Yes, doxycycline is an oral tetracycline antibiotic that works by slowing the growth of acne-producing bacteria and exhibiting anti-inflammatory effects. It is commonly prescribed by dermatologists for moderate-to-severe acne, and the American Academy of Dermatology strongly recommends this treatment as well.

How does it work?

Doxycycline helps to treat acne by reducing the number of bacteria on the skin surface and in the hair follicles, as well as by lessening inflammation that may cause redness. Doxycycline is in a group of antibiotics with similar properties called tetracyclines.

• Doxycycline works by acting on bacteria by slowing protein synthesis in the microbial RNA. RNA is a molecule found in all living cells needed for protein synthesis.
• They are primarily bacteriostatic - which means that they prevent bacteria from multiplying - but do not necessarily kill them.
• Tetracyclines also exhibit immune system properties that help to slow down white blood cell movement during inflammation.

What is acne vulgaris?

Acne vulgaris, usually just called "acne", is caused by blocked hair follicles and oil (sebaceous) glands of the skin, and may be triggered by hormonal changes. It is the most common skin disorder in the U.S., affecting 85% of older children and teens, and often persists into adulthood.

The bacteria associated with acne is Cutibacterium acnes (C. acnes), also known as Propionibacterium acnes. The bacteria releases lipase, an enzyme that digests the oily substance on the skin known as sebum which leads to inflammation and redness.

The term acne refers to not only pimples on the face, but blackheads, cysts, and nodules that may occur on the skin, including the neck, back and chest. It can greatly affect quality of life and may lead to mental health issues such as depression or social isolation. Teens may be especially impacted academically, socially or mentally by acne development.

Acne treatment by a board-certified dermatologist is important because acne left unchecked can often lead to permanent scars and dark facial spots, as well as lower a person’s quality of life.

See Managing and Treating Acne for other treatment options.

What is the dose?

The typical oral dose of doxycycline for acne is 50 to 100 mg by mouth twice per day, or 100 mg once per day. Some doctors may use lower doses if side effects are a concern. Doses are individual and may be adjusted based on your tolerance or effectiveness.

Doxycycline is available as a capsule, tablet or oral liquid suspension. Take the medicine with a full glass of water. Try to stay upright for at least 30 minutes after your dose to help prevent heartburn. Be sure to drink plenty of liquids while you are taking this medicine.

Follow all of the dosing directions on your prescription label, as different forms of doxycycline may have different directions.

• Most brands of this medicine may be taken with food if you have stomach upset. However, different brands of doxycycline may have different instructions about taking them with or without food, so check your labels or ask your pharmacist.
• Avoid consuming dairy products like milk, and iron or calcium supplements within 1 hour before or 2 hours after taking doxycycline, which may affect how well the medicine is absorbed.

Brand and Generic names

• Brand name examples of doxycycline include Acticlate, Dorxy, Oracea, Targadox and Vibramycin among others.
• Generic options, which may be much more affordable or covered by your insurance, include doxycycline hyclate and doxycycline monohydrate.

Visit the Drugs.com Prices, Coupons, Copay Cards & Patient Assistance page to learn more about doxycycline pricing and access a discount coupon.

How long does doxycycline take to work?

The length of time it takes for doxycycline to slow the growth of acne will vary among patients. In some patients, the initial beneficial effects may be visible within 2 weeks, but most people see an improvement after about 12 weeks of treatment.

Some people who take doxycycline for acne may find that their acne gets worse before it starts to get better. This is sometimes described as the "purging phase" and occurs as the skin clears out debris from the acne lesions. Although it appears that your acne is worsening, it is usually a sign that your medicine is working. The purging phase typically lasts about 2 to 4 weeks on average.

How long can you take doxycycline for acne?

Most people are prescribed doxycycline for about 3 months before treatment is stopped. Stopping at 3 months helps to prevent antibiotic resistance, which may make the medicine less effective. Your healthcare provider may also start or continue topical treatments to help control your acne over the longer term.

Topical treatments for acne that may be prescribed in addition to oral doxycycline include:

• adapalene/benzoyl peroxide gel (Epiduo, Epiduo Forte)
• tretinoin (Retin A, Avita)
• benzoyl peroxide (Twyneo)
• adapalene (Differin)
• tazarotene topical (Arazlo, Fabior, Tazorac)
• clascoterone (Winlevi)

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Common side effects

Doxycycline may be commonly associated with stomach side effects like nausea and vomiting, diarrhea, loss of appetite, painful swallowing or heartburn (from esophagitis).

