crown was seen in association with treatment against acne prior to the completion of crown formation at the age of about 15 years. This uniform staining can be attributed to incorporation of minerals during ongoing maturation of the occlusal enamel, which is concomitant with the formation of the cervical crown regions. When acne was treated between 15 and 22 years of age, only the roots of the third molars displayed annular discolorations, which seemed to result from the incorporation of tetracyclines into dentin, while fine fluorescent incremental lines in root cementum were too thin to be apparent clinically. Three accidentally removed interradicular bony septa revealed that tetracyclines incorporated into alveolar bone remained there for about 2 years, but thereafter disappeared as a result of physiological remodelling.

Topics: Acne Vulgaris; Adolescent; Adult; Alveolar Process; Anti-Bacterial Agents; Dental Enamel; Dentin; Female; Humans; Male; Microscopy, Fluorescence; Minocycline; Tooth Calcification; Tooth Crown; Tooth Discoloration; Tooth Root; Young Adult

Topics: Acne Vulgaris; Anti-Bacterial Agents; Doxycycline; Humans; Minocycline

Multiple cutaneous osteomas are a rare complication of chronic inflammatory acne that often goes unrecognized. We report a case concerning a 35-year-old woman.. A 35-year-old woman had been treated for acne since the age of 22 years, as part of which she received two courses of oral isotretinoin. We noted the secondary appearance of several microcysts on the face for which the excision was very difficult. Curiously, these small formations did not contain keratin but were very callous. Histological examination revealed foci of osseous metaplasia, probably of postinflammatory origin. Treatment consisted solely of excision of the lesions.. Osteoma cutis comprises two distinct groups (primary and secondary). In our case, there were multiple cutaneous osteomas of the face resulting from chronic acne. The differential diagnosis was idiopathic miliary osteomatosis of the face, but this was ruled out by the young age of the patient, the improvement of the acneiform lesions under isotretinoin (confirming the initial diagnosis of acne) and the subsequent appearance of microcysts. Although there are as yet no codified treatments, excision appears to yield good results.

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Dermatologic Agents; Durapatite; Female; Fenofibrate; Humans; Hypertriglyceridemia; Hypolipidemic Agents; Isotretinoin; Minocycline; Neoplasms, Multiple Primary; Osteoma; Skin Neoplasms

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare serious adverse effect associated with a variety of medications. We present a case of minocycline-induced DRESS syndrome, which resulted in acute renal failure, transient thyroiditis, and transaminitis, and a persistent lymphocytic myocarditis resulting in congestive heart failure. To our knowledge, this is the third reported case of minocycline-induced myocarditis. Additionally, we report successful plasmapheresis and rituximab treatment for minocycline-induced myocarditis associated with the DRESS syndrome.

Topics: Acne Vulgaris; Adult; Antibodies, Monoclonal; Antibodies, Monoclonal, Murine-Derived; Drug Eruptions; Drug Hypersensitivity; Eosinophilia; Female; Humans; Minocycline; Myocarditis; Plasmapheresis; Rituximab

Previous studies have shown an association between isotretinoin and inflammatory bowel disease (IBD). The majority of patients prescribed isotretinoin for their acne are previously on an extended course of antibiotics. Therefore, it is important to consider antibiotic use as a confounding variable for the development of IBD.. We performed a retrospective cohort study using The Health Improvement Network database of the United Kingdom. We identified 94,487 individuals with acne who were followed up by a general practitioner for 406,294 person-years.. >A prescription for minocycline was received by 24,085 individuals, for tetracycline/oxytetracycline by 38,603 individuals, and doxycycline by 15,032 individuals. IBD was noted in 41 individuals exposed to minocycline, 79 individuals exposed to tetracycline/oxytetracycline, 32 individuals exposed to doxycycline, and 55 (0.11%) individuals not exposed to any of these antibiotics. The hazard ratio (HR) for developing IBD for any exposure to a tetracycline antibiotic was 1.39 (1.02, 1.90). HRs for individual antibiotics were 1.19 (0.79, 1.79) for minocycline, 1.43 (1.02, 2.02) for tetracycline/oxytetracycline, and 1.63 (1.05, 2.52) for doxycycline. For ulcerative colitis, the associations (HR) were 1.10 (0.76, 1.82) for minocycline, 1.27 (0.78, 2.07) for tetracycline/oxytetracycline, and 1.06 (0.53, 2.13) for doxycycline. For Crohn's disease (CD), the associations (HR) were 1.28 (0.72, 2.30) for minocycline, 1.61 (0.995, 2.63) for tetracycline/oxytetracycline, and 2.25 (1.27 4.00) for doxycycline.. Tetracycline class antibiotics, and particularly doxycycline use may be associated with the development of IBD, particularly CD. Potential confounding by previous doxycycline exposure should be considered when assessing whether treatment with other acne medications increases the risk of IBD.

Topics: Acne Vulgaris; Chi-Square Distribution; Confounding Factors, Epidemiologic; Dermatologic Agents; Doxycycline; Drug Interactions; Female; Humans; Inflammatory Bowel Diseases; Isotretinoin; Male; Minocycline; Oxytetracycline; Proportional Hazards Models; Retrospective Studies; Risk Factors; Statistics, Nonparametric; Tetracycline; United Kingdom; Young Adult

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Bone Diseases; Humans; Male; Metacarpal Bones; Minocycline; Pigmentation Disorders

Minocycline is an oral tetracycline that, unlike some other drugs in its class, is a once-daily treatment and need not be taken on an empty stomach.1 Such potential advantages together with preferential use in secondary care helped to establish minocycline as the oral tetracycline of choice for acne.2,3 However, concerns over the safety of minocycline and the lack of therapeutic advantage over other tetracyclines have challenged this view.1,4,5 Here we consider how trends in prescribing of minocycline have changed in the UK in recent years.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Drug Costs; Humans; Minocycline; Practice Patterns, Physicians'; Prescription Drugs

Drug hypersensitivity syndrome (DHS) is a severe, multisystem adverse drug reaction that may occur following the use of numerous medications, including anticonvulsants, sulfonamides, and minocycline hydrochloride. Long-term autoimmune sequelae of DHS have been reported, including hypothyroidism.. A 15-year-old female adolescent developed DHS 4 weeks after starting minocycline therapy for acne vulgaris. Seven weeks later she developed autoimmune hyperthyroidism (Graves disease), and 7 months after discontinuing minocycline therapy she developed autoimmune type 1 diabetes mellitus. In addition, she developed elevated titers of several markers of systemic autoimmune disease, including antinuclear, anti-Sjögren syndrome A, and anti-Smith antibodies.. Minocycline-associated DHS may be associated with multiple autoimmune sequelae, including thyroid disease, type 1 diabetes mellitus, and elevated markers of systemic autoimmunity. Long-term follow-up is needed in patients with DHS to determine the natural history of DHS-associated sequelae.

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Autoimmune Diseases; Diabetes Mellitus, Type 1; Drug Hypersensitivity; Female; Graves Disease; Humans; Minocycline

Over the years, a variety of abnormal immune reactions to minocycline have been reported including arthritis, systemic lupus erythematosus, and hepatitis. The current report describes the detailed clinical and pathologic features of 3 patients who presented with chronic/autoimmune hepatitis alone while on minocycline at our hospital over a 2-year period. Minocycline use in these patients was temporally related to onset of severe hepatitis. Adolescents with such a reaction to minocycline have been included in previous reports but have not been well described as a distinct entity. We have compared our cases with similar cases previously reported with a review of the literature and a discussion of the implications for prescribing physicians.

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Chemical and Drug Induced Liver Injury, Chronic; Female; Hepatitis, Autoimmune; Humans; Male; Minocycline; Severity of Illness Index

(1) In mid-2008 the French National Pharmacovigilance Committee examined spontaneous reports of adverse effects observed during tetracycline therapy; (2) When sales figures are taken into account, reports were more frequent with minocycline than with doxycycline. The proportion of severe adverse effects was also higher with minocycline than with doxycycline; (3) Life-threatening hypersensitivity reactions and autoimmune adverse effects were more frequent with minocycline than with doxycycline; (4) In practice, minocycline has a less favourable risk-benefit balance than doxycycline, particularly in the treatment of acne.

Topics: Acne Vulgaris; Autoimmune Diseases; Doxycycline; Drug Hypersensitivity; Drug-Related Side Effects and Adverse Reactions; France; Humans; Minocycline

This office-based case series describes the use of a new formulation of benzoyl peroxide (BPO) delivered via a porous microsphere cream vehicle in patients with mild to moderate acne vulgaris. While BPO has been used for many years as antimicrobial in the treatment of acne, in recent years its use has been increasingly encouraged as part of a strategy designed to reduce Propionibacterium acnes (P acnes) resistance to antibiotics. Historically, a major drawback to BPO treatment has been irritation, which may be concentration-dependent or vehicle-dependent. A new BPO microsphere cream formulation has recently been introduced and appears to offer favorable efficacy with a very low potential for irritation. This article presents a series of patients from 2 private dermatologic practices treated with a new BPO microsphere cream formulation both as monotherapy and in combination with other acne drugs.

Topics: Acne Vulgaris; Adapalene; Administration, Topical; Adolescent; Adult; Anti-Bacterial Agents; Benzoyl Peroxide; Dermatologic Agents; Drug Therapy, Combination; Female; Humans; Keratolytic Agents; Male; Microspheres; Minocycline; Naphthalenes; Tretinoin

Minocycline is an effective antibiotic widely used in the treatment of acne vulgaris. We report a previously well 20-year-old woman who developed liver dysfunction with jaundice and malaise following a 1 year course of minocycline for acne vulgaris. Serum antinuclear antibody was strongly positive (1 : 2560) and liver transaminases were grossly deranged. All other causes of liver disease were excluded. Both the clinical symptoms and laboratory abnormalities resolved spontaneously on stopping the drug. We review the three different types of hepatotoxicity associated with minocycline and draw evidence to support the diagnosis of minocycline-induced autoimmune hepatitis. This case supports the call to monitor patients on minocycline therapy for autoimmune disease of the liver and highlights the need for a multicentre prospective trial of the risks and benefits of long-term minocycline therapy.

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Chemical and Drug Induced Liver Injury; Female; Hepatitis, Autoimmune; Humans; Minocycline

We describe a 31-year-old woman who had ingested minocycline for 18 months prior to presenting with hyperthyroidism and a palpable thyroid nodule. There was no evidence of Graves' disease or autonomous nodule on thyroid scintigraphy, and a clinical diagnosis of thyroiditis was made. Fine-needle aspiration biopsy of the palpable lesion suggested papillary carcinoma, and the patient underwent a total thyroidectomy. Intraoperatively, the thyroid gland was found to have a striking black discoloration. Subsequent histological examination revealed the accumulation of pigment globules within the apical cytoplasm of the follicular cells, and associated findings of a drug-induced thyroiditis. The tumor nodule showed features of infarction and was felt to represent a necrotic papillary microcarcinoma. We postulate that in addition to causing black thyroid pigmentation, chronic minocycline use in our patient resulted in thyroiditis and subsequent hyperthyroidism. The papillary microcarcinoma was probably a coincidental finding.

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Carcinoma, Papillary; Female; Humans; Hyperthyroidism; Incidental Findings; Minocycline; Thyroid Gland; Thyroid Neoplasms; Thyroiditis

An 18-year-old patient is described who presented with febrile neutropenia and hepatitis caused by minocycline therapy. This rare complication of minocycline-induced lupus syndrome is discussed here.

Topics: Acne Vulgaris; Adolescent; Antibodies, Antineutrophil Cytoplasmic; Autoantibodies; Humans; Lupus Erythematosus, Systemic; Male; Minocycline; Neutropenia

Minocycline-induced drug rash with eosinophilia and systemic symptoms (DRESS) may have a prolonged course, especially in African and African-American patients.. To determine if a prolonged course of minocycline-induced DRESS was associated with an accumulation of the culprit drug.. We determined plasma and skin levels of minocycline in patients with minocycline-induced DRESS. We investigated the genetic polymorphisms of enzymes potentially involved in the detoxification of the drug, glutathione S-transferases and UDP-glucuronosyltransferases.. We demonstrated the persistence of minocycline in the plasma and/or in the skin of 7 out of 9 patients with skin phototypes V-VI. As pigmented skin contains more melanin, this could promote the formation of a melanin-minocycline complex, which could explain the severe and prolonged DRESS which may occur in this subgroup of patients.

Topics: Acne Vulgaris; Adolescent; Adult; Anti-Bacterial Agents; Black People; Chromatography, High Pressure Liquid; Drug Hypersensitivity; Eosinophilia; Female; Genetic Predisposition to Disease; Genotype; Glutathione Transferase; Humans; Male; Melanins; Middle Aged; Minocycline; Polymerase Chain Reaction; Polymorphism, Genetic; Sequence Deletion; Skin; Skin Pigmentation; Syndrome

Topics: Acne Vulgaris; Adult; Anti-Allergic Agents; Anti-Bacterial Agents; Diphenhydramine; Epinephrine; Famotidine; Female; Humans; Methylprednisolone; Minocycline; Prednisone; Risk Factors; Serum Sickness; Triamcinolone

Mitochondrial myopathies are heterogeneous disorders with diverse presentations including laboratory findings of lactic acidosis. Often times they are diagnosed in childhood or the early teenage years following an infectious illness. Minocycline is a common antibiotic used for the treatment of acne. It has been reported to alter mitochondrial respiratory chain complexes. We report an interesting case of a teenager in which mitochondrial myopathy with severe lactic acidosis presented following a bout of infectious mononucleosis and minocycline use. It is hypothesized that oxidative stress from the infectious illness plus the minocycline use triggered the patient's presentation. The clinical manifestations and genetics of mitochondrial myopathies and treatment are discussed along with the management of lactic acidosis.

