Oral antibiotics are the most widely prescribed oral therapy worldwide. Tetracyclines (tetracycline, oxytetracycline, doxycycline and minocycline) are the antibiotics of choice.but erythromycin is preferable in the female who is or might become pregnant or is breastfeeding. Trimethoprim is also sometimes used. However, reducing the P. acnes bacteria will not, in itself, do anything to reduce the oil secretion. Additionally the antibiotics are becoming less and less useful as resistant P. acnes are becoming more common. Acne will generally reappear quite soon after the end of treatment—days later in the case of topical applications, and weeks later in the case of oral antibiotics. Furthermore side effects of tetracycline antibiotics can include yellowing of the teeth and an imbalance of gut flora, so are only recommended after topical products have been ruled out. Now a days doycycline and minocycline are more often used than tetracycline. Minocycline produces a blue-black pigmentation in a dose-dependent way, and in the skin this presents in three forms: pigmentation in inflamed acne lesions, in scars (acne and non-acne) and, more rarely, generalized dark-grey discoloration. The pigmentation is due to a melanin-drug complex and it lasts for an average of 8-15 months posttherapy.The brown-grey pigmentation due to minocycline may also occur in the nails,oral mucous membranes and sclera.
The serious side-effects are of three types, all of which are rare. Hypersensitivity syndrome reactions (including pulmonary eosinophilia) and serum sickness-like reactions occur within 3 months of treatment and are characterized by fever, malaise, and arthralgia possibly with major organ involvement. The late-reaction pattern occurs much later, usually at about 6-48 months. These patients, predominantly female, present with a symmetrical polyarthritis or polyarthralgia in the small joints. Some of these patients have concomitant liver disease, which may occur in the absence of joint symptoms. A liver biopsy shows chronic active hepatitis, and serology for lupus is usually positive. Thus, minocycline should be avoided in patients with a personal or family.
The serious side-effects are of three types, all of which are rare. Hypersensitivity syndrome reactions (including pulmonary eosinophilia) and serum sickness-like reactions occur within 3 months of treatment and are characterized by fever, malaise, and arthralgia possibly with major organ involvement. The late-reaction pattern occurs much later, usually at about 6-48 months. These patients, predominantly female, present with a symmetrical polyarthritis or polyarthralgia in the small joints. Some of these patients have concomitant liver disease, which may occur in the absence of joint symptoms. A liver biopsy shows chronic active hepatitis, and serology for lupus is usually positive. Thus, minocycline should be avoided in patients with a personal or family.
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