Minocycline is a semi-synthetic, second-generation
tetracycline. It was introduced in 1972 and has both antibacterial and anti-inflammatory properties.
Minocycline is used for a variety of
infectious diseases and in
acne. Even today, new indications beyond the antibacterial indications are being investigated such as its use in neurologic diseases. Formerly,
minocycline was thought to have a superior efficacy in the treatment of inflammatory
acne, especially with respect to antibacterial-resistant Propionibacterium acnes. A thorough review of the literature, however, shows that
minocycline is not more effective in
acne than other
tetracyclines. Compared with first-generation
tetracyclines,
minocycline has a better pharmacokinetic profile, and compared with
doxycycline it is not phototoxic. However,
minocycline has an increased risk of severe adverse effects compared with other
tetracyclines. It may induce
hypersensitivity reactions affecting the liver, lung, kidneys, or multiple organs (
Drug Reaction with Eosinophilia and Systemic Symptoms [
DRESS] syndrome) in the first weeks of treatment and, with long-term treatment, may cause autoimmune reactions (
systemic lupus erythematosus,
autoimmune hepatitis). In addition, CNS symptoms, such as
dizziness, are more frequent compared with other
tetracyclines. Long-term treatment may induce
hyperpigmentation of the skin or other organs. Resistance of P. acnes to
minocycline also occurs, dependent on the prescribing behavior. Considering the aspects of efficacy, its adverse effect profile, resistance, price, and alternatives,
minocycline is no longer considered the first-line antibacterial in the treatment of
acne.