Topics: Acidosis, Lactic; Acne Vulgaris; Adolescent; Anti-Bacterial Agents; DNA, Mitochondrial; Female; Humans; Infectious Mononucleosis; Lactic Acid; Minocycline; Mitochondrial Myopathies; Muscle Fatigue; Oxidative Stress

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Antibodies, Antineutrophil Cytoplasmic; Female; Humans; Minocycline; Polyarteritis Nodosa

A relatively newer class of chemotherapy agents, known as the epidermal growth factor receptor inhibitors (EGF-RIs), is being used to treat advanced stages of solid tumors. Acneiform eruptions are a frequent adverse effect and one which has been associated with increased survival in some studies. We describe 3 patients who presented shortly after initiation of EGF-RI therapy. Characteristics included an absence of comedones, facial and truncal involvement, and a perifollicular lymphoneutrophilic infiltrate detected on biopsy. Lesion counts were reduced with topical adapalene and oral tetracyclines in two patients. Patient 3 had dramatic clearance with low-dose isotretinoin (20 mg daily) until completion of EGF-RI therapy. Acneiform eruptions are a common adverse reaction to EGF-RI therapy and can be treated with traditional acne therapy. This should not be considered a drug hypersensitivity eruption or allergy, and patients should continue therapy. For patients with severe eruptions, oral isotretinoin is a consideration.

Topics: Acne Vulgaris; Adapalene; Administration, Oral; Administration, Topical; Adult; Anti-Bacterial Agents; Antineoplastic Agents; Colonic Neoplasms; Dermatologic Agents; Dose-Response Relationship, Drug; ErbB Receptors; Humans; Isotretinoin; Lung Neoplasms; Male; Middle Aged; Minocycline; Naphthalenes

Topics: Acne Vulgaris; Adult; Alveolitis, Extrinsic Allergic; Female; Humans; Minocycline; Radiography

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Female; Follow-Up Studies; Humans; Liver Failure, Acute; Liver Transplantation; Minocycline

Minocycline (MN), one of the commonly prescribed therapies for acne, is known to be associated with autoimmune disorders including drug-induced lupus. However, data are sparse regarding the prevalence of autoimmune disease in acne or in patients with acne treated with MN.. To establish the prevalence of antinuclear antibodies (ANA), antineutrophil cytoplasmic antibodies (ANCA) and new autoimmune syndromes in an MN-exposed and unexposed population with acne.. In a cross-sectional study, 252 patients with acne vulgaris were assessed. Sixty-nine per cent had been exposed to MN at some point or were taking the drug at the time of the interview. Data recorded included duration of disease (acne) and drug history as well as possible side-effects of drugs, in particular joint symptoms (pain and swelling). In addition, blood was taken for ANA, ANCA, liver function tests and HLA analysis.. There was no statistical difference in the prevalence of ANA positivity between patients exposed (13%) or not exposed (11%) to MN. However, higher titres of ANA (1/160 or higher) were found in the MN-exposed group (45% compared with 12% in the unexposed group). ANCA positivity was found in 7% of the MN-exposed group but no positivity was found in the unexposed cohort (P = 0.022). In 58% of cases, the ANCA detected were of the perinuclear pattern (p-ANCA) with myeloperoxidase specificity, and this finding was associated with clinical symptoms in the majority of cases. Two p-ANCA-positive patients were thought in retrospect to have developed a drug-induced lupus syndrome.. ANA positivity is seen in patients with acne irrespective of exposure to MN; however, p-ANCA appear to be a serological marker for developing autoimmune disease in patients receiving MN.

Topics: Acne Vulgaris; Adolescent; Adult; Aged; Anti-Bacterial Agents; Antibodies, Antineutrophil Cytoplasmic; Antibodies, Antinuclear; Autoimmune Diseases; Cross-Sectional Studies; England; Female; Humans; Lupus Erythematosus, Systemic; Male; Middle Aged; Minocycline

Minocycline is a tetracycline derivative with multiple clinical uses including the treatment of various infections, acne vulgaris, and rosacea. Numerous adverse events have been reported ranging from minor complaints such as nausea, to serious life-threatening toxicities such as acute renal failure, hepatotoxicity, and systemic lupus erythematosus. We report the case of an 18-year-old female patient who developed minocycline-induced cutaneous polyarteritis nodosa after taking minocycline for acne vulgaris. The vasculitis resolved after discontinuation of the minocycline without need for corticosteroids. This case is the eighth biopsy-confirmed case of minocycline-induced polyarteritis nodosa. Although minocycline is an effective medication with a wide variety of clinical uses, clinicians must be aware of its potential side effects including autoimmune-related disorders such as polyarteritis nodosa or systemic lupus erythematosus.

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Antibodies, Antinuclear; Female; Humans; Minocycline; Polyarteritis Nodosa

Previous studies have associated tetracyclines and, perhaps more specifically, minocycline use for the treatment of acne with onset of drug-induced lupus erythematosus (LE).. To determine the frequency of LE among those with acne who used antibiotics from the tetracycline class of antibiotics.. A retrospective cohort study of individuals aged 15-35 years with acne within the practices of the general practice physicians in the U.K. who participate in The Health Information Network (THIN). Our outcome measure was physician reports of LE.. We identified 97 694 subjects with acne who were followed for about 520 000 person-years. They were on average about 22 years old and 57.5% were female. Minocycline exposure was noted in 24.8% of our subjects, doxycycline exposure in 15.6%, other tetracyclines in 42.3%, and 17.3% had not received a tetracycline antibiotic. The overall hazard ratio for the association of minocycline to LE was 2.64 (95% confidence interval 1.51-4.66) and when adjusted for age and gender was 3.11 (1.77-5.48). Those affected were often treated for LE. No association was noted for doxycycline and the other tetracyclines.. The use of minocycline and not the other tetracyclines is associated with LE. LE as reported in THIN often required systemic therapy. Overall, the event is uncommon but the risk and benefit of minocycline therapy must be carefully considered.

Topics: Acne Vulgaris; Adolescent; Adult; Anti-Bacterial Agents; Cohort Studies; Female; Humans; Lupus Erythematosus, Systemic; Male; Minocycline; Retrospective Studies; Treatment Outcome

Topics: Acne Vulgaris; Adenoma; Humans; Male; Middle Aged; Minocycline; Pigmentation; Thyroid Neoplasms

Topics: Acne Vulgaris; Anti-Bacterial Agents; Conjunctival Diseases; Humans; Male; Middle Aged; Minocycline; Pigmentation Disorders; Scleral Diseases

Hyperpigmentation associated with prolonged minocycline use is well documented. The histopathology of cutaneous minocycline pigment is characterized by deposition of brown/black, Fontana-Masson, and Perls' positive granules deposited along elastic fibers in the papillary dermis and occurring within macrophages along vessels and eccrine units in the dermis. The subcutis may also be involved; however, the specific subcutaneous findings associated with minocycline hyperpigmentation have not been well established. We present the histopathologic findings of 4 cases of minocycline hyperpigmentation with subcutaneous involvement. Green-gray, flocculent, nonrefractile globules within macrophages were found in the subcutis of all patients. Two of 4 cases exhibited lipomembraneous changes that were also associated with pigment. These distinctive findings may provide additional clues to enable a diagnosis of drug-induced hyperpigmentation to be offered, even in the absence of a clear clinical history.

Topics: Acne Vulgaris; Adolescent; Adult; Anti-Bacterial Agents; Female; Humans; Macrophages; Middle Aged; Minocycline; Pigmentation Disorders; Subcutaneous Fat

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Female; Hepatitis, Autoimmune; Humans; Immunoglobulins, Intravenous; Minocycline; Purpura, Thrombocytopenic, Idiopathic

Although disfiguring hyperpigmentation is a well-defined complication of minocycline therapy, modalities to reverse the phenomenon are unpredictable. We report a case of minocycline-induced, blue-black pigmentation in a 23-year-old Hispanic man, which resolved after treatment with oral isotretinoin for acne vulgaris.

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Dermatologic Agents; Humans; Hyperpigmentation; Isotretinoin; Male; Minocycline; Skin

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Diagnosis, Differential; Humans; Lupus Erythematosus, Systemic; Male; Minocycline

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Antihypertensive Agents; Hepatitis, Autoimmune; Humans; Hypertension; Immunosuppressive Agents; Liver; Liver Cirrhosis; Lupus Vulgaris; Male; Minocycline

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Bedding and Linens; Female; Humans; Minocycline; Skin Pigmentation; Sweat; Syndrome

Propionibacterium acnes is often discussed as a contributing pathogenic factor in the aetiology of acne lesions. The aim of this study was to test which porphyrin patterns are synthesized by P. acnes in vivo in untreated acne patients and during standard acne regimens. These photosensitive compounds are potential targets for photo-dynamic therapy of acne and need to be better characterized in the skin. Using high-performance liquid chromatography coproporphyrin III was the main porphyrin identified in all patients. Coproporphyrin I and protoporphyrin were found at considerably lower concentrations. When the porphyrin concentration of individual patients receiving isotretinoin was analysed repeatedly over time, clinical improvement was associated with lowered levels of porphyrins. Statistical analysis demonstrated a significant reduction in the porphyrin fractions only in the isotretinoin group which was associated with clinical improvement 2 months after starting therapy.

Topics: Acne Vulgaris; Adolescent; Adult; Anti-Bacterial Agents; Benzoyl Peroxide; Chromatography, High Pressure Liquid; Coproporphyrins; Dermatologic Agents; Female; Humans; Isotretinoin; Male; Minocycline; Porphyrins; Propionibacterium acnes; Protoporphyrins

We report the case of an 18-year-old woman with arthralgia and swelling of distal joints at hands and feet, photosensitive reaction, butterfly rash, fatigue, tachypnea and unspecific cardiac pain three months after beginning a treatment with minocycline for acne. Recurrence of symptoms at a higher intensity occurred within hours of reexposition with minocycline. The antinuclear antibody test was positive. After withdrawal of minocycline, the symptoms improved and minocycline-induced lupus was diagnosed. In the Swissmedic and WHO adverse drug reaction databases 267 other cases of possible minocycline-induced lupus were identified. Typical clinical and laboratory features are arthralgia, arthritis, myalgia, increased transaminases and/or jaundice, unspecific symptoms like fatigue and fever, skin disorders and positive antinuclear antibodies.

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Antibodies, Antinuclear; Diagnosis, Differential; Female; Humans; Lupus Erythematosus, Systemic; Minocycline; Time Factors

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Female; Humans; Minocycline; Polyarteritis Nodosa; Skin Diseases

Topics: Acne Vulgaris; Delayed-Action Preparations; Humans; Minocycline

This article reports on recent studies and case reports that evaluated the stability, tolerability, and efficacy of clindamycin 1%-benzoyl peroxide 5% tube gel in combination with topical retinoids and oral antibiotics. Overall, these combinations appeared to be well-tolerated, effective, and, as reported in the case studies, adaptable to common clinical practice.

Topics: Acne Vulgaris; Adapalene; Administration, Cutaneous; Administration, Oral; Adolescent; Adult; Anti-Bacterial Agents; Benzoyl Peroxide; Clindamycin; Dermatologic Agents; Drug Combinations; Female; Gels; Humans; Keratolytic Agents; Male; Minocycline; Naphthalenes; Nicotinic Acids; Retinoids; Treatment Outcome; Tretinoin

Topics: Acne Vulgaris; Adult; Female; Humans; Intracranial Hypertension; Minocycline

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Antipsychotic Agents; Bipolar Disorder; Dibenzothiazepines; Drug Therapy, Combination; Female; Humans; Lithium Carbonate; Minocycline; Quetiapine Fumarate

We present a 15-year-old girl with bilateral lower extremity discoloration of one-year duration while taking minocycline for acne vulgaris. The clinical characteristics best supported type II minocycline hyperpigmentation, but the histology revealed that the pigmentation was solely limited to the subcutaneous adipose tissue, completely sparing the dermis. Special stain for iron was negative. This is the first case to our knowledge with pigment exclusively located in the subcutaneous fat and with the unusual finding of a negative stain for iron.

Topics: Acne Vulgaris; Adipose Tissue; Adolescent; Anti-Bacterial Agents; Female; Humans; Hyperpigmentation; Minocycline; Skin

Topics: Acne Vulgaris; Adrenal Cortex Hormones; Adult; Diagnosis, Differential; Eosinophilia; Female; Humans; Hypersensitivity; Minocycline; Myocardium; Shock, Cardiogenic

Pigmentary disorders are recognized adverse effects of the semi-synthetic tetracycline derivative antibiotic, minocycline. Three distinct types of minocycline-induced cutaneous pigmentation have been described. Type I, blue-black pigmentation confined to sites of scarring or inflammation on the face; Type II, blue-grey circumscribed pigmentation of normal skin of the lower legs and forearms; and Type III, diffuse muddy brown pigmentation of normal skin accentuated in sun-exposed areas. We report two patients with acne vulgaris with a fourth type of minocycline-induced cutaneous pigmentation. They presented with circumscribed blue-grey pigmentation within acne scars confined to the back. Histology showed pigment within dendritic cells, and extracellularly throughout the dermis. Histochemistry identified a calcium containing melanin-like substance. Iron was absent. Immunohistochemistry confirmed some pigment-containing cells to be macrophages. Electron microscopy demonstrated electron-dense granules, free and membrane-bound, within macrophages and fibroblast-like cells. Energy-dispersive X-ray analysis confirmed the presence of calcium. Iron was absent. This fourth type of cutaneous minocycline hyperpigmentation may be a variant of Type I, but based on clinical, pathological and microanalytical differences, appears to be a new entity. The pigment may be a drug metabolite-protein complex chelated with calcium, or an insoluble minocycline-melanin complex. We propose a classification of cutaneous minocycline pigmentation based on clinico-pathological criteria.

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Biopsy; Humans; Hyperpigmentation; Male; Minocycline; Skin

Patients with depersonalization disorder experience episodes in which they have a feeling of detachment from themselves. Symptoms of depersonalization may occur in individuals who have other mental disorders, or who have various medical conditions, or who have taken certain medications. A woman developed depersonalization symptoms after initiation of minocycline therapy. Her symptoms ceased after treatment was stopped and recurred when she restarted the drug. Medications that have been associated with causing symptoms of depersonalization are presented and the postulated pathogenesis by which some of these drugs induced depersonalization symptoms is discussed. Medication-associated depersonalization symptoms typically resolve once the inducing drug has been withdrawn.

