Try Doxycycline Twice a Day!

Doxycycline

(dox i sye' kleen)

http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682063.html

Why is this medication prescribed?Return to top

Doxycycline is used to treat bacterial infections, including pneumonia and other respiratory tract infections; Lyme disease; acne; infections of skin, genital, and urinary systems; and anthrax (after inhalational exposure). It is also used to prevent malaria. Doxycycline is in a class of medications called tetracycline antibiotics. It works by preventing the growth and spread of bacteria. Antibiotics will not work for colds, flu, or other viral infections.

How should this medicine be used?Return to top

Doxycycline comes as a regular and a coated capsule, a tablet, a syrup, and a suspension (liquid), all to take by mouth. Doxycycline is usually taken once or twice a day. Drink a full glass of water with each dose of the capsule or tablet. If your stomach becomes upset when you take doxycycline, you may take it with food or milk. However, taking doxycycline with milk or food may decrease the amount of medication absorbed from your stomach. Talk with your doctor or pharmacist about the best way to take doxycycline if your stomach becomes upset. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take doxycycline exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Shake the syrup or suspension well before each use to mix the medication evenly.

If you are taking doxycycline for the prevention of malaria, start taking it 1 or 2 days before traveling to an area where there is malaria. Continue taking doxycycline for 4 weeks after leaving the area where there is malaria. You should not take doxycycline for the prevention of malaria for more than 4 months.

Continue to take doxycycline even if you feel well. Take all the medication until you are finished, unless your doctor tells you otherwise.

Other uses for this medicineReturn to top

Doxycycline may also be used for the treatment of malaria. Talk to your doctor about the possible risks of using this medication for your condition.

This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

What special precautions should I follow?Return to top

Before taking doxycycline,

• tell your doctor and pharmacist if you are allergic to doxycycline, minocycline, tetracycline, sulfites (for doxycycline syrup only), or any other medications.
• tell your doctor and pharmacist what prescription and nonprescription medications you are taking, especially antacids, anticoagulants ('blood thinners') such as warfarin (Coumadin), carbamazepine (Tegretol), penicillin, phenobarbital, phenytoin (Dilantin), and vitamins. Doxycycline decreases the effectiveness of some oral contraceptives; another form of birth control should be used while taking this drug.
• be aware that antacids, calcium supplements, iron products, and laxatives containing magnesium interfere with doxycycline, making it less effective. Take doxycycline 1 hour before or 2 hours after antacids (including sodium bicarbonate), calcium supplements, and laxatives containing magnesium. Take doxycycline 2 hours before or 3 hours after iron preparations and vitamin products that contain iron.
• tell your doctor if you have or have ever had diabetes or kidney or liver disease.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking doxycycline, call your doctor immediately. Doxycycline can harm the fetus.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking doxycycline.
• plan to avoid unnecessary or prolonged exposure to sunlight and to wear protective clothing, sunglasses, and sunscreen. Doxycycline may make your skin sensitive to sunlight.
• you should know that when you are receiving doxycycline for prevention of malaria, you should also use protective measures such as effective insert repellent, mosquito nets, clothing covering the whole body, and staying in well-screened areas, especially from early nighttime until dawn. Taking doxycycline does not give you full protection against malaria.
• you should know that when doxycycline is used during pregnancy or in babies or children up to age 8, it can cause the teeth to become permanently stained. Doxycycline should not be used in children under age 8 except for inhalational anthrax or if your doctor decides it is needed.

What special dietary instructions should I follow?Return to top

Unless your doctor tells you otherwise, continue your normal diet.

What should I do if I forget a dose?Return to top

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What side effects can this medication cause?Return to top

Doxycycline may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• diarrhea
• itching of the rectum or vagina
• sore mouth

Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately:

• severe headache
• blurred vision
• skin rash
• hives
• difficulty breathing or swallowing
• redness of the skin (sunburn)
• yellowing of the skin or eyes
• itching
• dark-colored urine
• light-colored bowel movements
• loss of appetite
• upset stomach
• vomiting
• stomach pain
• extreme tiredness or weakness
• confusion
• decreased urination

What storage conditions are needed for this medicine?Return to top

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

In case of emergency/overdoseReturn to top

In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

What other information should I know?Return to top

Keep all appointments with your doctor and laboratory. Your doctor will want to check your response to doxycycline.

Before having any laboratory test, tell your doctor and the laboratory personnel that you are taking doxycycline.

If you have diabetes, doxycycline can cause false results in some tests for sugar in the urine. Check with your doctor before changing your diet or the dosage of your diabetes medicine.

Do not let anyone else take your medication. Your prescription is probably not refillable. If you still have symptoms of infection after you finish the doxycycline, call your doctor.