Other side effects may include skin rash or itching, sun sensitivity and sunburn, darkened skin color, and vaginal itching or discharge. Use a sunscreen, hat or other protective clothing to prevent sunburn, and avoid the sun at the hottest times of the day.

• Learn more about the warnings, precautions and side effects with doxycycline.

Most oral formulations of this drug should not be used during pregnancy unless the benefit outweighs the risk. Use of this drug in pregnant women may cause fetal harm. Use of the 40 mg capsule formulation is not recommended.

Use of tetracyclines after the first 18 weeks of pregnancy may affect the formation of the baby's teeth and cause discoloration.

If you are pregnant or planning a pregnancy, tell your healthcare provider before you are prescribed this medicine.

Learn more: Doxycycline use in pregnancy and breastfeeding

Which medicines are recommended for acne?

Practice Guidelines published in 2024 from the American Academy of Dermatology (AAD) list several evidence-based recommendations for the treatment of acne. In addition to oral doxycycline, which is strongly recommended, other acne treatments recommended by this group include:

Oral agents

• Tetracycline oral antibiotics: minocycline (brand name examples: Dynacin, Minocin, Solodyn) and sarecycline (Seysara).
• Combined oral contraceptives such as norgestimate/ethinyl estradiol (Estarylla), or drospirenone/ethinyl estradiol (Yaz), to help balance hormones that may be contributing to acne.
• Spironolactone, an anti-androgen that may be used in adult women with hormonal acne to help regulate oil production.
• For severe, nodular cystic acne that has not responded to other treatments, that is causing scars, or that may be affecting mental and social health, oral isotretinoin (brand examples: Accutane, Amnesteem, Claravis) is strongly recommended. Oral isotretinoin is available only from a certified pharmacy under a special program called iPLEDGE. This drug should NOT be used by female patients who are or may become pregnant. There is an extremely high risk that severe birth defects will result if pregnancy occurs while taking this drug.

Topical agents

• Benzoyl peroxide (available over-the-counter and by prescription)
• Topical retinoids, like tretinoin (Retin A, Atralin, Altreno)
• Topical antibiotics (clindamycin, erythromycin)
• Clascoterone (Winlevi), an anti-androgren cream
• Salicylic acid
• Azelaic acid (Azelex, Finacea)

Topical agents are applied to the skin and may come as creams, lotions, solutions, gels or on saturated pads to wipe on the face.

The AAD also recommends some general treatment guidelines, such as:

• Combining topical therapies that work differently
• Limiting oral (systemic) antibiotic use
• Combining oral antibiotics with topical treatments
• Adding corticosteroid injections directly into larger acne lesions

Bottom Line

• Doxycycline is an effective oral tetracycline antibiotic that works in acne by slowing the growth of bacteria and promoting anti-inflammatory effects. It is recommended for use by dermatologists and in recent evidence-based guidelines.
• Oral treatments like doxycycline are often combined with topical therapy, like creams, lotions, solutions, saturated pads or gels, to employ different mechanisms of action, enhance effectiveness and lower side effects.
• If you have severe acne or acne that does not respond to over-the-counter (OTC) agents, see a dermatologist as soon as possible to help avoid scarring and permanent tissue damage. Prescription products can have a positive effect on acne lesions when used as directed, and may increase your quality of life.

This is not all the information you need to know about doxycycline for safe and effective use and does not take the place of your doctor’s directions. Review the full product information and discuss this information and any questions you have with your doctor or other health care provider.

References

• Reynolds RV, Yeung H, Cheng CE, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2024 May;90(5):1006.e1-1006.e30. doi: 10.1016/j.jaad.2023.12.017 
• Gold LS, Cruz A, Eichenfield L, et al. Effective and safe combination therapy for severe acne vulgaris: a randomized, vehicle-controlled, double-blind study of adapalene 0.1%-benzoyl peroxide 2.5% fixed-dose combination gel with doxycycline hyclate 100 mg. Cutis. 2010 Feb;85(2):94-104
• Baldwin H. Oral Antibiotic Treatment Options for Acne Vulgaris. J Clin Aesthet Dermatol. 2020 Sep;13(9):26-32
• Graber E (author). Patient education: Acne (Beyond the Basics). October 8, 2024. Up to Date. Accessed Nov. 19, 2024 at https://www.uptodate.com/contents/acne-beyond-the-basics

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