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Depersonalization; Female; Humans; Minocycline

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Humans; Lymphomatoid Papulosis; Male; Minocycline

Propionibacterium acnes is the predominant organism in acne lesions, but the sensitivity of different biotypes of P. acnes to therapeutic agents has seldom been reported.. To characterize biotypes of P. acnes and to measure the effects of Keigai-rengyo-to (KRT) and minocycline (MINO) on clinical P. acnes isolates.. Propionibacterium acnes biotype III (BIII) is the most common form of identified acne lesion, followed by P. acnes biotype I. BIII was isolated from mild, moderate and severe severity and the average lipase activity of BIII was higher than that of Biotypes I, II, IV and V. No significant differences in the decrease of free fatty acid production elicited by KRT or by MINO were found between BIII and the other biotypes. The degree of decreased butyric acid production was greater than that of propionic acid production in the medium supplemented with MINO. The percent decrease of butyric acid production elicited by 1 mg/mL of KRT was the same as that elicited by 0.1 microg/mL of MINO. Among biotypes of P. acnes, the minimal inhibitory concentrations of agents tested were generally higher in erythritol-positive biotypes than in erythritol-negative biotypes.. The high frequency of BIII might be responsible for the severity of acne in patients. It seems that if the same concentrations of MINO and KRT are used, the antilipase activity of MINO is stronger than that of KRT. Minocycline also has a direct anti-lipase activity against P. acnes. The mechanism underlying the influence of erythritol on the susceptibility of P. acnes to these agents remains unknown.

Topics: Acne Vulgaris; Adult; Bacterial Typing Techniques; Drug Resistance, Bacterial; Drugs, Chinese Herbal; Female; Humans; Male; Medicine, Kampo; Microbial Sensitivity Tests; Minocycline; Propionibacterium acnes; Risk Assessment; Sampling Studies; Sensitivity and Specificity

A 28-year-old patient is described who presented with progressive dyspnoea and jaundice due to interstitial pneumonia and hepatitis. The most likely cause is a drug-related reaction to minocycline. We discuss the different kinds of drug-related reactions that are most likely involved.

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Chemical and Drug Induced Liver Injury; Dyspnea; Humans; Lung Diseases, Interstitial; Male; Minocycline; Radiography, Thoracic

Topics: Acetazolamide; Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Carbonic Anhydrase Inhibitors; Female; Humans; Minocycline; Pseudotumor Cerebri

After 10 days of minocycline therapy, stomatitis, glossitis and esophagitis were seen in a 62-year-old male patient, who had previously tolerated minocycline for > 20 years without complications. This typical side effect of minocycline was initially misinterpreted in the differential diagnosis and was only diagnosed, when the patient was reexposed to a new 7-day minocycline therapy. Healing was achieved by termination of the minocycline therapy and the initiation of antimycotic treatment.

Topics: Acne Vulgaris; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Esophagitis; Glossitis; Humans; Male; Middle Aged; Minocycline; Stomatitis; Time Factors

Alkaptonuria, a rare autosomal-recessive disorder caused by mutations in the HGD gene and a deficiency of homogentisate 1,2-dioxygenase, is characterized by accumulation of homogentisic acid (HGA), ochronosis, and destruction of connective tissue resulting in joint disease. Certain medications have been reported to cause cutaneous hyperpigmentation resembling that of alkaptonuria. We present 5 such cases. Eighty-eight patients with a possible diagnosis of alkaptonuria were examined at the National Institutes of Health Clinical Center between June 2000 and March 2004. The diagnosis of alkaptonuria was confirmed or ruled out by measurement of HGA in the urine. Five patients with findings consistent with ochronosis, including pigmentary changes of the ear and mild degenerative disease of the spine and large joints, were diagnosed clinically as having alkaptonuria, but the diagnosis was withdrawn based on normal urine HGA levels. All 5 patients were women who had taken minocycline for dermatologic or rheumatologic disorders for extended periods. Minocycline-induced hyperpigmentation should be considered in the differential diagnosis of ochronosis. This could be of increased significance now that minocycline and other tetracyclines have been proposed as therapeutic options for rheumatoid arthritis, bringing a new population of patients with ochronosis and arthritis to medical attention with the potential, but incorrect, diagnosis of alkaptonuria.

Topics: Abscess; Acne Vulgaris; Adult; Aged; Alkaptonuria; Arthralgia; Arthritis, Rheumatoid; Diagnosis, Differential; Facial Dermatoses; Female; Humans; Hyperpigmentation; Middle Aged; Minocycline; Radiography

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Critical Care; Drug Hypersensitivity; Female; Humans; Lymphocyte Activation; Minocycline; Respiratory Distress Syndrome; T-Lymphocytes

A 25-year-old woman with no history of liver disease developed liver dysfunction associated with severe jaundice and general malaise following a prolonged therapy with minocycline for acne vulgaris. Serum anti-nuclear antibody was detected and immunoglobulin G level was elevated. Symptoms resolved and liver function normalized following minocycline discontinuation and corticosteroid administration. Our diagnosis was drug-induced hepatitis with autoimmune features, as liver histology revealed acute hepatitis. Drug-induced hepatitis should be considered when liver dysfunction or systemic symptoms develops during long-term minocycline therapy.

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Antibodies, Antinuclear; Chemical and Drug Induced Liver Injury; Female; Hepatitis, Autoimmune; Humans; Immunoglobulin G; Minocycline

Reactive oxygen species generated by neutrophils are closely correlated with the pathogenesis of a variety of inflammatory skin diseases. The aim of this study was to investigate the possible role of reactive oxygen species generated by neutrophils in the mediation of acne inflammation.. Bacterial phagocytotic stimuli, mediated by opsonin activity, were applied to whole blood, and neutrophil hydrogen peroxide production was measured.. Patients with acne inflammation showed a significantly increased level of hydrogen peroxide produced by neutrophils compared to patients with acne comedones and healthy controls. There were no marked differences in the level of hydrogen peroxide produced by neutrophils between patients with acne comedones and healthy controls. In addition, patients with acne inflammation treated by oral administration of minocycline hydrochloride, a drug that inhibits hydrogen peroxide generation by neutrophils, showed a significant decrease in the ability of neutrophils to produce hydrogen peroxide in accordance with a decrease in the inflammatory activity of acne lesions.. The present study seems to suggest that acne inflammation is mediated in part by hydrogen peroxide generation by neutrophils.

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Case-Control Studies; Humans; Hydrogen Peroxide; Minocycline; Neutrophils; Reactive Oxygen Species

The antibiotic minocycline, which is used in the treatment of acne, has been associated with various pulmonary complications such as pulmonary lupus and hypersensitivity pneumonitis. We now report a particularly severe case of minocycline-related pulmonary toxicity that was characterized by a relapsing form of hypersensitivity eosinophilic pneumonia complicated by acute respiratory failure.

Topics: Acne Vulgaris; Acute Disease; Administration, Oral; Anti-Bacterial Agents; Female; Humans; Middle Aged; Minocycline; Pulmonary Eosinophilia; Recurrence; Respiratory Insufficiency

Minocycline hydrochloride, an analog of tetracycline, is widely used in the treatment of acne. Its use has been associated with discoloration of teeth, bone, and other tissues.. A case is presented involving a patient with minocycline-induced staining of the torus palatinus and alveolar bone.. No treatment was rendered since the patient was not concerned with the appearance of the discoloration. The patient's dermatologist elected to change antibiotics.. Patients on long-term minocycline therapy should be made aware of the possibility of pigmentation of bone and soft tissue that may be reversible with discontinuation of therapy; however, minocycline-induced staining of the permanent dentition may not be reversible.

Topics: Acne Vulgaris; Adult; Alveolar Process; Anti-Bacterial Agents; Exostoses; Female; Humans; Maxillary Diseases; Minocycline; Palate; Pigmentation Disorders

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Female; Gingival Diseases; Humans; Minocycline; Pigmentation Disorders

Minocycline is an effective treatment of acne vulgaris, especially for inflammatory forms. Prescription rates have increased in recent years accompanied by a number of reports concerning drug-induced side effects. An otherwise healthy woman developed an erythema multiform-like rash and and toxic hepatic damage causing cholestatic jaundice following long-term minocycline use. Unusual cutaneous lipid deposition also developed. Minocycline-induced side effects are reviewed.

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Biopsy; Erythema Multiforme; Female; Follow-Up Studies; Humans; Jaundice, Obstructive; Liver; Minocycline; Skin; Time Factors; Xanthomatosis

Isotretinoin is indicated for the treatment of severe, recalcitrant nodular acne. Spontaneous reports have suggested a possible association between isotretinoin and depression that has not been supported by prior studies. Depression has been reported in patients with acne and is common among adolescents.. The objective of this study was to investigate whether there is an association between isotretinoin use and onset of depression.. A large retrospective database study was performed through a review of pharmacy claims to evaluate the order of first-recorded isotretinoin and antidepressant dispensings in incident users. The study included 2821 patients, aged 12 to 49 years, who filled isotretinoin prescriptions between June 1, 1999, and March 31, 2000. The ratio of the number of patients who filled isotretinoin prescription first versus second was computed, with adjustment for variations in physician prescribing patterns; a ratio significantly greater than 1.0 indicates a depression-invoking relationship. Similar analyses of minocycline were performed.. Adjusted ratios for all antidepressants and by class were not significantly greater than 1.0. Similar results were found for minocycline.. The results do not support an association between the use of isotretinoin and the onset of depression.

Topics: Acne Vulgaris; Adolescent; Adult; Adverse Drug Reaction Reporting Systems; Age Distribution; Antidepressive Agents; Child; Cohort Studies; Confidence Intervals; Depressive Disorder; Dermatologic Agents; Drug Prescriptions; Drug Therapy; Drug Utilization; Female; Humans; Incidence; Isotretinoin; Male; Middle Aged; Minocycline; Probability; Retrospective Studies; Risk Assessment; Severity of Illness Index; Sex Distribution

Topics: Acne Vulgaris; Anti-Bacterial Agents; Female; Humans; Minocycline; Periodontal Diseases; Pigmentation Disorders

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Chemical and Drug Induced Liver Injury; Humans; Male; Minocycline; Treatment Outcome

A 15-year-old Caucasian boy experienced severe fever, fatigue, and a 40-lb weight loss after 2 years of minocycline therapy. A workup for infectious causes was negative. One week after minocycline discontinuation, the patient reported that his fever had resolved. Two months later, he reported full resolution of symptoms, weight gain, and a return to normal activity. An objective causality assessment indicated that his illness probably was caused by minocycline, which is considered a safe drug; however, it has been associated with rare serious adverse effects. This patient's presentation of fever was noteworthy not only because minocycline is a rare cause of drug fever, but also because of the delayed onset. Clinicians should be aware that minocycline may cause severe fever and illness even after an extended period of drug exposure.

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Fever; Humans; Male; Minocycline; Time Factors

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Drug Hypersensitivity; Female; Humans; Minocycline; Rhabdomyolysis; Syndrome

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Dermatologic Agents; Female; Humans; Minocycline; Mouth Diseases; Pigmentation Disorders

We studied the effects of minocycline on Propionibacterium granulosum. P. granulosum lipase activity was detected from acne lesions. Production of propionic and butyric acids by P. granulosum was well suppressed by all tested media with added minocycline; the higher the concentration of minocycline in the medium, the less of these acids was produced. It appeared that the decrease in these acids due to minocycline was greater in P. granulosum than in P. acnes. Although the influence of P. granulosum on acne lesions might be feebler than that of P. acnes, we should not neglect its presence. More research is needed to elucidate the relationship between the two species in acne lesions.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Butyrates; Dose-Response Relationship, Drug; Humans; Microbial Sensitivity Tests; Minocycline; Propionates; Propionibacterium

Minocycline in another drug that can induce drug-induced lupus. Minocycline is frequently used for acne as a prolonged treatment, so it is important to be aware of the risks in this treatment. The risk ratio for the development of lupus due to minocycline is not known, but it seems to be low. We described a 26 year old female who was treated with minocycline due to acne. The treatment was complicated by rash and serological signs of lupus (antinuclear antibodies and anti-DNA antibodies). The aim of this article is to raise the level of awareness of this complication due to minocycline.

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Antibodies, Antinuclear; Female; Humans; Lupus Erythematosus, Systemic; Minocycline

Cutaneous propionibacteria are implicated in acne pathogenesis, although their exact role in the genesis of inflammation is still poorly understood. Agents, including antibiotics, that reduce the numbers of propionibacteria on skin are therapeutic. Resistance in the target organism is a well-recognized consequence of antibiotic therapy for acne but formal prevalence and distribution data are lacking.. To monitor the prevalence of skin colonization by antibiotic-resistant propionibacteria in acne patients attending the dermatology out-patient clinic at Leeds General Infirmary over a 10-year period beginning in 1991, and to examine the distribution of resistant strains on acne-prone skin and in the nares.. Propionibacterial samples were obtained from the skin surface of the worst affected site (usually the face) of 4274 acne patients using a moistened swab. The swab was used to inoculate agar plates with and without selective antibiotics. After anaerobic incubation at 37 degrees C for 7 days, the amount of growth in the presence of each antibiotic was scored on a scale from 0 to 5+. A small number of patients (72) were selected for more detailed quantitative sampling at six different sites to examine the distribution of resistant propionibacteria on acne-prone skin and in the anterior nares.. The proportion of patients carrying strains resistant to one or more commonly used antiacne antibiotics rose steadily from 34.5% in 1991 to a peak of 64% in 1997. The prevalence dropped to 50.5% during 1999 and then rose again to 55.5% in 2000. Resistance to erythromycin was the most common and the majority of erythromycin-resistant strains were cross-resistant to clindamycin. Resistance to tetracyclines was less common in all years and with little increase over time. The more detailed quantitative study in 72 patients showed that population densities of resistant propionibacteria varied considerably between sites and between individuals. Almost invariably, patients were colonized with resistant strains at multiple sites, including the nares.. Skin colonization with antibiotic-resistant propionibacteria is much more common now than a decade ago. Resistant propionibacteria are widely distributed on acne-prone skin and in the nares. This suggests that they will be very difficult to eradicate using existing therapeutic regimens, especially from the nasal reservoir.