Acne scars

Severe acne often leaves small scars where the skin gets a "volcanic" shape. Acne scars are difficult and expensive to treat,^[26] and it is unusual for the scars to be successfully removed completely.^{[citation needed]} In those cases, acne scar treatment may be appropriate.

The psychological and emotional effects caused by acne scars can be as devastating to one's confidence as the acne itself.

Acne scars generally fall into two categories: physical scars and pigmented scars. Physical acne scars are often referred to as "Icepick" scars. This is because the scars tend to cause an indentation in the skins surface. Pigmented scars is a slightly misleading term, suggesting a change in the skin's pigmentation. This is not true. Pigmented scars are usually the result of nodular or cystic acne (the painful 'bumps' lying under the skin). They often leave behind an inflamed red mark. Often, the pigmentation scars can be avoided simply by avoiding aggravation of the nodule or cyst. When sufferers try to 'pop' cysts or nodules, pigmentation scarring becomes significantly worse, and may even bruise the affected area. Pigmentation scars often fade with time, and those who suffered from acne before, and have developed scars are generally relieved that the acne has gone, and emotional effects of acne scars tend to be less distressing.

Acne scars are unsightly, and it is for this reason they can be psychologically and emotionally distressing. However, there are a range of treatments available. If acne scars are causing severe psychological distress, social withdrawal and/or emotional ill-health, a physician should be contacted.

Wikipedia

Preferred treatments by types of acne vulgaris

• Comedonal (non-inflammatory) acne: local treatment with azelaic acid, salicylic acid, topical retinoids, benzoyl peroxide.
• Mild papulo-pustular (inflammatory) acne: benzoyl peroxide or topical retinoids, topical antibiotics (such as erythromycin).
• Moderate inflammatory acne: benzoyl peroxide or topical retinoids combined with oral antibiotics (tetracyclines). Isotretinoin is an option.
• Severe inflammatory acne, nodular acne, acne resistant to the above treatments: isotretinoin, or contraceptive pills with cyproterone for females with virilization or drospirenone.
• Most physicians state that topical retinoids are the preferred treatment for all forms of acne vulgaris

Wikipedia

Updated Treatment of Acne

Blue and red light

It has long been known that short term improvement can be achieved with sunlight. However, studies have shown that sunlight worsens acne long-term, presumably due to UV damage. More recently, visible light has been successfully employed to treat acne (Phototherapy) - in particular intense blue light generated by purpose-built fluorescent lighting, dichroic bulbs, LEDs or lasers. Used twice weekly, this has been shown to reduce the number of acne lesions by about 64%;^[15] and is even more effective when applied daily. The mechanism appears to be that a porphyrin (Coproporphyrin III) produced within P. acnes generates free radicals when irradiated by blue light.^[16] Particularly when applied over several days, these free radicals ultimately kill the bacteria.^[17] Since porphyrins are not otherwise present in skin, and no UV light is employed, it appears to be safe, and has been licensed by the U.S. FDA.^[18] The treatment apparently works even better if used with red visible light (660 nanometer) resulting in a 76% reduction of lesions after 3 months of daily treatment for 80% of the patients;^[19] and overall clearance was similar or better than benzoyl peroxide. Unlike most of the other treatments few if any negative side effects are typically experienced, and the development of bacterial resistance to the treatment seems very unlikely. After treatment, clearance can be longer lived than is typical with topical or oral antibiotic treatments; several months is not uncommon. The equipment or treatment, however, is relatively new and reasonably expensive.

Photodynamic therapy

In addition, basic science and clinical work by dermatologists Yoram Harth and Alan Shalita and others has produced evidence that intense blue/violet light (405-425 nanometer) can decrease the number of inflammatory acne lesion by 60-70% in 4 weeks of therapy, particularly when the P.acnes is pretreated with delta-aminolevulinic acid (ALA), which increases the production of porphyrins. However this photodynamic therapy is controversial and apparently not published in a peer reviewed

Wikipedia

Causes of Acne

• Hormonal activity, such as menstrual cycles and puberty
• Stress, through increased output of hormones from the adrenal (stress) glands.
• Hyperactive sebaceous glands, secondary to the three hormone sources above.
• Diet ^{[citation needed]}
• Accumulation of dead skin cells.
• Bacteria in the pores, to which the body becomes 'allergic'.
• Skin irritation or scratching of any sort will activate inflammation.
• Use of anabolic steroids.
• Any medication containing halogens (iodides, chlorides, bromides), lithium, barbiturates, or androgens.
• Exposure to high levels of chlorine compounds, particularly chlorinated dioxins, can cause severe, long-lasting acne, known as Chloracne.

Wikipedia

Can I fully cured?

Acne vulgaris eventually remits spontaneously, but when this will occur cannot be predicted. The condition may persist throughout adulthood and may lead to severe scarring if left untreated. Patients treated with antibiotics continue to improve for the first 3-6 months of therapy. Relapse during treatment may suggest the emergence of resistant P acnes. The disease is chronic and tends to flare intermittently in spite of treatment. Remissions following systemic treatment with isotretinoin may be lasting in up to 60% of cases. Relapses after isotretinoin usually occur within 3 years and require a second course in up to 20% of patients.

