If you've ever had the misfortune of battling serious acne, you've probably seen a dermatologist. And if you've seen a dermatologist for acne, they most likely have discussed using an oral medication as part of your blemish-busting strategy. For chronic, intense, widespread acne—and when topical treatments (be they over-the-counter or prescribed) alone aren't cutting it—dermatologists will often prescribe oral antibiotics. These work by delivering system-wide effects, targeting the bacteria that cause acne and combating the issue from the inside-out. Of the options out there, minocycline is one of the most-often prescribed picks. But, how does it work exactly and what makes it different from the other acne meds out there? Ahead, dermatologists Dr. Joshua Zeichner, Dr. Y. Claire Chang, Dr. Jeremy Fenton, and Dr. Jordan Carqueville explain why they might perscribe this pill, and exactly how it can be the extra element you need to achieve clear skin for good.
Meet the Expert
- Dr. Joshua Zeichner is the Director of Cosmetic and Clinical Research in the Department of Dermatology at Mount Sinai Hospital in New York City.
- Y. Claire Chang, MD, is a board-certified cosmetic dermatologist at Union Square Laser Dermatology in New York City.
- Jordan Carqueville, MD, is a celebrity dermatologist based in Chicago, IL.
- Jeremy Fenton, MD, is a dermatologist at Schweiger Dermatology Group in New York City.
What Is Minocycline?
Minocycline is an antibiotic that's part of the tetracycline family. "It has both antibacterial and anti-inflammatory properties, and is used for a wide range of infectious diseases, as well as for the treatment of inflammatory skin diseases like acne," explains Chang. There are other antibiotics in the tetracycline category, namely doxycycline, another often-prescribed antibiotic for acne, but minocycline has a few unique features. "It's the most oil-soluble of all of the antibiotics in this class, which enhances its penetration into the oil-rich environment of the hair follicle," says Zeichner. Why is this important? This is where it needs to be in order to exert its action against acne, he points out. It also generally has fewer side effects than doxycycline (namely a lower likelihood for increased sun sensitivity and stomach upset), and one study showed that the resistance of the acne bacteria to minocycline tends to be lower than other antibiotics. An important attribute since, in talking about any kind of antibiotic, bacterial resistance is always a very real issue.
How Minocycline Works to Treat Acne
To understand exactly how minocycline can help treat acne, it's important to first dig into the nitty-gritty of acne pathology. Buckle up for a quickie dermatology crash course. At the root of the issue is a chicken-or-the-egg cycle where bacteria, oil, and inflammation are the key players. "The causes of acne are multifactorial, including overgrowth of bacteria on the skin and an inflammatory reaction to the presence of those bacteria. Excess oil production often leads to the bacteria thriving, byproducts of the bacteria lead to inflammation, and then a cycle of inflammation perpetuates," explains Fenton. Enter antibiotics, the class of tetracyclines specifically. Not only do they inhibit the acne-causing bacteria, p.acnes, they also innately have anti-inflammatory effects themselves, says Carqueville. A study published in the Journal of the American Academy of Dermatology found both minocycline and doxycycline to be effective forms of acne treatment.
The big caveat, though? A systemic antibiotic, minocycline or otherwise, isn't for your run-of-the-mill blackheads, whiteheads, or occasional breakout. This is known as comedonal acne, which doesn’t have an inflammatory component and as such does not usually require antibiotics, points out Fenton. Instead, "minocycline and antibiotics are best reserved for dealing with active, inflammatory acne, in other words blemishes that are angry, tender, and red," Carqueville says. They can also come into play only when topical treatments aren't working, or when the acne is very severe and/or covering large areas, adds Zeichner.
How to Use Minocycline
At the end of the day, all the derms we spoke with point out that whether or not taking an antibiotic is part of your acne treatment plan, and if so which one, is a complex decision that needs to be discussed with your dermatologist. (It's also worth noting that while minocycline tends to be better tolerated than doxycycline, that same study found that neither is more effective than the other.) If you and your dermatologist do decide that minocycline is the best course of action for you, here's what you need to know: Depending on the exact type and dosage, it can be taken once or twice daily, says Chang, as there are both regular and extended release options, the latter of which a study also showed to be safe and effective. "Remember that it takes about six to eight weeks for any acne medication to start working, so do not expect to see results immediately," she adds. While minocycline has traditionally always been an oral drug, a topical minocycline foam was recently approved as well, notes Fenton, who cites a 2020 study confirming its efficacy. This should be applied to affected areas nightly, he adds.
The possible side effects for minocycline are the same as for the entire class of tetracyclines, namely the potential for stomach upset and fungal infections. And all antibiotics carry the downside of wiping out the good bacteria in your gut, notes Fenton. Minocycline specifically can cause dizziness and vertigo, more commonly, and, in rare cases, joint aches, fatigue, and dark patches of color on the skin, says Zeichner. The topical version can cause redness and skin irritation. Oh, and very important to note, you can't take minocycline while you're pregnant or breastfeeding, or if you're allergic to tetracycline antibiotics. As always, you should chat with your dermatologist about any existing health conditions before asking about minocycline.
Still, once you're on minocycline, that's not the end all be all. "The best practice is to not prescribe oral antibiotics by themselves or for extended periods of time, because this can promote bacterial resistance. We try to limit use to no more than three or four months, and also use minocycline in combination with topical benzoyl peroxide to prevent bacterial resistance," explains Zeichner. The bottom line: Taking this prescribed medication can help, but it's more of a short-term solution that will hopefully kick start your complexion clearing up, rather than something you'll have to do for the rest of your life.
Xu H, Li H. Acne, the skin microbiome, and antibiotic treatment. Am J Clin Dermatol. 2019;20(3):335-344. doi:10.1007/s40257-018-00417-3
Zaenglein AL, Pathy AL, Schlosser BJ, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016;74(5):945-73.e33. doi:10.1016/j.jaad.2015.12.037
Torok HM. Extended-release formulation of Minocycline in the treatment of moderate-to-severe acne vulgaris in patients over the age of 12 years. J Clin Aesthet Dermatol. 2013;6(7):19-22.
Raoof TJ, Hooper D, Moore A, et al. Efficacy and safety of a novel topical minocycline foam for the treatment of moderate to severe acne vulgaris: a phase 3 study. J Am Acad Dermatol. 2020;82(4):832-837. doi:10.1016/j.jaad.2019.05.078