Topics: Acne Vulgaris; Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Child; Child, Preschool; Drug Resistance, Bacterial; Erythromycin; Female; Follow-Up Studies; Humans; Infant; Male; Microbial Sensitivity Tests; Middle Aged; Minocycline; Nose; Population Surveillance; Propionibacterium; Skin; Tetracycline Resistance

Minocycline is an oral antibiotic widely used for the long-term treatment of acne vulgaris. Unusual side effects of this medication include two overlapping autoimmune syndromes: drug-induced lupus and autoimmune hepatitis. In addition, in a few patients livedo reticularis or subcutaneous nodules have developed in association with arthritis and serum perinuclear antineutrophil cytoplasmic antibodies (P-ANCA) during long-term minocycline therapy. We report the cases of two young women receiving long-term minocycline therapy (>3 years) in whom P-ANCA-positive cutaneous polyarteritis nodosa developed. Both patients presented with a violaceous reticulated pattern on the lower extremities. Histologic examination of biopsy specimens from a reticulated area and a subcutaneous nodule showed necrotizing vasculitis of medium-sized arteries in the deep dermis, consistent with the diagnosis of polyarteritis nodosa. The cutaneous lesions rapidly resolved on discontinuation of minocycline and initiation of prednisone therapy. A high index of suspicion and testing for antineutrophil cytoplasmic antibody in addition to the standard antinuclear antibody panel can facilitate diagnosis of minocycline-related autoimmune disorders.

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Antibodies, Antineutrophil Cytoplasmic; Drug Eruptions; Female; Humans; Leg Dermatoses; Minocycline; Polyarteritis Nodosa; Skin Diseases, Vascular

Topics: Acne Vulgaris; Adolescent; Adult; Anti-Bacterial Agents; Female; Humans; Minocycline; Serum Sickness

To describe the clinical symptoms and serology of drug-induced lupus in patients treated with the semisynthetic tetracycline derivative, minocycline.. For a 5-year period, all consultant rheumatologists and dermatologists in the West of Scotland were asked to report any suspected cases of a lupus-like syndrome to one center. Twenty cases were identified on the basis of arthritis, positive antinuclear factor and at least one other extraarticular feature following treatment for acne with minocycline. Case histories were reviewed to determine any demographic, clinical, or serological correlations.. Minocycline had been prescribed for a mean of 25 months for the 20 patients identified with drug-induced lupus; 15 were female, 5 were male with a mean age of 24 years. All patients had arthritis and most had at least one other extraarticular feature including lethargy, myalgia, fevers, Raynaud's phenomenon, abdominal pain, and butterfly rash. None had renal involvement. All symptoms resolved at a mean of 15.7 weeks after discontinuation of minocycline treatment.. Minocycline is widely used in the treatment of acne and increasingly in the treatment of rheumatic diseases. Although the absolute risk of developing drug-induced lupus is relatively low, it has been estimated that current use of minocycline is associated with an 8.5 fold increased risk of developing a lupus-like syndrome. Prescribing physicians must be vigilant for any of the characteristic symptoms to avoid unnecessary morbidity, investigations, and therapy.

Topics: Acne Vulgaris; Adolescent; Adult; Anti-Bacterial Agents; Arthritis; Female; Humans; Lupus Erythematosus, Systemic; Male; Minocycline; Scotland; Treatment Outcome

Topics: Acetazolamide; Acne Vulgaris; Child; Drug Information Services; Drug Labeling; Humans; Internship and Residency; Male; Minocycline; Pediatrics; Periodicals as Topic; Pseudotumor Cerebri

Topics: Acne Vulgaris; Administration, Oral; Anti-Bacterial Agents; Chlamydia Infections; Chlamydia trachomatis; Communicable Diseases; Humans; Minocycline; Pneumonia, Mycoplasma

Topics: Acne Vulgaris; Administration, Oral; Administration, Topical; Adolescent; Adult; Combined Modality Therapy; Detergents; Dicarboxylic Acids; Female; Humans; Male; Minocycline; Pregnancy

Topics: Acne Vulgaris; Anti-Bacterial Agents; Antibodies, Antineutrophil Cytoplasmic; Humans; Lupus Vulgaris; Minocycline; Skin Pigmentation

Pseudotumor cerebri or benign intracranial hypertension is a syndrome of raised intracranial pressure without obvious explanation. Most patients are obese women at childbearing age. Symptoms and signs usually include headache, nausea, vomiting, edema of the papilla, visual obscurations and rarely palsy of the nervus abducens. The prognosis is generally good, but progressive visual loss and eventual blindness are major risks. We report the case of a 21-year-old non-obese young woman who developed pseudotumor cerebri while taking minocycline for acne therapy. Identical symptoms occurred upon inadvert rechallenge with minocycline for the second time.

Topics: Acne Vulgaris; Adult; Diagnosis, Differential; Female; Humans; Minocycline; Pseudotumor Cerebri

This report describes a 15-year-old white boy who presented with fever, back pain, a disseminated exanthematous rash, renal failure, and hepatopathy 3 weeks after the initiation of oral minocycline therapy for facial acne. Marked peripheral and urine eosinophilia were noted. A bone marrow aspiration showed more than 50% eosinophils without any evidence of malignancy, and a simultaneous kidney biopsy showed acute interstitial nephritis (AIN). The patient's symptoms and laboratory findings improved after high-dose steroid therapy was initiated, worsened when it was withheld, and improved again after it was reinitiated in view of the biopsy findings. The patient recovered completely, and steroids were tapered to discontinuation over 3 months. Over a year later, the patient's peripheral blood mononuclear cells (PBMCs) were cultured for 2 weeks in the presence or absence of minocycline ex vivo, and minocycline was found to induce the emergence of CD4(+) cells after 1 week in culture. In conclusion, this article shows for the first time several new aspects of minocycline-induced morbidity: renal and hepatic failure can occur together, and AIN and elevated blood eosinophil counts can be accompanied by marked bone marrow eosinophilia, suggesting a systemic allergic response as the underlying pathomechanism. Furthermore, the initial phase of such a response appears to involve CD4(+) T cells detectable ex vivo. Lastly, high-dose treatment with corticosteroids appears to be beneficial in this setting.

Topics: Acne Vulgaris; Adolescent; CD4 Lymphocyte Count; Eosinophilia; Humans; Liver Failure, Acute; Male; Minocycline; Nephritis

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Antibodies, Antinuclear; Female; Hepatitis, Autoimmune; Humans; Immunoglobulin G; Jaundice; Liver Failure; Liver Transplantation; Minocycline

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Female; Hepatitis, Autoimmune; Humans; Lupus Vulgaris; Minocycline

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Female; Humans; Hyperpigmentation; Minocycline; Tongue

Topics: Acne Vulgaris; Adolescent; Adult; Anti-Bacterial Agents; Arthralgia; Arthritis; Case-Control Studies; Cohort Studies; Drug Eruptions; Female; Humans; Lupus Erythematosus, Systemic; Male; Minocycline; Odds Ratio

Topics: Acne Vulgaris; Adult; Biopsy, Needle; Chemical and Drug Induced Liver Injury; Female; Humans; Liver; Liver Function Tests; Minocycline

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Biopsy, Needle; Connective Tissue Diseases; Elastic Tissue; Face; Female; Humans; Hyperpigmentation; Minocycline

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Female; Humans; Minocycline; Polyarteritis Nodosa

Recently several case reports described the association between minocycline and lupuslike syndrome. Minocycline, one of the tetracyclines, is widely used to treat acne. We aimed to examine the association of exposure to minocycline and other tetracyclines with the development of lupuslike syndrome.. We conducted a nested case-control study in a cohort of 27 688 acne patients aged 15 to 29 years, using data automatically recorded on general practitioners' office computers in the United Kingdom. Controls were matched to cases on age, sex, and practice. The main outcome was lupuslike syndrome defined as the occurrence of polyarthritis or polyarthralgia of unknown origin, with negative rheumatoid factor or latex agglutination test, positive or unmeasured antinuclear factor, elevated or unmeasured erythrocyte sedimentation rate, and absence of or unmeasured antinative DNA antibody levels.. We identified 29 cases and selected 152 controls. Current single use of minocycline was associated with an 8.5-fold (95% confidence interval [CI], 2.1-35) increased risk of developing lupuslike syndrome compared with non-users and past users of tetracyclines combined. The risk of past exposure to any of the tetracyclines was closely similar to nonuse (relative risk, 1.3; 95% CI, 0.5-3.3). Current use of doxycycline, oxytetracycline, or tetracycline combined was associated with a 1.7-fold (95% CI, 0.4-8.1) increase of risk. The risk increased with longer use.. Current use of minocycline increased the risk of developing lupuslike syndrome 8.5-fold in the cohort of young acne patients. The effect was stronger in longer-term users. However, the absolute risk of developing lupuslike syndrome seems to be relatively low.

Topics: Acne Vulgaris; Adolescent; Adult; Anti-Bacterial Agents; Case-Control Studies; Female; Humans; Lupus Vulgaris; Male; Minocycline; Risk; Syndrome

The treatment of moderate to severe acne often relies on antibiotherapy in order to eradicate as much as possible microorganisms such as Propionibacterium spp colonizing the sebaceous follicles. In recent years, bacterial resistances against specific antibiotics have emerged. Both the antibiotic and its administration modalities must be considered in order to control the risk. With regard to this conundrum, minocycline is a medication of choice among the diverse anti-acneic therapies.

Topics: Acne Vulgaris; Administration, Cutaneous; Administration, Oral; Anti-Bacterial Agents; Drug Resistance, Microbial; Gram-Positive Bacterial Infections; Hair Follicle; Humans; Minocycline; Propionibacterium acnes; Risk Factors; Sebaceous Glands

In recent years, minocycline has become a commonly used agent for the treatment of acne vulgaris and rosacea. With this increased use have come reports of severe and in some cases life-threatening toxicity, often occurring in otherwise healthy young women after prolonged courses of minocycline. These adverse reactions include hepatotoxicity, drug-induced lupus erythematosus, eosinophilic pneumonitis, and hypersensitivity syndrome. We describe a 35-year-old woman who had necrotizing vasculitis of the skin and uterine cervix after 2 years of minocycline therapy for acne vulgaris. Skin and cervical biopsies revealed acute inflammation involving through-and-through necrosis of vessel walls with thrombosis, focal fibrinoid change, and a perivascular lymphohistiocytic infiltrate. The disease fully resolved within 3 months of discontinuance of the minocycline therapy. Patients should be informed of these rare but potentially serious adverse effects before the initiation of minocycline therapy. Early recognition of these complications can result in complete resolution.

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Drug Eruptions; Female; Humans; Minocycline; Uterine Cervical Diseases; Vasculitis

A 22-year-old black man developed fever, chills, fatigue, night sweats, tender lymphadenopathy, and a generalized, pruritic, macular eruption 3 weeks after starting minocycline therapy for acne. His illness was also characterized by a palpable spleen tip, marked lower extremity and scrotal edema, and generalized lymphadenopathy. The patient had leukocytosis with a large percentage of atypical lymphocytes on peripheral smear and liver dysfunction. Titers for Epstein-Barr virus, hepatitis B, toxoplasmosis; and cytomegalovirus were all negative. Human immunodeficiency virus-1 viral load and antibodies were also negative. Marked improvement was noted after the discontinuation of minocycline and the use of systemic corticosteroids. With the negative viral serologies, the clinical picture was most consistent with an infectious mononucleosis-like syndrome produced by the minocycline ingestion.

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Diagnosis, Differential; Drug Hypersensitivity; Humans; Infectious Mononucleosis; Male; Minocycline; Syndrome

Among several adverse effects following treatment with minocycline, certain cases of autoimmune hepatitis, associated with lupus erythematosus, have been described. The possibility of hepatic damage, although rare, is important to keep in mind because of its delicate diagnostic.. We report one case of autoimmune hepatitis following treatment with minocycline for acne, in a 25-year-old woman. This autoimmune hepatitis was associated with induced lupus syndrome. Usual causes of hepatitis were eliminated. Evolution was spontaneously favorable upon minocycline treatment interruption, with the disappearance of clinical symptoms and normalization of hepatic and immunologic biological values.. The possibility of hepatic damage and lupus syndrome, following treatment with minocycline, should be recalled and verified in cases of long-term prescription. This observation stresses the difficulties of anamnesis in internal medicine. For those who know how to listen cautiously and rigorously, anamnesis may prove more helpful than many complementary examinations.

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Female; Hepatitis, Autoimmune; Humans; Lupus Vulgaris; Minocycline; Syndrome

A 14-year-old girl developed maculopapular rash, myalgias, arthralgias and myocarditis with elevated anti-nuclear and anti-double-stranded DNA antibodies. She was taking minocycline for acne and all symptoms resolved when this treatment was stopped. The patient has no evidence of disease one year after onset of symptoms. Clinicians should be aware of minocycline's responsibility in inducing lupus-like disease.

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Antibodies, Antinuclear; Female; Humans; Lupus Vulgaris; Minocycline

Topics: Acne Vulgaris; Anti-Bacterial Agents; Humans; Minocycline

To report a case of scleral discoloration secondary to minocycline therapy.. Case report of a patient referred to a university-based cornea and external disease clinic.. The patient had been treated with oral minocycline therapy for adult facial acne for 12 years when she began to develop bilateral blue-gray discoloration of the sclera as well as of the teeth, hard palate, ears, nail beds, and skin.. Chronic systemic minocycline therapy may induce scleral pigmentary changes. The mechanism of discoloration and the long-term natural history upon cessation of minocycline are unclear.

