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How to reduce the side effects of oral acne medicinesReduce Side Effects of Oral Acne Medicines


The basic problem with all acne medications, both surface treatments and oral medications, is that the side effects come before the improvement in acne. It takes about two months to start to see the improvement with acne treatment. Most of the side effects are less of a problem over time but many patients don’t get that far in their treatments, they stop when they still have side effects but before the improvement is visible. The side effects are frustrating and unless you know how to prevent and deal with them, you quit before the acne actually gets better. The other problem that I see is when patients take the first month prescription of acne pills, then don’t refill them and continue. Oral acne medicines are meant to be continued until your dermatologist tells you to stop. I do see patients who were treated by another physician and say they were not told how long to take the pills. It is your dermatologist’s job to explain that to you.

OMG here he is again. My lawyer is butting in and says if I am going to talk about these issues, I have to tell you this again. So here it is, one more time:

Electronic message exchanges to, from, or with Dr. Cook do not constitute medical advice, an evaluation, or consultation and must not be considered a replacement or substitute for a formal evaluation in the office. Information and correspondence in this blog does not form and will not result in a doctor-patient relationship. If you desire an evaluation or consultation, contact our office for an appointment. Recommended changes to your present treatment plan or therapy must be approved by your physician. Explanation and/or discussion of off-label services and/or products, if mentioned, do not reflect endorsement or promotion by Dr. Cook and must not be construed as such. This means—I am not your doctor, unless I really am your doctor. Done and done.

The side effects of oral antibiotics are usually less of an issue to patients than those seem with surface treatments. See my post, Medications Dermatologists Use to Treat Acne, for a discussion of the side effects of oral antibiotics. Two issues that can be a problem with the most commonly used oral medications—minocycline (Minocin, Dynacyn, Solodyn and generics), doxycycline (Adoxa, Avidoxy, Doryx, Monodox, Oracea, Vibramycin and generics) and tetracycline---are sun sensitivity and gastrointestinal upset.

Sun Sensitivity from Oral Acne Medicines

All of them cause sun sensitivity but doxycycline is the worst offender. The sun sensitivity with doxycycline can be significant, causing sunburn and even causing the nails to lift off from nail bed. If you are going skiing, to the lake or beach or planning a day at the pool, don’t take the doxycycline the night before and the morning of the sun exposure to reduce the risk. Even the UV lights used at nail salons can cause the nails to lift from the bed if you are on doxycycline. And for heaven’s sake, no tanning beds.

Nausea and Diarrhea from Oral Acne Medicines

Some people get significant GI upset with any of the oral antibiotics used to treat acne, but it is the most significant with doxycycline. This can be reduced by taking the medication with food. Prescription bottles for this group of antibiotics often have warning labels in all caps stating “WARNING: DO NOT TAKE WITH FOOD OR MILK,” causing patients to think this is dangerous and will kill them. It will not. You will absorb a little less if you take it within a time period two hours before or two hours after food or milk. Nevertheless, it is better to take it with food or milk, and absorb a little less, than to try to get a teenage boy to find 4 hours twice a day when he is not eating to take his medication. And not taking it at all, because there are not 8 hours in a day when teenage boys are not eating. The exception is tetracycline, which is not absorbed at all if taken with food or milk. You might as well throw it in the trash.  So if you have GI upset with minocycline or doxycycline, or just can’t remember to take it regularly at other times, go ahead and take it with a meal.

Other Side Effects from Oral Acne Medicines

Remember, acne antibiotics aren’t used during pregnancy to prevent staining of fetal bones and teeth. Any oral antibiotic may interfere with effectiveness of birth control pills, increasing the risk of pregnancy. If you develop rash, persistent headache, pigmentation or think you are having a reaction to medication, stop it and call your dermatologist. As with any medication, if you have significant rash, severe reaction or difficulty breathing you should go directly to the Emergency Room.

This is not a comprehensive discussion of all possible side effects from acne medications. You need to discuss those with your dermatologist. Now my lawyer can get his elbow out of my ribs.

Next: How to deal with the dryness, flaking and peeling from surface acne medications


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