Question

Which oral tetracycline should I prescribe for acne vulgaris?

Bottom Line

Oral tetracyclines (eg, doxycycline, lymecycline, oxytetracycline) are effective in the treatment of moderate to severe acne vulgaris. Minocycline is no more effective than the others but is more expensive and is associated with safety concerns.

Caveat

Minocycline, like other tetracyclines can cause candidiasis, gastrointestinal upset, hypersensitivity reactions, photosensitivity and benign intracranial hypertension. Minocycline is more likely than other tetracyclines to produce a lupus-like syndrome. Unlike other tetracyclines, minocycline can cause a potentially irreversible slate-grey hyperpigmentation of the skin.

Context

Acne vulgaris is the most common skin disease of adolescence, affecting over 80 per cent of teenagers (aged 13-18 years) at some point. Depending on severity, there is a variety of effective topical and systemic treatments, including oral tetracyclines.