Treating acne with the tetracycline class of antibiotics: A review

Abstract

Acne, one of the most common dermatologic conditions seen by dermatologists, is frequently treated with oral antibiotics. As such, dermatologists prescribe more antibiotics than any other specialty, the majority of which are of the tetracycline class. This family of antibiotics includes tetracycline, doxycycline, minocycline, and sarecycline. Although linked by a similar mechanism of action, each agent has unique characteristics that should be considered carefully. Sarecycline, recently approved by the United States Food and Drug Administration, is a narrow‐spectrum antibiotic and acts primarily on cutaneous bacteria such as Cutibacterium acnes . In contrast, tetracycline, doxycycline, and minocycline are broad‐spectrum antibiotics—indiscriminately inhibiting bacteria in both the skin and gastrointestinal tract. Rising concerns about antibiotic resistance and the need for antibiotic stewardship may make a narrow‐spectrum antibiotic a more attractive therapeutic choice for the acne patient. It is vital that the clinician understand the pros and cons of each tetracycline agent so as to optimally serve our acne population.