Resistance of Cutibacterium acnes to topical antibiotics historically used to treat acne (topical erythromycin and clindamycin and, more recently, topical azithromycin and clarithromycin) has been steadily increasing and new topical antibiotics are needed. Minocycline is a semisynthetic tetracycline-derived antibiotic currently used systemically to treat a wide range of infections caused by Gram-negative and Gram-positive bacteria. In addition to its antibiotic activity, minocycline possesses anti-inflammatory properties, such as the downregulation of proinflammatory cytokine production, suppression of neutrophil chemotaxis, activation of superoxide dismutase, and inhibition of phagocytosis, among others. These characteristics make minocycline a valuable agent for treatment of dermatological diseases such as acne vulgaris and papulopustular rosacea. However, more frequent or serious adverse effects have been observed upon the systemic administration of minocycline than with other tetracyclines. Examples of serious adverse effects include hypersensitivity syndrome reaction, drug-induced lupus, idiopathic intracranial hypertension, and other autoimmune syndromes that may cause death. Here, we review adverse effects and drug–drug interactions observed with oral administration of minocycline and contrast this with topical minocycline formulations recently approved or under development for effectively treating dermatological disorders with fewer adverse effects and less drug interaction.

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.

Broad spectrum tetracyclines are a well-known, widely used, and often successful treatment for use in inflammatory skin pathologies such as acne and rosacea. However, the steady rise of antibiotic resistance and gut dysbiosis associated with broad spectrum tetracyclines emphasizes the importance and responsibility of antibiotic stewardship. Narrow spectrum antibiotics have become increasingly important therapies to slow the progression of resistance as well as decrease negative side effect profiles, particularly those associated with broad spectrum tetracyclines. This case shows the successful treatment of periorificial dermatitis with a novel, narrow spectrum tetracycline, sarecycline, in a patient with underlying Crohn’s. J Drugs Dermatol. 20(1):98-100. doi:10.36849/JDD.2021.5678

Acne has been written about since ancient Greek times and was a recognized entity even during Cleopatra's reign. Today, acne is pervasive in most cultures and is the number two reason why patients visit a dermatologist in the United States. It is the eighth most common disease worldwide. Despite the longstanding awareness of acne and its prevalence, no perfect treatment yet exists.