Topics: Acne Vulgaris; Administration, Oral; Anti-Bacterial Agents; Face; Female; Humans; Middle Aged; Minocycline; Nail Diseases; Pigmentation Disorders; Scleral Diseases; Skin Pigmentation; Tooth Discoloration

Topics: Acne Vulgaris; Anti-Bacterial Agents; Chromatography, High Pressure Liquid; Humans; Minocycline; Prospective Studies

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Diagnosis, Differential; Female; Humans; Lupus Erythematosus, Systemic; Minocycline; Syndrome

Follicular mucinosis can be a primary idiopathic disease or a secondary disease associated with lymphoma. When it appears in childhood or adolescence, it is usually primary and self-limited. We describe four cases of follicular mucinosis occurring in early adulthood that have had protracted courses. Each presented as an unusual acneiform eruption. Two of the cases demonstrated a clonal genetic rearrangement of the T-cell receptor within the cutaneous lymphoid infiltrate, a finding not previously reported. Although its significance is not clear, the clonal lymphocytic expansion indicates a need for continued surveillance of these patients.

Topics: Acne Vulgaris; Administration, Topical; Adult; Anti-Bacterial Agents; Anti-Inflammatory Agents; Clobetasol; Clone Cells; Diagnosis, Differential; Female; Follow-Up Studies; Gene Rearrangement, T-Lymphocyte; Glucocorticoids; Humans; Isotretinoin; Keratolytic Agents; Lymphocytes; Male; Minocycline; Mucinosis, Follicular; Receptors, Antigen, T-Cell; Tetracycline; Tretinoin

Antibiotic therapy is one of the main methods of acne treatment, however, bacterial resistance is on the rise and can affect the treatment outcome. Quantitative bacteriologic cultures are the gold standard methodology for the assessment of such a problem; however, certain important biological aspects remain uncovered.. The purpose of this study was to compare the antibacterial activity of minocycline and lymecycline in sebaceous follicle infundibula and comedones of acne patients.. We used a recently introduced flow cytometric method, allowing a distinction to be made between viable, injured (presumably resistant), and dead microorganisms.. Minocycline (100 mg) proved to be superior to lymecycline (600 mg) in abating the microflora harboring in the sebaceous follicles of acne patients.. The dissimilar bioavailability and antimicrobial efficacy between the two bacteriostatic agents may impart different clinical efficacy.

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Female; Flow Cytometry; Humans; Lymecycline; Male; Microbial Sensitivity Tests; Minocycline; Pilot Projects; Treatment Outcome

To demonstrate the association between minocycline treatment and development of the pseudotumor cerebri syndrome.. A retrospective study was conducted of 12 patients from five neuro-ophthalmic referral centers who developed pseudotumor cerebri syndrome after being treated with standard doses of minocycline for refractory acne vulgaris. The main outcome measures included resolution of headaches, transient visual obscurations, diplopia, papilledema, and visual fields static thresholds after withdrawal of minocycline and treatment for increased intracranial pressure.. Nine (75%) of the 12 patients developed symptoms of the pseudotumor cerebri syndrome syndrome within 8 weeks of starting minocycline therapy; six were not obese. Two patients developed symptoms only after a year had elapsed because of commencement of treatment with minocycline. One patient was asymptomatic, and pseudotumor cerebri syndrome was diagnosed by finding papilledema on routine examination 1 year after minocycline was started. None of the patients developed recurrences for at least 1 year after the discontinuation of minocycline and treatment for increased intracranial pressure, but three (25%) of the 12 patients had substantial residual visual field loss.. Minocycline is a cause or precipitating factor in pseudotumor cerebri syndrome. Although most patients have prominent symptoms and are diagnosed promptly, others are asymptomatic and may have optic disk edema for a long period of time before diagnosis. Withdrawal of minocycline and treatment for increased intracranial pressure lead to resolution of the pseudotumor cerebri syndrome, but visual field loss may persist.

Topics: Acne Vulgaris; Adolescent; Adult; Anti-Bacterial Agents; Diplopia; Female; Follow-Up Studies; Headache; Humans; Intracranial Pressure; Minocycline; Papilledema; Pseudotumor Cerebri; Retrospective Studies; Syndrome; Vision Disorders; Visual Acuity

Minocycline can cause various types of hepatotoxicity. We report an 18-year-old male who developed a delayed onset of minocycline-induced cholestatic hepatitis with autoimmune features and neutropenia. He responded to withdrawal of the drug and a short course of corticosteroids. If minocycline is to be administered, then periodic monitoring for hepatoxicity is recommended.

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Chemical and Drug Induced Liver Injury; Hepatitis, Autoimmune; Humans; Male; Minocycline; Neutropenia

Steroid acne is a folliculitis that can result from systemic or topical administration of steroid, and has been described as showing a similar clinical picture to Pityrosporum folliculitis, but there have been few reports about the incidence of Pityrosporum ovale and the effect of antimycotic drugs in steroid acne and other acneiform eruptions. Our purpose was to describe the association between steroid acne and P. ovale, and to confirm the superior efficacy of oral antifungal drugs over anti-acne drugs in the treatment of steroid acne.. The history, clinical features direct microscopy, histopathologic analysis, and therapeutic results of 125 cases with steroid acne or other acneiform eruptions were described and compared.. Over 80% of patients with acneiform eruption receiving systemic steroid revealed significant numbers of P. ovale in the lesional follicle. Furthermore, oral antifungal drug (itraconazole) showed significantly better clinical and mycologic effects than any other group of medications used in this study.. Steroid acne and other acneiform eruptions showing discrete follicular papules and/or pustules localized to the upper trunk and acneiform facial skin lesions associated with multiple acneiform lesions on the body in the summer period should be suspected as Pityrosporum folliculitis. In addition, oral antifungal drugs recommended for Pityrosporum folliculitis; however, it will require a larger case-control study to confirm the superiority of antifungal therapy over anti-acne treatment.

Topics: Acne Vulgaris; Acneiform Eruptions; Adolescent; Adult; Anti-Bacterial Agents; Antifungal Agents; Dermatomycoses; Diagnosis, Differential; Female; Folliculitis; Hair Follicle; Humans; Incidence; Itraconazole; Korea; Malassezia; Male; Miconazole; Microscopy; Middle Aged; Minocycline; Skin; Spores; Treatment Outcome

Prolonged treatment with minocycline for acne vulgaris has been associated with the development of arthralgia, arthritis, and other autoimmune phenomena. We characterized the clinical, laboratory, and immunological profiles of seven patients with this syndrome.. Clinically the patients were studied with special emphasis on prior minocycline treatment, presenting symptoms, physical findings, course, and outcome. Laboratory tests included fluorescent antinuclear and antineutrophil cytoplasmic (ANCA) antibodies, as well as antibodies to myeloperoxidase, bactericidal permeability increasing protein, elastase, cathepsin G, lactoferrin, cardiolipin, and histone.. All 7 patients presented with polyarthritis or arthralgia, morning stiffness, and fever after 6 to 36 months of minocycline treatment. The skin was involved in five patients (three with livedo reticularis and two with subcutaneous nodules). Two patients had chronic active hepatitis. Increased titers of perinuclear ANCA (p-ANCA) were detected in all seven patients; five patients had fluorescent antinuclear antibodies, two had antihistone autoantibodies and one had anticardiolipin antibodies. Antigenic characterization of p-ANCA disclosed antibodies to bactericidal permeability increasing protein in one patient, to elastase in three patients, and to cathepsin G in five patients. Symptoms resolved in five patients upon discontinuation of minocycline; the other two patients were treated with corticosteroids and also achieved remissions.. Minocycline-induced autoimmune syndrome is characterized by reversible polyarthralgia or arthritis, morning stiffness, fever, frequent skin involvement, occasional chronic active hepatitis, and increased titers of p-ANCA with various minor p-ANCA-related antigens.

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Antibodies, Anticardiolipin; Antibodies, Antineutrophil Cytoplasmic; Arthralgia; Arthritis; Autoantibodies; Autoimmune Diseases; C-Reactive Protein; Female; Humans; Male; Minocycline

A rising percentage of tetracycline-resistant Propionibacterium acnes strains has been reported in the English literature.. We studied a population of 16 patients with acne who had been treated with oral tetracyclines during the preceding year. A bacteriological examination of a skin biopsy was obtained in all patients to determine aerobic and anaerobic flora as wells as resistance to tetracycline and minocycline.. Staphylococcus epidermidis strains were frequently resistant to tetracycline (87.5%) as well as minocycline (30%). Tetracycline-resistant Propionibacterium acnes were also observed (7%). Inversely, we were unable to evidence any minocycline-resistant Propionibacterium acnes strains.. These findings emphasize the importance of determining whether therapeutic response is related or not to the presence of resistant strains.

Topics: Acne Vulgaris; Administration, Oral; Adolescent; Adult; Anti-Bacterial Agents; Colony Count, Microbial; Female; Humans; Male; Minocycline; Prevalence; Propionibacterium acnes; Staphylococcus epidermidis; Tetracycline; Tetracycline Resistance

Minocycline is widely prescribed for long-term treatment in acne. Major side effects are rare and include hepatitis and drug-related lupus. Hepatitis can be early and acute or late and chronic, whereas lupus presents as a tardive and insidious disease. We report a case of minocycline-induced lupus initially presenting as acute hepatitis, evolving to chronic cytolysis, in a young man treated for facial acne.

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Chemical and Drug Induced Liver Injury; Humans; Lupus Erythematosus, Systemic; Male; Minocycline

Topics: Acne Vulgaris; Administration, Oral; Anti-Bacterial Agents; Humans; Minocycline

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Female; Humans; Hyperpigmentation; Male; Minocycline; Mouth Diseases

A 17-year-old female patient who had been taking oral minocycline (50 mg twice daily) for 3 weeks for acne developed an eruption that progressed to an exfoliative dermatitis. This illness was also characterized by fever, lymphadenopathy, pharyngitis, a leukemoid reaction, lymphocytosis, eosinophilia, hepatitis, and noncardiogenic pulmonary edema. Dramatic improvement followed institution of corticosteroid therapy. Studies for infectious and collagen vascular diseases were negative. This severe illness was likely caused by minocycline, and we speculate that minocycline may have acted as a superantigen, causing lymphocyte over-activation and massive cytokine release.

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Chemical and Drug Induced Liver Injury; Drug Eruptions; Eosinophilia; Female; Fever; Hematologic Diseases; Humans; Lymphocytosis; Minocycline

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Female; Humans; Minocycline; Pseudotumor Cerebri

Topics: Acne Vulgaris; Administration, Cutaneous; Administration, Oral; Anti-Bacterial Agents; Cost-Benefit Analysis; Drug Monitoring; Humans; Liver; Minocycline; Risk; Risk Assessment

Topics: Acne Vulgaris; Anti-Bacterial Agents; Black People; Chemical and Drug Induced Liver Injury; Dermatitis, Exfoliative; Drug Eruptions; Eosinophilia; Humans; Minocycline; Retrospective Studies; Risk; Risk Assessment

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Antibodies, Antinuclear; Autoimmune Diseases; Chemical and Drug Induced Liver Injury; Female; Humans; Minocycline; Thyroiditis, Autoimmune

A case of psoriatic arthritis where diagnosis was originally complicated by the presence of minocycline-induced auto-antibodies and hepatic dysfunction. The range of auto-antibodies associated with minocycline includes ds DNA and SCL 70.

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Arthritis, Psoriatic; Autoantibodies; Diagnosis, Differential; Female; Humans; Minocycline; Psoriasis

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Female; Humans; Hypertension; Minocycline; Vision Disorders

Serum levels of minocycline hydrochloride were determined by bioassay in a total of 223 acne patients (123 male, 100 female) receiving either the recommended dose (100mg/day) or a high dose (200mg/day) of the standard preparation (101 patients) of a modified release formulation (132 patients). Sera were collected within 6 h of the morning dose 7-10 days after the start of treatment. Mean minocycline serum levels were consistently higher in females than in males, irrespective of dose or formulation. The differences only reached statistical significance (P < 0.05, Student's t-test) in the case of the standard preparation at a dose of 50 mg, b.d. Serum levels were increased significantly in both sexes at the higher dosage of each formulation (P < 0.01) but there was no significant difference between formulations at either dosage. Variation in serum concentrations was not accounted for by variation in body mass. Serum levels above the modal minimum inhibitory concentration (MIC) of minocycline for fully sensitive strains of Propionibacterium acnes I (0.125 micrograms/mL) were recorded in all patients. In contrast, serum levels equal to or greater than the modal MIC of minocycline for resistant propionibacteria (2 micrograms/mL) were recorded in only 17.9% of patients on the low dose standard preparation compared with 55.6% on the high dose standard preparation (P < 0.001, chi 2). Even in females on the high-dose modified release formulation, 32.2% had serum levels below the modal MIC of minocycline for resistant strains. We conclude that, in terms of achievable serum levels over a short time period, there is no advantage of the modified release formulation over the standard preparation of minocycline. Whichever formulation is used, dose manipulation may be necessary to achieve maximum therapeutic benefit, especially in those individuals who are colonized by propionibacteria with reduced sensitivity to minocycline.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Body Mass Index; Delayed-Action Preparations; Female; Humans; Male; Minocycline; Sex Factors

Topics: Acne Vulgaris; Anti-Bacterial Agents; Humans; Minocycline; Tetracycline

Topics: Acne Vulgaris; Anti-Bacterial Agents; Female; Humans; Male; Minocycline

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Female; Humans; Male; Minocycline

Topics: Acne Vulgaris; Anti-Bacterial Agents; Humans; Minocycline; Oxytetracycline; Tetracycline

Monocycline is the most widely prescribed systemic antibiotic for acne largely because it needs to be given only once or twice a day and seems not to induce resistance. Up to April 1994 11 cases of minocycline induced systemic lupus erythematosus and 16 cases of hepatitis had been reported to the Committee on Safety of Medicines. An analysis of these cases together with seven other cases shows the severity of some of these reactions. Two patients died while taking the drug for acne and a further patient needed a liver transplant. Acne itself can induce arthritis and is often seen in association with autoimmine liver disease, but the clinical and biochemical resolution seen after withdrawal of the drug, despite deterioration of the acne, suggests a drug reaction. In five cases re-exposure led to recurrence. Because reactions may be severe early recognition is important to aid recovery and also to avoid invasive investigations and treatments such as corticosteroids and immunosuppresants. Safer alternatives should be considered for treating acne.

