Minocycline for Acne Cream and foam is a formulation of topical tetracycline antibiotic that is used in the therapy of mild to extreme non-nodular acne (in conjunction with other therapies).

Minocycline Uses:

• Acne vulgaris:

  • For the treatment of non-nodular mild to extreme acne vulgaris in adults and children aged 9 or above, minocycline is used.

Note:

• Topical antibiotics are not recommended as monotherapy for the treatment of acne vulgaris because of the emergence of antibiotic resistance. They should be used in conjunction with other therapies.

Read:

• How to treat moderate to severe acne
• Isotretinoin (Accutane, Claravis)

Minocycline Dose in Adults:

Minocycline Cream Dose in the treatment of moderate to severe Acne vulgaris:

Note:

• Topical antibiotics are not recommended as monotherapy in the treatment of acne Vulgaris because of emerging antibiotic resistance. They should be used in conjunction with other medications.
• Topical:
  • It is applied topically as a small (cherry-sized) amount to fingertips and applied to acne-affected areas once a day.
  • The treatment is continued until all acne-affected areas clear.

Minocycline Dose in Children:

Minocycline Dose in the treatment of Acne vulgaris:

Note:

• Topical antibiotics are not recommended as monotherapy in the treatment of acne vulgaris because of the emerging antibiotic resistance.

• Children ≥9 years and Adolescents:

  • Topical: Foam:
    • Apply a small amount (cherry-sized) to the affected area once a day.

Pregnancy Risk Category: D

• If administered orally during pregnancy, it can cross the placental barriers and cause harm to the fetus.
• Systemic absorption is much lower when topical applications are used than oral.
• You can also read about systemic minocycline.

Minocycline use during breastfeeding:

• It is unknown if the drug is excreted in breast milk after topical application. Oral use of the drug may result in substantial excretion into breast milk.
• Additionally, there is a very small amount of drug available systemically after topical application of minocycline to treat acne.
• Because of possible adverse drug reactions in infants, the manufacturer suggests that breastfeeding should be avoided.
• You can also read about systemic minocycline.

Dose in Kidney Disease:

There are no dosage adjustments provided in the manufacturer's labeling. However, dosage adjustment is not required due to minimal systemic absorption.

Dose in Liver disease:

There are no dosage adjustments provided in the manufacturer's labeling. However, dosage adjustment is not required due to minimal systemic absorption.

Common Side Effects of Minocycline Cream:

• Dermatologic:

  • Erythema of skin
  • Hyperpigmentation

Less Common Side Effects of Minocycline Cream:

• Central nervous system:

  • Headache

• Dermatologic:

  • Xeroderma
  • Pruritus
  • Desquamation

Contraindications to Minocycline Cream:

Allergy reactions to tetracyclines and any component of the formulation

Warnings and precautions

• Autoimmune syndromes:

  • Oral minocycline has been linked to autoimmune conditions like autoimmune hepatitis and lupus-like Syndrome, vasculitis, and serum sickness that manifests as fever, arthralgia, and malaise.
  • You should immediately stop using the treatment.

• CNS effects

  • It can cause dizziness, vertigo, and lightheadedness. 
  • It should be used with caution by patients who are required to maintain mental alertness for tasks such as driving or operating heavy machinery.
  • It is possible to see improvement after discontinuing treatment.

• Hepatotoxicity:

  • Oral minocycline use has been linked to hepatotoxicity, including drug-induced liver injury, and hepatitis.
  •  

• Hypersensitivity and skin reaction

  • Allergy reactions may include drug rash, Steven-Johnson syndrome and erythema multifle, Steven-Johnson syndrome, Steven-Johnson syndrome as well as fever, eosinophilia, and anaphylaxis.
  • Oral minocycline has been linked to DRESS syndrome (drug rash associated with eosinophilia, systemic symptoms, and drug rash). If DRESS syndrome is suspected, the treatment should be stopped immediately.

• Intracranial hypertension

  • Oral minocycline may cause intracranial hypertension. This may cause headaches, blurred vision, visual impairment, diplopia, papilledema, and blurred vision.
  • Intracranial hypertension is more common in women who are pregnant or using hormonal contraceptives.
  • Concomitant use of medications that may cause intracranial hypertension such as isotretinoin should be avoided.
  • Although treatment discontinuation can improve intracranial hypertension, it is possible to experience permanent vision loss.
  • If visual symptoms occur, patients should immediately consult an ophthalmologist. 
  • Patients may need to be monitored for several weeks as the intracranial pressure can remain elevated for many weeks.

• The Metabolic Effects

  • The antianabolic effects of this drug may lead to an increase in BUN.

• Photosensitivity

  • Photosensitivity has been linked to oral tetracyclines, especially minocycline.
  • Patients receiving topical treatment with topical tetracyclines should use appropriate skin protection.
  • Patients should wear loose-fitting clothing and limit exposure to artificial sunlight and sun.
  • Sunburn should be treated immediately if it is detected

• Superinfection

  • The development of superinfections, including serious fungal or bacterial infections, has been linked to the prolonged use of oral antibiotics such as tetracyclines.
  • Clostridium difficile-associated diarrhea (CDAD), also known as Clostridium difficile (formerly Clostridium) has been linked to prolonged oral tetracyclines, including minocycline. CDAD can occur even after discontinuing treatment for two months.

Minocycline (topical): Drug Interaction

Monitoring parameters:

None mentioned. Monitor the response to treatment.

How to administer Topical Minocycline?

Topical:

• It is only intended for topical use over the face and skin. It should not be taken orally, applied over the mucosa, or used inside the vagina.
• The lotion should be shaken well before use
• The can must be warmed to room temperature prior to first use.
• Consider applying it 1hr or more prior to sleeping at night and continue applying it at the same time of the day.
• For at least an hour following its administration, the patients should be instructed not to rinse it off and to refrain from bathing, showering, or swimming.
• Immediately after or during the application, avoid smoking, fire, or flame.

Mechanism of action of Minocycline Cream:

• It is unknown what the exact mechanism of action it has for treating acne. 
• It is a tetracycline antibiotic that can alter the skin's flora. 
• It is a powerful penetrating agent and can penetrate the sebaceous and apocrine glands. 
• It can also be used to modulate local immunity and act as an anti-inflammatory drug.

Absorption:

• • It can be applied topically and it will reach a steady state after six days. It has a 2.4-fold greater C-max in children aged 10-17 years and a 2.5-fold greater AUC than adults.

International Brand Names of Minocycline Cream:

• Amzeeq

Minocycline Cream Brand Names in Pakistan:

• Minogen
• Minoderm