13.6.2 Oral preparations for acne

Oral antibacterials

1st choiceLymecycline capsules 408mgDose: 408mg daily
2nd choiceDoxycycline capsules 100mgDose: 100mg daily
Erythromycin tablets 250mgDose: 500mg twice daily

Prescribing Notes

  • Avoid concomitant treatment with different oral and topical antibacterials to reduce the likelihood of development of bacterial resistance.  As a general rule if an oral antibiotic is prescribed there is no need to continue the topical antibacterial therapy.
  • The use of topical benzoyl peroxide should be considered when prescribing an oral antibiotic for acne in order to help reduce the development of resistance.
  • Oral antibacterial treatment for acne should be reviewed after 3 months.
  • Switch to an alternative antibiotic if no response after 3 months.
  • Doxycycline can cause photosensitivity in some patients.
  • Tetracyclines must be avoided in pregnancy.

Hormonal treatments

  • COCs are recommended as a first line adjunctive treatment for women who have acne. The evidence shows few differences between different types of COCs (including co-cyprindiol) but progesterone only contraceptives may worsen acne. See section 7.3.1 for COC choices.
  • Co-cyprindiol 2000/35 is a treatment for severe acne refractory to prolonged antibiotic therapy. Only in those patients may it also be used as an oral contraceptive see section 7.3.1 for further details.

Oral retinoids

  • If a patient does not respond to first or second line oral therapy, after an appropriate therapeutic trial of 3-6 months, a referral to dermatology is appropriate. Oral isotretinoin (Roaccutane®) is a teratogenic drug which is only prescribable by a consultant dermatologist.  For this reason, oral isotretinoin is a RED list medication in Northern Ireland.