Topics: Acne Vulgaris; Adult; Aged; Anti-Bacterial Agents; Autoimmune Diseases; Chemical and Drug Induced Liver Injury; Female; Humans; Lupus Erythematosus, Systemic; Male; Minocycline; Syndrome

Topics: Acne Vulgaris; Anti-Bacterial Agents; Humans; Minocycline; Practice Patterns, Physicians'

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Biological Availability; Food-Drug Interactions; Humans; Minocycline

Topics: Acne Vulgaris; Anti-Bacterial Agents; Chronic Disease; Female; Humans; Middle Aged; Minocycline; Nephritis, Interstitial

Pyoderma gangrenosum often presents a difficult therapeutic challenge. The case is described of a 42-year-old black man with the association of cystic acne, hidradenitis suppurativa, and seronegative arthritis with pyoderma gangrenosum. The pyoderma gangrenosum ulcers remained refractory to treatment until therapies aimed in part at the associated diseases were begun. Minocycline was given for treatment of cystic acne and hidradenitis suppurativa as well as pyoderma gangrenosum. Sulfasalazine was prescribed for seronegative arthritis as well as pyoderma gangrenosum. The combination therapy permitted healing of the pyoderma gangrenosum ulcers.

Topics: Acne Vulgaris; Adult; Arthritis; Cysts; Drug Therapy, Combination; Hidradenitis Suppurativa; Humans; Male; Minocycline; Pyoderma Gangrenosum; Sulfasalazine; Treatment Outcome

Tetracycline may cause fatty infiltration of the liver; more recently, it has been reported to cause intrahepatic cholestasis with bile duct depletion. However, minocycline, a derivative of tetracycline, is not generally recognized to be hepatotoxic. We report a series of six cases of presumed minocycline-induced liver injury; five of these patients had acute hepatitic illness, whereas one had a more prolonged course with histological evidence of chronic hepatitis. In addition, three patients demonstrated abnormal anti-nuclear antibody levels, and one had positive double-stranded DNA.

Topics: Acne Vulgaris; Adolescent; Adult; Anti-Bacterial Agents; Biopsy; Chemical and Drug Induced Liver Injury; Chemical and Drug Induced Liver Injury, Chronic; Female; Humans; Liver; Liver Function Tests; Male; Middle Aged; Minocycline

To describe a novel iatrogenic immunological reaction produced by minocycline.. The clinical course and laboratory results of three women who presented with similar rheumatological manifestations after a prolonged exposure to minocycline are described. All three presented a unique reaction manifested by fever, arthritis/arthralgia and livedo reticularis during treatment with minocycline for acne vulgaris. The clinical syndrome was associated with high titre of serum perinuclear anticytoplasmatic antibodies (p-ANCA) and antimyeloperoxidase antibody (anti-MPO). Symptoms resolved after stopping the drug and recurred promptly after rechallenge in all three patients.. Minocycline, which is widely used in the treatment of acne, often without adequate supervision, may induce arthritis and livedo vasculitis associated with anti-MPO.

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Antibodies, Antineutrophil Cytoplasmic; Arthritis; Autoantibodies; Biomarkers; Female; Fever; Humans; Minocycline; Peroxidase; Skin Diseases, Vascular

Topics: Acne Vulgaris; Anti-Bacterial Agents; Autoimmune Diseases; Chemical and Drug Induced Liver Injury; Humans; Lupus Erythematosus, Systemic; Minocycline; Risk Factors

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Dental Enamel; Humans; Minocycline; Tetracycline

We report the case of a woman who presented with dyspnoea whilst taking minocycline for acne. Imaging features of bilateral patchy alveolar opacities suggested a diagnosis of bronchiolitis obliterans organizing pneumonia, which was confirmed by lung biopsy. The patient improved, partially, after stopping minocycline, and then completely on treatment with corticosteroids, without relapse when these where stopped 8 weeks later.

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Biopsy; Cryptogenic Organizing Pneumonia; Diagnosis, Differential; Female; Glucocorticoids; Humans; Minocycline; Respiratory Function Tests; Tomography, X-Ray Computed

Minocycline can cause hyperpigmentation of the conjunctiva, oral mucosa, and skin. Pigmentation of the oral mucosa may also be associated with a variety of endogenous or exogenous factors. Lingual pigmentation may be seen in Addison's disease, amalgam tatoo, malignant melanoma, Peutz-Jegher's syndrome, and other diseases. Two women who had isolated pigmentation of the tongue while taking minocycline are described; no other drug-induced pigmentation of their oral mucosa or skin occurred. Minocycline-induced pigmentation should be added to the differential diagnosis of isolated lingual hyperpigmentation.

Topics: Acne Vulgaris; Adult; Female; Humans; Hyperpigmentation; Middle Aged; Minocycline; Mouth Mucosa; Rosacea; Tongue Diseases

Minocycline hydrochloride is a semisynthetic tetracycline derivative used widely for the treatment of acne vulgaris. Among its side effects is the ability to pigment many tissues particularly thyroid, skin, tooth, and bone. A case is presented in which long-term minocycline therapy (500 g taken orally over 11 years) resulted in dark bone pigmentation (black bone disease) severe enough to be visible through the alveolar and palatal mucosa. No skin or tooth pigmentation was present.

Topics: Acne Vulgaris; Adult; Alveolar Process; Female; Humans; Hyperpigmentation; Minocycline

Topics: Acne Vulgaris; Adolescent; Cyproterone Acetate; Drug Therapy, Combination; Ethinyl Estradiol; Female; Humans; Lupus Erythematosus, Systemic; Minocycline

Topics: Acne Vulgaris; Adult; Female; Humans; Minocycline; Pulmonary Eosinophilia; Radiography

Topics: Acne Vulgaris; Adult; Female; Humans; Minocycline; Pigmentation Disorders; Tongue Diseases

We report a patient who developed symptoms of lupus erythematosus which was apparently related to minocycline therapy for acne vulgaris. To our knowledge, this is only the second reported case of minocycline-associated lupus erythematosus.

Topics: Acne Vulgaris; Adolescent; Female; Humans; Lupus Erythematosus, Systemic; Minocycline

Topics: Acne Vulgaris; Adult; Female; Humans; Minocycline; Tetracycline; Tooth Discoloration

Topics: Acne Vulgaris; Adolescent; Humans; Lupus Erythematosus, Systemic; Male; Minocycline

We studied the susceptibility of antimicrobial agents to Propionibacterium acnes (P. acnes) and Staphylococcus epidermidis (S. epidermidis) isolated from acne patients. We measured the minimum inhibitory concentrations (MICs) of the following five drugs: roxithromycin (RXM), erythromycin (EM), clindamycin (CLDM), minocycline (MINO) and ofloxacin (OFLX), which are frequently used to treat acne and skin infections. We found many resistant strains of S. epidermidis and some resistant strains of P. acnes. There was a correlation between the resistance of S. epidermidis and the former therapy for acne, but no distinct correlation between the resistance of P. acnes and the former therapy for acne.

Topics: Acne Vulgaris; Adolescent; Adult; Anti-Bacterial Agents; Clindamycin; Drug Resistance, Microbial; Erythromycin; Female; Humans; Male; Minocycline; Ofloxacin; Propionibacterium acnes; Staphylococcus epidermidis

Five cases of suspected drug-related lupus are described in young female patients who had been taking minocycline for several years. All were asymptomatic before starting treatment. After variable but prolonged periods of continuous therapy all abruptly developed arthralgia/arthritis and on testing were antinuclear factor positive. In four cases the symptoms and signs disappeared within a short time of stopping the drug, whereas in the remaining case the systemic nature of the illness required treatment with corticosteroids. Three patients who were rechallenged with minocycline quickly developed a recurrence of their joint symptoms. Resolution of the serological abnormalities noted in these patients occurred more slowly than the resolution of the clinical symptoms. We propose a direct relationship in these cases between minocycline therapy and the occurrence of a lupus-like syndrome.

Topics: Acne Vulgaris; Adolescent; Female; Humans; Lupus Erythematosus, Systemic; Minocycline; Time Factors

Minocycline is a tetracycline agent frequently used for acne therapy. It has a few rare but severe side effects that are not widely known but should be recognized early as drug related. These include acute hepatitis and liver failure; a Löffler-like syndrome with pulmonary infiltrates, wheezing, fever, and eosinophilia; skin eruptions, eosinophilic cellulitis, and pustular folliculitis with eosinophilia; and a lupuslike syndrome. Side effects that are better known and recognized include photosensitization, skin exanthema with pruritus, and pseudotumor cerebri.

Topics: Acne Vulgaris; Adult; Drug Eruptions; Drug Hypersensitivity; Eosinophilia; Female; Fever; Humans; Liver; Lymphatic Diseases; Minocycline; Neutropenia

Acute pulmonary eosinophilia was observed in the patient after taking minocycline. The clinical picture recurred when the drug was re-introduced. However, this is a rare complication after taking a derivative of tetracycline. An eosinophilia was seen in the peripheral blood and also in the bronchoalveolar lavage. Cessation of the drug therapy without the addition of corticosteroids allowed a cure.

Topics: Acne Vulgaris; Adult; Bronchoalveolar Lavage Fluid; Drug Hypersensitivity; Eosinophilia; Humans; Male; Minocycline; Pulmonary Eosinophilia

Fifty-four patients taking minocycline for acne or rosacea were assessed for adverse effects. Their mean duration of treatment was 17 months, and their average cumulative dose was 47 g. No symptoms attributable to the therapy were reported. Biochemistry and haematology profiles were normal. There was no evidence of an adverse effect on thyroid function. Skin pigmentation was detected in eight patients (14.8%). Five patients had diffuse facial pigmentation, and three patients had localized pigmentation at the site of a scar or injury. Diffuse pigmentation occurred only in patients who had been on treatment for 3 years or more; 50% of such patients were affected. Age and solar damage may also have been factors in this type of pigmentation. Localized pigmentation occurred at sites of previous tissue damage, and was not directly related to the duration of therapy. Patients who receive long-term minocycline therapy should be regularly monitored for the development of pigmentation.

Topics: Acne Vulgaris; Adolescent; Adult; Age Factors; Aged; Cicatrix; Facial Dermatoses; Female; Humans; Male; Middle Aged; Minocycline; Pigmentation Disorders; Rosacea; Skin Aging; Skin Pigmentation; Thyroid Gland; Thyrotropin; Thyroxine; Time Factors

A 16-year-old girl complained about a headache of one-month's duration, accompanied by vertical diplopia that had appeared ten days earlier. The girl reported receiving vitamin A and minocycline to treat acne vulgaris for the previous six weeks. An examination revealed bilateral optic disc edema. Normal computed tomographic and magnetic resonance imaging examinations enabled a diagnosis of pseudotumor cerebri to be made. Soon after discontinuation of those medications, the headaches and diplopia diminished. We suggest a periodic ophthalmologic examination during systemic therapy with vitamin A combined with minocycline to detect the early occurrence of pseudotumor cerebri.

Topics: Acne Vulgaris; Adolescent; Diplopia; Drug Therapy, Combination; Female; Fundus Oculi; Headache; Humans; Magnetic Resonance Imaging; Minocycline; Papilledema; Pseudotumor Cerebri; Tomography, X-Ray Computed; Vitamin A

Topics: Acne Vulgaris; Administration, Oral; Adolescent; Androgen Antagonists; Drug Therapy, Combination; Female; Hidradenitis Suppurativa; Humans; Minocycline; Scalp Dermatoses; Syndrome

Topics: Acne Vulgaris; Adolescent; Female; Humans; Hyperpigmentation; Middle Aged; Minocycline

Topics: Acne Vulgaris; Adolescent; Adult; Female; Hepatic Encephalopathy; Hepatorenal Syndrome; Humans; Liver Transplantation; Minocycline; Necrosis; Pancreatitis

Antibiotic-resistant propionibacteria are being isolated with increasing frequency from antibiotic-treated acne patients. Minimum inhibitory concentrations (MICs) of three tetracyclines, extensively used in acne therapy, were determined for 46 resistant and 19 sensitive propionibacteria isolates. Sensitive strains were inhibited by < or = 1 microgram/ml of all three tetracyclines. For every resistant strain tested, the MIC of tetracycline exceeded that of doxycycline which, in turn, exceeded that of minocycline. The mean MIC for resistant strains was 20.61 +/- 4.56 micrograms/ml of tetracycline, 9.70 +/- 2.03 micrograms/ml of doxycycline and 1.95 +/- 0.35 micrograms/ml of minocycline. In order to determine whether these strains could be inhibited by concentrations of minocycline achievable in vivo, serum levels of minocycline were determined in acne patients receiving either the recommended dose of 50 mg b.d. (20 males, 14 females), or twice this dose (21 males, 12 females). Serum levels were significantly higher (P < 0.001, Student's t-test) in patients receiving 100 mg b.d. Males on 50 mg b.d. had significantly lower serum levels than females on the same dose (P < 0.05. Student's t-test). For all patients, the mean serum level on high-dose minocycline was 2.46 +/- 0.45 micrograms/ml, compared with 1.38 +/- 0.30 micrograms/ml on the smaller dose. These results indicate that tetracycline-resistant propionibacteria should be considered clinically minocycline sensitive, if patients who harbour such strains are prescribed 100 mg b.d. The recommended dose of minocycline for treating acne, especially in male patients, should be re-assessed.

Topics: Acne Vulgaris; Adolescent; Adult; Child; Doxycycline; Drug Administration Schedule; Female; Humans; Male; Microbial Sensitivity Tests; Minocycline; Propionibacterium acnes; Tetracycline Resistance

A 25-year-old woman with gray striated staining on all teeth took minocycline for two years. Staining corresponded with the treatment time.