CMDT 2006

Stages of Acne

1. Mild acne —

The first choice of topical antibiotics in terms of efficacy and relative lack of induction of resistant P acnes is the combination of erythromycin or clindamycin with benzoyl peroxide topical gel. Clindamycin (Cleocin T) lotion (least irritating), gel, or solution, or one of the many brands of topical erythromycin gel or solution, may be used twice daily and the benzoyl peroxide in the morning. (A combination of erythromycin or clindamycin with benzoyl peroxide is available as a prescription item.) The addition of tretinoin 0.025% cream or 0.01% gel at night may be effective, since it works via a different mechanism.

2. Moderate acne —

Tetracycline, 500 mg twice daily, doxycycline, 100 mg twice daily, and minocycline, 50-100 mg twice daily, are all effective though minocycline is more expensive. When initiating minocycline therapy, start at 100 mg in the evening for 4-7 days, then 100 mg twice daily, to decrease the incidence of vertigo. Plan a return visit in 6 weeks and at 3-4 months after that. If the patient's skin is quite clear, instructions should be given for tapering the dose by 250 mg for tetracycline and erythromycin, by 100 mg for doxycycline, or by 50 mg for minocycline every 6-8 weeks — while treating with topicals — to arrive at the lowest systemic dose needed to maintain clearing. In general, lowering the dose to zero without other therapy results in prompt recurrence of acne. Tetracycline, minocycline, and doxycycline are contraindicated in pregnancy, but oral erythromycin may be used.

It is important to discuss the issue of contraceptive failure when prescribing antibiotics for women taking oral contraceptives. Women may need to consider using barrier methods as well, and should report breakthrough bleeding. Oral contraceptives or spironolactone (50-200 mg daily) may be added as an antiandrogen in women with antibiotic-resistant acne or in women in whom relapse occurs after isotretinoin therapy.

3. Severe acne —

a. Isotretinoin (Accutane) —

A vitamin A analog, isotretinoin is used for the treatment of severe cystic acne that has not responded to conventional therapy. Informed consent must be obtained before its use. A dosage of 0.5-1 mg/kg/d for 20 weeks for a cumulative dose of at least 120 mg/kg is usually adequate for severe cystic acne. Patients should be offered isotretinoin therapy before they experience significant scarring if they are not promptly and adequately controlled by antibiotics. The drug is absolutely contraindicated during pregnancy because of its teratogenicity; two serum pregnancy tests should be obtained before starting the drug in a female and every month thereafter. Sufficient medication for only 1 month should be dispensed. Two forms of effective contraception must be used. Side effects occur in most patients, usually related to dry skin and mucous membranes (dry lips, nosebleed, and dry eyes). If headache occurs, pseudotumor cerebri must be considered. Depression has been reported. About 25% of patients will develop hypertriglyceridemia, 15% hypercholesterolemia, and 5% a lowering of high-density lipoproteins. Some patients develop minor elevations of liver function tests. Fasting blood sugar may be elevated. Miscellaneous adverse reactions include decreased night vision, musculoskeletal or bowel symptoms, dry skin, thinning of hair, exuberant granulation tissue in lesions, and bony hyperostoses (seen only with very high doses or with long duration of therapy). Moderate to severe myalgias necessitate decreasing the dosage or stopping the drug. Laboratory tests to be performed in all patients before treatment and after 4 weeks on therapy include cholesterol, triglycerides, and liver function studies.

Elevations of liver enzymes and triglycerides return to normal upon conclusion of therapy. The drug may induce long-term remissions in 40-60%, or acne may recur that is more easily controlled with conventional therapy. Occasionally, acne does not respond or promptly recurs after therapy, but it may clear after a second course.

b. Intralesional injection —

In otherwise moderate acne, intralesional injection of dilute suspensions of triamcinolone acetonide (2.5 mg/mL, 0.05 mL per lesion) will often hasten the resolution of deeper papules and occasional cysts.

c. Laser, dermabrasion —

Cosmetic improvement may be achieved by excision and punch-grafting of deep scars and by abrasion of inactive acne lesions, particularly flat, superficial scars. The technique is not without untoward effects, since hyperpigmentation, hypopigmentation, grooving, and scarring have been known to occur. Dark-skinned individuals do poorly. Corrective surgery within 12 months after isotretinoin therapy may not be advisable.

