Side Effects

 

HYPERPIGMENTATION                                                                                                                                                                                 

Young K, Pagan AD, Yoon J, Getachew E, Leung B, Nguyen N, Mostaghimi A, Semenov YR, Theodosakis N. Differences in risk of tetracycline-associated hyperpigmentation between racial and ethnic groups in patients with acne vulgaris: A national US retrospective study. J Am Acad Dermatol. 2023. PMID: 36228939.

MY SUMMARY: Compared rates of incident hyperpigmentation 2 weeks after starting doxycycline or minocycline for acne to cephalexin. There were increased rates of hyperpigmentation with doxy and mino compared to cephalexin, primarily in black and hispanic, but the effect size is clinically small (per 1000, 56.4 cases for doxy, 44.5 for mino, 50.1 for cephalexin).  Except for black patients using mino, it provided an overall protective effect agains hyperpigmentation, especially when used with a retinoid (for which rates of hyperpigmentation were lower for both whites and blacks).  Median amount of time that was calculated that patients were on these medications was around 3 months, and median amount of time to hyperpigmentation was around 3-4 months (supplemental material).  There are many limitations in this study including the population of patient being studied were on tetracyclines for relatively short periods of time.  Although there was no clear relationship between length of time on antibiotics and development of hyperpigmentation, this did not adequately assess whether or not longer courses significantly increase risk.  It may be interpreted as short. courses of tetracyclines having a negligible risk of hyperpigmentation.  This also did not address minocycline-induced hyperpigmentation or differentiate it from hyperpigmentation from doxycycline, so it may obscure a small but significant increased risk of minocycline-induced hyperpigmentation. 

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