Topics: Acne Vulgaris; Adult; Female; Humans; Minocycline; Tooth Discoloration

This is the second reported case of minocycline-induced Sweet's syndrome (and the first such case to appear in the American literature). The syndrome developed in a 32-year-old man 10 days after minocycline therapy for acne was begun and resolved rapidly after discontinuation of the medication and start of oral prednisone therapy.

Topics: Acne Vulgaris; Adult; Drug Eruptions; Humans; Male; Minocycline; Sweet Syndrome

A 39-year-old woman was evaluated for possible liver transplantation due to rapidly developing hepatic failure 4 weeks after initiation of oral minocycline 100 mg twice a day for the treatment of acne. The patient developed a maculopapular rash, malaise, fever, nausea, and vomiting 2 weeks prior to admission to the hospital. On admission, her symptoms rapidly progressed to liver failure characterized by rapidly rising liver enzyme levels, worsening encephalopathy, and coagulopathy. Viral hepatitis serologies and blood cultures were all negative. After intensive supportive care for 2 weeks, the patient's condition gradually improved and she was discharged with mildly elevated liver enzyme levels and pruritus, without need of liver transplantation. Minocycline-induced hepatic injury is an idiosyncratic reaction with a sensitization period that appears to be 3-4 weeks in duration. The characteristic features include rash, fever, lymphadenopathy, and eosinophilia, as well as severe alterations in liver function. The high liver enzyme levels and the significant prolongation of the prothrombin time suggest massive hepatocellular damage. In light of the profound liver damage that occurs with this adverse reaction, care should be taken in administering minocycline to patients who have concomitant liver disease. It is recommended that patients should be instructed as to the possible signs and symptoms of toxicity and be monitored for evidence of idiosyncratic reaction or liver failure.

Topics: Acne Vulgaris; Acute Disease; Administration, Oral; Adult; Alanine Transaminase; Alkaline Phosphatase; Aspartate Aminotransferases; Bilirubin; Chemical and Drug Induced Liver Injury; Female; Humans; Liver Function Tests; Minocycline

Sweet's syndrome (acute febrile neutrophilic dermatosis) occurred in a 29-year-old woman with acne. Although Sweet's syndrome initially seemed to be triggered by an acute acne flare, minocycline could later be identified as the causal agent. Because this could be confirmed in an oral provocation test, this seems to be the first case of a true connection between Sweet's syndrome and its induction by a drug, namely minocycline.

Topics: Acne Vulgaris; Acute Disease; Adult; Drug Eruptions; Female; Humans; Minocycline; Neutrophils; Recurrence; Skin Diseases; Syndrome

Two sisters are described who developed facial pigmentation while on minocycline therapy for acne vulgaris. It is suggested that the possible mechanisms for this relatively uncommon complication occurring in these two patients may be due to either a genetically acquired alteration in metabolic handling of minocycline or to the ethinyloestradiol component of Dianette, which they were also receiving as treatment for their acne vulgaris. It is concluded that patients on minocycline should be regularly screened for signs of hyperpigmentation, especially if they are on other drugs which are known to accentuate pigmentation of skin.

Topics: Acne Vulgaris; Adolescent; Androgen Antagonists; Cyproterone; Cyproterone Acetate; Drug Combinations; Drug Synergism; Drug Therapy, Combination; Ethinyl Estradiol; Family; Female; Humans; Minocycline; Pigmentation Disorders; Skin Pigmentation

Biotypes 1-5 Propionibacterium acnes (P. acnes) strains were grown in the presence of 1/10 minimal inhibitory concentrations (sub-MIC) of erythromycin (EM), tetracycline (TC), clindamycin (CLDM), or minocycline (MINO) and their culture filtrates were assayed for human neutrophil chemotactic activity using Boyden chamber methods. The addition of sub-MIC of MINO to the medium strongly suppressed the neutrophil chemotactic activity of the culture filtrates of P. acnes strains of all biotypes. In contrast, with sub-MIC of EM, TC, or CLDM, the activity of the culture filtrates of P. acnes strains of biotypes 2 and 3 were suppressed but those of biotypes 1, 2, and 5 were not. These results indicate that sub-MIC of MINO is capable of decreasing the inflammatory capacity of P. acnes strains of all biotypes.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Chemotactic Factors; Clindamycin; Erythromycin; Humans; Microbial Sensitivity Tests; Minocycline; Neutrophils; Propionibacterium acnes; Tetracycline

Topics: Acne Vulgaris; Female; Humans; Isotretinoin; Minocycline; Pseudotumor Cerebri

Comedonal bacteria, Propionibacterium acnes, P. granulosum and coagulase-negative staphylococci (CNS) seem to play an important initiating role in the inflammatory process by producing neutrophil chemotactic factors. The attracted neutrophils, after phagocytosis, release inflammatory factors such as reactive oxygen species (ROS). We investigated the effects of minocycline at subminimal inhibitory concentrations (sub-MIC), i.e. one-tenth MIC, on the production of human neutrophil chemotactic factors in comedonal bacteria, and on several inflammatory parameters of neutrophils, including neutrophil phagocytosis and generation of ROS (O2-, H2O2, OH.). ROS generation in a cell-free, xanthine-xanthine oxidase system was also assessed. Production of neutrophil chemotactic factors in all strains of P. acnes, P. granulosum and CNS were significantly suppressed by sub-MIC minocycline. Sub-MIC minocycline effectively reduced three kinds of neutrophil-generated ROS (O2-, H2O2, OH.). However, neutrophil phagocytosis and the ROS generated in a cell-free system were not markedly changed in the presence of sub-MIC minocycline. The results suggest that sub-MIC minocycline has an anti-inflammatory effect by inhibiting the production of neutrophil chemotactic factors in comedonal bacteria as well as ROS generated by neutrophils in the inflammatory process of acne.

Topics: Acne Vulgaris; Chemotactic Factors; Humans; In Vitro Techniques; Minocycline; Neutrophils; Oxygen; Phagocytosis; Propionibacterium; Propionibacterium acnes; Staphylococcus

A healthy woman aged 21 years who used the oral contraceptive Trigynon became pregnant while being treated with Minocin (minocycline; 100 mg per day) for acne conglobata. While the risk of use of antibiotics such as this one reducing the efficacy of oral contraceptives is small, patients should nevertheless be informed that the risk exists.. A 21-year old woman using an oral contraceptive, the combination preparation Trigynon containing levonorgestrel (LNG) and ethinyl estradiol (EE), since June 1987 had experienced pain in the groin. In September 1988 she had a single occurrence of bleeding, a sign of lessened effectiveness of the OC. She was treated with 50 mg of minocycline/day as of April 1989, and for inguinal acne conglobata with locally applied clindamycine (10 mg/ml of clindamycine hydrochloride lotion). She switched to another OC, and the next month timely, normal menstruation ensued. A few days later the dose of minocycline was raised to 100 mg/day. Subsequently she had a regular breakthrough bleeding followed by a missed cycle and a positive pregnancy test. There have been several recent reports about the interaction between antibiotics and OCs (breakthrough bleeding and contraceptive failure). Rifampicin and griseofulvin are known to reduce the activity of OCs via induction of liver enzymes. Between 1968-84 there was a total of 62 failures of OCs (15 using OCs with 50 mcg of EE) reported in the UK. The suspected cause was the combined use with antibiotics (70% penicillin and tetracycline). In the Netherlands 6 cases of possible interactions were reported during 1980-86: 2 cases caused by nitrofurantoin and/or trimethoprim, and 1 case by sulfamethoxazol with trimethoprim. The interference of minocycline with the intestinal flora can occur as 34% of it is excreted in feces, and its antibacterial spectrum corresponds to that of tetracycline hydrochloride (reduction of beta-glucuronidase in the feces). The failure of Trigynon cannot be irrefutable ascribed to minocycline as unintended pregnancy also occurs while using OCs without antibiotics. Clindamycine could have also influenced the intestinal flora percutaneously.

Topics: Acne Vulgaris; Adult; Contraceptives, Oral, Hormonal; Contraceptives, Oral, Synthetic; Ethinyl Estradiol; Ethinyl Estradiol-Norgestrel Combination; Female; Humans; Minocycline; Norgestrel; Pregnancy; Tetracyclines

A case of pseudo-tumor cerebri is reported in a woman being treated with minocycline and tretinoin for acne who also ingested liver as a self-treatment for her condition. A possible cumulative effect between these agents is postulated.

Topics: Acne Vulgaris; Adult; Female; Humans; Minocycline; Pseudotumor Cerebri; Tretinoin

A study of the outcome of conventional antibiotic treatment in 543 patients with acne was performed. All were treated initially with erythromycin 1 g/day and topical 5% benzoyl peroxide. The median improvement at 6 months was 78%, with an interquartile range of 67-90%. Four-hundred and eight of the 492 who completed 6 months' treatment showed over 50% improvement and 247 of the 279 patients treated for a subsequent 6 months with benzoyl peroxide alone, continued to do well. Another subgroup of 174 patients, was continued for 6 months with systemic antibiotic and 5% benozyl peroxide. No significant benefit was gained, however, by maintaining successfully treated patients on a further 6 months of systemic antibiotics. Of the 84 patients who did less well, 18 were given alternative treatment (Diane, isotretinoin). The other 60, subsequently referred to as slow responders, were continued on antibiotics (erythromycin, 31; minocin, 29; cotrimoxazole, 4; trimethoprim, 2) and benzoyl peroxide. Those prescribed minocycline for the second 6 months appeared to have greater benefit (64%) than those receiving erythromycin (57%). This level of improvement was still lower than that seen in those who responded well within 6 months (78%). Of the risk factors analysed, the poorest response occurred in males with truncal acne. Age at presentation, duration and severity did not adversely affect therapeutic outcome. Side-effects were minimal.

Topics: Acne Vulgaris; Adolescent; Adult; Benzoyl Peroxide; Drug Administration Schedule; Drug Therapy, Combination; Erythromycin; Female; Humans; Male; Minocycline; Peroxides; Tetracyclines; Time Factors

The authors studied the bioavailability of minocycline in sebum and serum. Blood and sebum samples were collected weekly for 6 weeks from ten healthy volunteers taking 200 mg of minocycline every day for 4 weeks. Sebum was collected by direct extraction with petroleum ether from the forehead. After evaporation, sebum was weighed on a scale accurate to 10 micrograms. Determination of minocycline in serum and sebum was performed using a high performance liquid chromatography technique (HPLC), with a better detection limit at 352 nm than at 400 nm (20 ng/ml and 0.324 microgram/ml respectively). Our results contrast with other studies since no minocycline was detected in the sebum samples of treated subjects and microbiological assays of minocycline in sebum were also negative. In our opinion, the current hypothesis claiming that the effectiveness of minocycline in the treatment of acne vulgaris is based on sebaceous secretion should be reconsidered.

Topics: Acne Vulgaris; Biological Availability; Female; Humans; Male; Minocycline; Sebum; Tetracyclines

Four cases of benign intracranial hypertension (BIH) associated with minocycline therapy are described. All subjects were young women being treated for acne. The durations of therapy from the onset of minocycline treatment until the diagnosis of BIH was made were 25 days, 4 weeks, 4 months and 18 months. Headache was severe in all cases. Two had intermittent visual obscurations. Papilloedema was present in each case. CT brain scans did not show any focal abnormalities other than the presence of small ventricles. Cessation of minocycline reversed the disease process though the resolution was much slower in the patient with the longest history of minocycline intake. One subject still had persisting lower nasal quadrantic field loss 6 months after cessation of minocycline. In each case the diagnosis of benign intracranial hypertension related to minocycline was not made by the primary referring doctor, indicating the need for increased awareness of this cause of headache.

Topics: Acne Vulgaris; Adolescent; Female; Humans; Minocycline; Papilledema; Pseudotumor Cerebri; Tetracyclines

A small, but clinically significant proportion of acne patients fail to respond adequately to antibiotic therapy. All non-responding acne patients attending the Leeds General Infirmary between September 1985 and April 1986 (49 out of a total of 610 patients; 8%) were investigated with respect to changes in their acne grade, microbial flora and sebum excretion rate. They were compared with 22 age and sex matched untreated control subjects. It was found that in 65% of non-responding patients there was no microbiological abnormality, in 16% there was evidence of Gram-negative folliculitis and 20% carried predominantly antibiotic resistant propionibacteria compared with only 5% of untreated controls. There was a significant association between erythromycin therapy and the isolation of erythromycin resistant propionibacteria (P less than 0.001). A causal link, however, has yet to be established between carriage of antibiotic resistant propionibacteria and failure to respond to antibiotic therapy. Our results show that for most patients with recalcitrant acne a non-microbiological explanation must be sought for the lack of therapeutic success. The mean sebum excretion rate (SER) of the non-responding patients was significantly higher than that of matched untreated acne patients (P less than 0.001). A majority of non-responders (69%) had an SER above the upper 95% confidence limit of the control mean. The SER may affect treatment efficacy by influencing the antibiotic concentration within the pilosebaceous ducts.

Topics: Acne Vulgaris; Adolescent; Adult; Anti-Bacterial Agents; Drug Resistance, Microbial; Erythromycin; Female; Humans; Malassezia; Male; Minocycline; Propionibacterium; Sebum; Staphylococcus; Tetracycline Resistance

A 19 year-old woman complained of headache and nausea occurring while she was taking minocycline for acne. Examination showed bilateral papilloedema and a bilateral VIth nerve palsy. Symptoms and signs rapidly resolved after the drug was stopped. Benign intracranial hypertension due to tetracyclines is well known in infants. It is rare in adults. Its pathophysiology remains unknown. The role of vitamin A is inconsistent. Others biological factors or personal susceptibility could be involved.