CMDT 2006

Treatment of Acne 3

B. Comedonal Acne

Treatment of acne is based on the type and severity of lesions. Comedones require treatment different from that of pustules and cystic lesions. In assessing severity, one must also take the sequelae of the lesions into account. Therefore, one must treat an individual who gets only two new lesions per month that scar or leave postinflammatory hyperpigmentation much more aggressively than a comparable patient whose lesions clear without sequelae. Soaps play little role in acne treatment, and unless the patient's skin is exceptionally oily, a mild soap should be used to avoid irritation that will limit the usefulness of other topicals, all of which are themselves somewhat irritating.

1. Topical retinoids —

Tretinoin is very effective for comedonal acne or for treatment of the comedonal component of more severe acne, but its usefulness is limited by irritation. Start with 0.025% cream (not gel) and have the patient use it at first twice weekly at night, then build up to as often as nightly. A few patients cannot use even this low-strength preparation more than three times weekly, but even that may cause improvement. A pea-sized amount is sufficient to cover half the entire face. To avoid irritation, have the patient wait 20 minutes after washing to apply. Adapalene gel 0.1% and reformulated tretinoin (Renova, Retin A Micro, Avita) are other options for patients irritated by standard tretinoin preparations. Some patients — especially teenagers — do best on 0.01% gel. Although the absorption of tretinoin is minimal, its use during pregnancy is contraindicated. Some patients report photosensitivity with tretinoin. Patients should be warned that they may flare in the first 4 weeks of treatment. Tazarotene gel (0.05% or 0.1%) (Tazorac), a topical retinoid approved for treatment of psoriasis and acne, may also be effective.

2. Benzoyl peroxide —

Benzoyl peroxide products are available in concentrations of 2.5%, 4%, 5%, 8%, and 10%, but it appears that 2.5% is as effective as 10% and less irritating. In general, water-based and not alcohol-based gels should be used to decrease irritation.

3. Antibiotics —

Use of topical antibiotics (see below) has been demonstrated to decrease comedonal lesions.

4. Comedo extraction —

Open and closed comedones may be removed with a comedo extractor but will recur if not prevented by treatment.

Treatment of Acne 2

A. General Measures

1. Education of the patient —

When scarring seems out of proportion to the severity of the lesions, one must suspect that the patient is manipulating the lesions. It is essential that the patient be educated in a supportive way about this complication. Although there are exceptions, it is wise to let the patient know that at least 4-6 weeks will be required to see improvement and that old lesions may take months to fade. Therefore, improvement will be judged according to the number of new lesions forming after 6-8 weeks of therapy. Additional time will be required to see improvement on the back and chest, as these areas are slowest to respond. If hair pomades are used, they should contain glycerin and not oil. Avoid topical exposure to oils, cocoa butter (theobroma oil), and greases.

2. Diet —

Foods do not cause or exacerbate acne.

CMDT 2006

What is Acne?

Acne vulgaris is a self-limited disorder primarily of teenagers and young adults, although perhaps 10 to 20% of adults may continue to experience some form of the disorder. The permissive factor for the expression of the disease in adolescence is the increase in sebum production by sebaceous glands after puberty. Small cysts, called comedones, form in hair follicles due to blockage of the follicular orifice by retention of sebum and keratinous material. The activity of bacteria (Proprionobacterium acnes) within the comedones releases free fatty acids from sebum, causes inflammation within the cyst, and results in rupture of the cyst wall. An inflammatory foreign-body reaction develops as a result of extrusion of oily and keratinous debris from the cyst.

The clinical hallmark of acne vulgaris is the comedone, which may be closed (whitehead) or open (blackhead). Closed comedones appear as 1- to 2-mm pebbly white papules, which are accentuated when the skin is stretched. They are the precursors of inflammatory lesions of acne vulgaris. The contents of closed comedones are not easily expressed. Open comedones, which rarely result in inflammatory acne lesions, have a large dilated follicular orifice and are filled with easily expressible oxidized, darkened, oily debris. Comedones are usually accompanied by inflammatory lesions: papules, pustules, or nodules.

The earliest lesions seen in early adolescence are generally mildly inflamed or noninflammatory comedones on the forehead. Subsequently, more typical inflammatory lesions develop on the cheeks, nose, and chin. The most common location for acne is the face, but involvement of the chest and back is not uncommon. Most disease remains mild and does not lead to scarring. However, a small number of patients develop large inflammatory cysts and nodules, which may drain and result in significant scarring.

Exogenous and endogenous factors can alter the expression of acne vulgaris. Friction and trauma may rupture preexisting microcomedones and elicit inflammatory acne lesions. This is commonly seen with headbands or chin straps of athletic helmets. Application of comedogenic topical agents in cosmetics or hair preparations or chronic topical exposure to certain industrial compounds that are comedogenic may elicit or aggravate acne. Glucocorticoids, applied topically or administered systemically in high doses, may also elicit acne. Other systemic medications such as lithium, isoniazid, halogens, phenytoin, and phenobarbital may produce acneiform eruptions, or aggravate preexisting acne

Harrisson - 16th edition