How Antibiotics work (and don't work) for Acne!

Almost everyone with acne has, at some point, tried antibiotics for their skin! It is a first line treatment for acne in conventional medicine and so it’s not surprising that the majority of my acne clients have experience with doxycycline - the good, the bad and the ugly!

The antibiotics used for acne are usually tetracycline antibiotics like doxycycline and minocycline. Interestingly, doxycycline seems to improve acne not by reducing acne causing bacteria, but by reducing inflammation in the skin.

We know that acne is an inflammatory condition - pimples are red, angry, swollen, hot, painful and produce pus. These are all the classic signs of inflammation!

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In particular, doxycycline appears to work by reducing the effect of IL-1 mediated inflammation (IL-1 is a type of inflammatory chemical in the body). This type of inflammation seems to cause keratinocytes (the skin cells that produce keratin) to go into overdrive. When in excess, keratin is a protein that clogs up the little oil glands in the skin. This clogging blocks the oil gland and a comedome forms - when bacteria and the immune system get involved, you’ll see the inflammation and redness that results in the form of a pustule.

So doxycycline reduces this inflammatory effect on keratinocytes to reduce the clogging and comedomes caused by too much keratin.

If you haven’t taken doxycycline before, you might start thinking that its a good idea to get yourself some of these antibiotic thingos, and it might be! You need to do what is right for you and sometimes antibiotics and other pharmaceutical medications can be a good circuit breaker when you are at your wits end and have tried everything else.

However, I really view antibiotics as a last resort. Even if they help to reduce some of the inflammation in the skin, they are not a long term fix. They don’t address the cause of that inflammation and can do some collateral damage along the way to the gut microbiome and gut lining. Given that the gut can generate a LOT of inflammation, it seems counterintuitive to use a drug that might negatively affect digestion and gut function.

As a Naturopath, I’m all about getting to the root cause of acne.

Antibiotics also don’t address hormonal drivers of acne. Regardless of your acne type, there is almost always a hormonal element at play. This might be testosterone in the case of androgenic acne, PCOS or post-pill acne. For PMS breakouts and acne at ovulation, oestrogen will be involved. The skin can also produce its own stress hormones in response to stress elsewhere in the body. Antibiotics don’t target any of this.

Perhaps I’m just seeing a lot of the women that doxycycline hasn’t worked for, but many who have taken it report their acne returns once they stop.

The initial trials of doxycline in acne in the 1970’s found that doxycycline only improved the severity in 33% of participants, compared to 22% in the placebo group. That’s 10% more effective than no treatment at all(1). The number of particpants was also small and uneven, with 21 participants administered docycline compare to 14 in the placebo group(1). There are other studies that report doxycline is most effective in combination with other antibiotics and topical therapies(2). So it is difficult to ascertain how effective just one antibiotic on its own can be. Most trials are no longer than 3 months, which limits the data on safety and efficacy of long term use. There is a need for more trials.

Like all drugs, doxycycline does have the potential to cause side effects such as:

  • Nausea, loss of appetite, vomiting, diarrhoea

  • Ulcerationa and erosion of the mucose in the oesophagus (take with plenty of water!)

  • Photosensitivity & hyperpigmentation

  • Skin rashes and pustular rash (acne?)

  • Others which you can read about here in the product information for doxycycline monohydrate

If you have tried doxycycline before and it worked a treat, but then your acne came back after stopping doxy, this shows you that inflammation is a major trigger for you. Inflammation can be managed in lots of different ways, some of which I will list here:

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Other ways to reduce IL-1:

  • Green tea

  • Omega-3 fish oil

  • Zinc

  • Ginger

  • Slippery Elm

We can also reduce inflammation by going in and finding the cause of the inflammation! This might be from dietary choices, stress, overgrowth of bacteria in the gut micrbiome or a lack of probiotic bacteria, alcohol or a mix of everything!

Remember, if there is inflammation in the skin, the re is likely to be inflammation in the gut too.

Still trying to figure out your acne cause and triggers? Take my free quiz here.

I cover all the ways to identify and reduce inflammation and other driving causes of acne in my online course Confident & Clear! I’m also hosting a free webinar soon where I will share some more juicy tips on clearing acne naturally so that you can reclaim your confidence, even if you feel like you have tried EVERYTHING! Join my mailing list to be notified of the webinar details.

Until then, keep doing your best and your skin will thank you.

Lexie x

Want to get more of my best clear skin secrets?

Reference List: 

1.        Plewig G, Petrozzi JW, Berendes U. Double-Blind Study of Doxycycline in Acne Vulgaris. Arch Dermatol. 1970;101(4):435-438. doi:10.1001/archderm.1970.04000040057011

2.        Walsh TR, Efthimiou J, Dréno B. Systematic review of antibiotic resistance in acne: An increasing topical and oral threat. Lancet Infect Dis. 2016;16(3):e23-e33. doi:10.1016/S1473-3099(15)00527-7


Alexandra McPhee