Topics: Acne Vulgaris; Adult; Female; Humans; Minocycline; Pseudotumor Cerebri; Tetracyclines

Topics: Acne Vulgaris; Adult; Female; Humans; Male; Minocycline; Patient Compliance; Tablets; Tetracyclines

Topics: Acne Vulgaris; Adolescent; Adult; Consumer Behavior; Family Practice; Female; Humans; Male; Minocycline; Tetracyclines

Topics: Acne Vulgaris; Adolescent; Female; Humans; Minocycline; Mouth Diseases; Mouth Mucosa; Pigmentation Disorders; Tetracyclines

Topics: Acne Vulgaris; Adolescent; Adult; Drug Therapy, Combination; Female; Humans; Ibuprofen; Male; Minocycline; Tetracyclines

Topics: Acne Vulgaris; Administration, Topical; Adrenal Cortex Hormones; Benzoyl Peroxide; Cicatrix; Contraceptives, Oral, Hormonal; Humans; Isotretinoin; Minocycline; Propionibacterium acnes; Tetracycline; Tretinoin

The Sebumeter method used in this study for quantitative analysis of skin surface lipids differs from previous techniques in simple handling and quick practicability and is therefore helpful in the clinical routine. Sebumetrical measurements carried out on healthy persons revealed symmetrical distribution of skin surface lipids. The highest levels were found on the forehead; young people generally showed higher values than older persons. During therapy with 13-cis retinoic acid on acne patients for 6 months (0.5 mg/kg daily), we found reduction of the random level in the first month, particularly in the forehead region. During therapy with minocycline on 3 acne patients for 3 months (2 X 50 mg daily), there was no variation of the random level observed. UVA irradiation on the face for 10 minutes daily (0.55 J/cm2/min) over a period of 3 weeks resulted in continuous reduction of the random level in most of the tested persons; a small part of them reacted by fluctuating values.

Topics: Acne Vulgaris; Adolescent; Adult; Age Factors; Aged; Child; Humans; Lipid Metabolism; Lipids; Middle Aged; Minocycline; Skin; Tetracyclines; Tretinoin; Ultraviolet Therapy

Topics: Acne Vulgaris; Bone and Bones; Humans; Lymph Nodes; Male; Minocycline; Pigmentation; Tetracycline; Tetracyclines; Thyroid Gland

The minimal inhibitory concentration (MIC) of Propionibacterium acnes in seventy-five acne patients receiving long-term antibiotic therapy demonstrated the emergence of resistant strains. The mean MIC in thirty-three patients receiving long-term tetracycline was four to five times higher than that found in control groups of acne patients not receiving antibiotic therapy and controls free of acne. The average MIC for erythromycin was more than 100 times higher in those receiving long-term antibiotic therapy. In a second group of sixty-two patients, the clinical course and number of P. acnes were correlated with the presence of "resistant strains" defined as P. acnes with a tenfold increase in MIC to tetracycline or erythromycin. Patients with resistant strains had higher counts of P. acnes and clinically were not doing as well as those with sensitive strains.

Topics: Acne Vulgaris; Adolescent; Adult; Anti-Bacterial Agents; Bacterial Infections; Clindamycin; Drug Resistance, Microbial; Erythromycin; Female; Humans; Male; Minocycline; Propionibacterium acnes; Tetracycline

Topics: Acne Vulgaris; Adult; Color; Female; Humans; Hyperplasia; Minocycline; Pigmentation Disorders; Tetracyclines; Thyroid Diseases; Thyroid Function Tests; Thyroid Gland

Strains of propionibacteria resistant to clindamycin or clindamycin and erythromycin were isolated from four patients with acne, three of whom were receiving clindamycin. Four strains of P. acnes and one of P. granulosum with moderate levels of tetracycline resistance were isolated from 25 patients with acne being treated with tetracycline. A similar increase in tetracycline resistance was achieved by training sensitive strains in vitro. P. acnes was sensitive to sulphonamide and trimethoprim but some strains of P. granulosum were resistant to sulphonamide. Similar reports of clindamycin and erythromycin resistance from the USA suggest resistance may be increasing in isolates from patients with acne.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Clindamycin; Drug Resistance, Microbial; Erythromycin; Humans; Minocycline; Propionibacterium; Propionibacterium acnes; Sulfamethoxazole; Tetracycline; Trimethoprim

Unpigmented and pigmented cystic epithelial inclusions were found bilaterally within the lower palpebral conjunctiva temporally of a 31-year-old man. He had a history of tetracycline/minocycline therapy for 14 years because of acne vulgaris. The cysts were studied by light and electron microscopy, histochemistry, and ultraviolet light. By light microscopy the unpigmented cysts contained faintly eosinophilic globular material that disclosed yellowish-green autofluorescence indicating the presence of tetracycline/minocycline. The pigmented cysts revealed laminated eosinophilic to brownish concretions that also showed yellowish-green autofluorescence. Autofluorescence, however, decreased with increasing brown pigmentation of the concretions. Histochemically, the pigment, which failed to show the staining characteristics of lipofuscin, melanin or iron, probably represented an oxidation product of tetracycline. By electron microscopy the cysts contained moderately electron dense amorphous material as well as degenerating epithelial cells. The epithelial cells lining the conjunctival cysts, did not contain membrane-bound, large, pigment granules within their cytoplasm as has been demonstrated in the colloid and follicular epithelium of the thyroid following minocycline therapy.

Topics: Acne Vulgaris; Adult; Conjunctiva; Conjunctival Diseases; Cysts; Cytoplasmic Granules; Drug Therapy, Combination; Epithelium; Humans; Male; Microscopy, Electron; Minocycline; Tetracycline; Tetracyclines

Two cases of black discoloration of the thyroid are reported, each in a young woman treated for acne; the first with minocycline alone, the second with tetracycline and minocycline. Light microscopy showed numerous brown granules in the cytoplasm of the follicular epithelium, with large brown deposits in the colloid, including, in Case 2, numerous crystalline forms. The association between drug therapy and pigment accumulation (in conjunction with animal experiments) was taken to indicate some form of causal relationship, and minocycline residues were anticipated. Histochemical studies indicated that the granules were lipofuscin and electron microscopy showed an increase in phagolysosomes but no novel structures. There was no evidence for persisting minocycline, or its derivatives, although these could not be excluded. The black thyroid appears to be a disorder at lysosome/substrate level, induced by drug action, particularly by minocycline, and manifested by an accumulation of heterogeneous intracellular material with the histochemical and electron microscopic appearances of lipofuscin.

Topics: Acne Vulgaris; Adult; Female; Histocytochemistry; Humans; Inclusion Bodies; Lipofuscin; Lysosomes; Microscopy, Electron; Microscopy, Fluorescence; Minocycline; Pigmentation Disorders; Tetracyclines; Thyroid Gland

The purpose of the study presented herein was to determine the safety and efficacy of minocycline in patients whose acne vulgaris failed to respond adequately to tetracycline therapy and to confirm continued improvement in tetracycline-responsive patients when minocycline was substituted for tetracycline. Thirty-six acne vulgaris patients were given oral tetracycline (250 mg four times a day) for six weeks, followed by oral minocycline (50 mg three times a day) for six weeks. An analysis of the increase or decrease in total lesion counts obtained at biweekly intervals revealed that minocycline caused statically significant improvement both in patients who did not respond to tetracycline and in patients who did respond to tetracycline. Patients who did not respond to tetracycline therapy achieved a mean decrease of 54 percent in lesions after after six weeks of minocycline treatment. In tetracycline-responsive patients, six weeks' treatment with tetracycline caused a 33.5 percent mean decrease in the lesion count. When these patients received minocycline for a subsequent six-week period, the mean lesion count decreased by an additional 60 percent. Only one patient developed a side effect: severe itching and urticaria in a minocycline-treated subject warranted discontinuance of therapy. Minocycline was a safe and effective agent in the treatment of acne both in tetracycline-resistant and in tetracycline-responsive patients.

Topics: Acne Vulgaris; Administration, Oral; Adolescent; Adult; Female; Humans; Male; Minocycline; Tetracycline; Tetracyclines; Urticaria

Minocycline, prescribed for a patient with acne, produced a photosensitivity reaction (photo-onycholysis) involving the fingernails. The onset of this reaction coincided with an increase in sun exposure and cleared several months later, when the drug was discontinued. This type of reaction has been reported to occur in patients taking tetracycline or a member of the tetracycline group of antibiotics, of which minocycline is a member. This appears to be first report of photo-onycholysis due to minocycline.

Topics: Acne Vulgaris; Adolescent; Female; Humans; Minocycline; Nail Diseases; Photosensitivity Disorders; Sunlight; Tetracyclines; Ultraviolet Rays

A case of pseudotumour cerebri (PTC) in a 13-year-old girl is reported. This patient experienced menarche seven months before presentation, and subsequently developed acne which necessitated antibiotic therapy. She had been treated with minocycline hydrochloride (100 mg twice a day) for two months before admission to hospital. The role of minocycline therapy associated with menarche in the aetiology of PTC is discussed.

Topics: Acne Vulgaris; Adolescent; Female; Humans; Menstruation Disturbances; Minocycline; Pseudotumor Cerebri; Tetracyclines

In four cases of minocycline hydrochloride-induced cutaneous pigmentation, blue-gray discoloration in sites of cutaneous inflammation was seen in all cases. An additional finding of generalized, brown hyperpigmentation with accentuation in sun-exposed areas was noted in one. Although all of the patients had used relatively high doses of medication, the variable duration of therapy before pigmentary changes and dearth of similar reports suggest an idiosyncratic response to this commonly used medication. Histochemical stains and electron microscopic studies suggest hemosiderin or a pigment with similar staining properties; a minocycline degradation product, however, cannot be discounted.

Topics: Acne Vulgaris; Adolescent; Adult; Biopsy; Female; Humans; Inflammation; Male; Middle Aged; Minocycline; Pigmentation Disorders; Skin; Tetracyclines

Localized brown to blue-black discoloration of the skin occurred in three patients receiving long-term minocycline hydrochloride therapy. Abundant perivascular pigmented material was present at all levels of the dermis below the upper papillary portion. Histochemical studies demonstrated reactivity with the Prussian blue stain and the Fontana-Masson silver technique. The granules were brightly refractile by dark-field illumination. Ultrastructurally, there were membrane-bound dense intracellular inclusions differing from melanin and iron but identical to those known to occur in the thyroid glands of minocycline-primed laboratory animals. The abnormal pigment most likely represents a metabolic derivative of minocycline.

Topics: Acne Vulgaris; Adult; Humans; Male; Middle Aged; Minocycline; Pigmentation Disorders; Skin; Tetracyclines

The recent literature contains sporadic mention of localized pigmentary accumulations in skin, bones, teeth, and thyroid tissue, presumably related to the use of systemic minocycline hydrochloride. It is our purpose to report the occurrence of generalized, cutaneous, dark blue-gray hyperpigmentation that developed in a woman while she was being treated with minocycline (Minocin) for acne vulgaris. We believe this pigmentary change to be minocycline-induced.

Topics: Acne Vulgaris; Adult; Biopsy; Female; Humans; Minocycline; Pigmentation Disorders; Skin; Tetracyclines

Topics: Acne Vulgaris; Administration, Oral; Humans; Minocycline; Pigmentation Disorders; Tetracyclines; Tooth Discoloration

Topics: Acne Vulgaris; Adult; Female; Humans; Minocycline; Tetracyclines; Tooth Discoloration

Topics: Acne Vulgaris; Administration, Oral; Adult; Carbon Dioxide; Female; Humans; Male; Minocycline; Oxygen; Pulmonary Eosinophilia; Radiography; Tetracycline; Tetracyclines; Urinary Tract Infections

Topics: Acne Vulgaris; Female; Humans; Minocycline; Pigmentation Disorders; Tetracyclines

Ninety-one patients with acne vulgaris were selected for a two-part study primarily because the severity of disease suggested that it might be tetracycline-recalcitrant. Of the eighty-eight patients completing the first part of the study, thirty-two were judged to have tetracycline-nonresponsive acne and received 50 mg of minocycline twice daily for the next six to eight weeks. Twenty-five patients completed this second part of the study. Of these twenty-five, twenty-two experienced a 33 percent or greater reduction in the number of lesions. It is concluded that minocycline in a dosage of 50 mg twice daily is a safe and effective antibiotic for those patients with tetracycline-recalcitrant acne vulgaris.

Topics: Acne Vulgaris; Adult; Drug Resistance; Female; Humans; Minocycline; Tetracycline; Tetracyclines

All tetracycline preparations seem to be systemically effective in acne. Quality and frequency of their side-effects, however, are different and should be carefully considered in each individual case. In an own study ninety-one patients treated with minocycline showed good response in 69% and moderate or no response in 31+. The main side-effects of the drug were nausea and giddiness, being of short duration in most cases. In patients with no response to a certain preparation change of the preparation may be helpful. Occasionally, acne does not respond to any tetracycline derivative. In these cases the use of non-tetracycline antibiotics, particularly of trimethoprim-sulphamethazol and lincomycines, is clearly effective. As a rule, we start treatment with tetracycline (500-750 mg/d) and reduce the dose to a minimum (ca. 100 mg/d), in order to withdraw the drug. In non-responsive cases another derivative and/or finally non-tetracycline antibiotics are administered for therapy.

Topics: Acne Vulgaris; Adolescent; Adult; Anti-Bacterial Agents; Humans; Male; Minocycline; Tetracyclines

Forty-seven patients with acne, unresponsive to tetracycline and erythromycin, were treated with 100 mg minocycline daily. About one-quarter showed a 50% improvement or better. Five patients became dizzy during the first week of therapy, making it necessary to stop the medication in four instances. Two patients stopped treatment after several months because of esophagitis in one and headaches in another. Vestibular side effects are the most common complication of treatment. Patients should be warned about this side effect and if it occurs should avoid driving or handling machines. In some instances, dizziness may be so severe that the drug will have to be discontinued.

Topics: Acne Vulgaris; Adolescent; Adult; Child; Drug Evaluation; Female; Humans; Male; Minocycline; Tetracyclines

Topics: Acne Vulgaris; Administration, Oral; Candidiasis, Vulvovaginal; Clindamycin; Colitis; Demeclocycline; Drug Evaluation; Erythromycin; Female; Humans; Minocycline; Photosensitivity Disorders; Tetracycline; Time Factors

Topics: Acne Vulgaris; Contraceptives, Oral; Diet Therapy; Minocycline; Oxytetracycline; Vitamin A