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Meta-Analysis
. 2012 Aug 15;2012(8):CD002086.
doi: 10.1002/14651858.CD002086.pub2.

Minocycline for acne vulgaris: efficacy and safety

Sarah E Garner  1 , Anne Eady, Cathy Bennett, John Norman Newton, Karen Thomas, Catalin Mihai Popescu
Affiliations
Meta-Analysis

Minocycline for acne vulgaris: efficacy and safety

Sarah E Garner et al. Cochrane Database Syst Rev. .

Abstract

Background: Minocycline is an oral antibiotic used for acne vulgaris. Its use has lessened due to safety concerns (including potentially irreversible pigmentation), a relatively high cost, and no evidence of any greater benefit than other acne treatments. A modified-release version of minocycline is being promoted as having fewer side-effects.

Objectives: To assess new evidence on the effects of minocycline for acne vulgaris.

Search methods: Searches were updated in the following databases to November 2011: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library, MEDLINE (from 1946), EMBASE (from 1974), and LILACS (from 1982). We also searched trials registers and checked reference lists for further references to relevant randomised controlled trials (RCTs).The Cochrane Skin Group's Trials Search Co-ordinator undertook searches exploring minocycline's adverse effects in EMBASE and MEDLINE in February 2012.

Selection criteria: We selected randomised controlled trials (RCTs) comparing minocycline, at any dose, to an active or a placebo control, in participants with inflammatory acne vulgaris. For adverse effects, we selected additional studies that reported the number of adverse effects and the number of participants treated.

Data collection and analysis: Outcome measures used in the trials included lesion counts, acne grades/severity scores, doctors' and participants' global assessments, adverse effects, and dropout rates. Two authors independently assessed the quality of each study. Effect sizes were calculated, and meta-analyses were undertaken where possible.Sixteen studies met the inclusion criteria for the review of adverse effects.

Main results: We included 12 new RCTs for this update, giving a total of 39 RCTs (6013 participants). These additional 12 RCTs have not changed the original conclusions about the clinical efficacy of minocycline.The identified RCTs were generally small and poor quality. Meta-analysis was rarely possible because of the lack of data and different outcome measures and trial durations. Although minocycline was shown to be an effective treatment for moderate to moderately-severe acne vulgaris, there was no evidence that it is better than any of the other commonly-used acne treatments. One company-sponsored RCT found minocycline to be less effective than combination treatment with topical erythromycin and zinc. No trials have been conducted using minocycline in those participants whose acne is resistant to other therapies. Also, there is no evidence to guide what dose should be used.The adverse effects studies must be interpreted with caution. The evidence suggests that minocycline is associated with more severe adverse effects than doxycycline. Minocycline, but not other tetracyclines, is associated with lupus erythematosus, but the risk is small: 8.8 cases per 100,000 person-years. The risk of autoimmune reactions increases with duration of use. The evidence does not support the conclusion that the more expensive extended-release preparation is safer than standard minocycline preparations.

Authors' conclusions: Minocycline is an effective treatment for moderate to moderately-severe inflammatory acne vulgaris, but there is still no evidence that it is superior to other commonly-used therapies. This review found no reliable evidence to justify the reinstatement of its first-line use, even though the price-differential is less than it was 10 years ago. Concerns remain about its safety compared to other tetracyclines.

PubMed Disclaimer

Conflict of interest statement

One of the reviewers (EAE) has previously received research funds from one of the manufacturers of minocycline, and she was the co‐author of published studies on minocycline, including the following included study: Ozolins M, Eady EA, Avery AJ, Cunliffe PWJ, Wan Po PAL, O'Neill PC, et al. Comparison of five antimicrobial regimens for treatment of mild to moderate inflammatory facial acne vulgaris in the community: randomised controlled trial. Lancet 2004;364(9452):2188‐95.

Associate Professor Catalin Popescu has received honoraria for speaking at Astellas Pharma‐sponsered meetings and symposia. Astellas Pharma is the producer of Unidox (doxycycline) tablets, but none of Associate Professor Popescu's talks and none of these meetings were about Unidox. Unidox is not actively promoted by Astellas, as there are lots of generic doxycycline products. Moreover, minocycline has never been available in Romania, which is the country in which Associate Professor Popescu works.

Figures

1
1
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
1.1
1.1. Analysis
Comparison 1 Minocycline 100 mg bd versus placebo, Outcome 1 Inflamed lesion count ‐ percentage change from baseline.
2.1
2.1. Analysis
Comparison 2 Minocycline ER versus placebo, Outcome 1 Percentage change in inflamed lesion counts.
2.2
2.2. Analysis
Comparison 2 Minocycline ER versus placebo, Outcome 2 Percentage change in total lesion counts.
2.3
2.3. Analysis
Comparison 2 Minocycline ER versus placebo, Outcome 3 Investigator global severity ‐ successful treatment.
2.4
2.4. Analysis
Comparison 2 Minocycline ER versus placebo, Outcome 4 Clear or almost clear 12 weeks.
3.1
3.1. Analysis
Comparison 3 Minocycline ER dose response, Outcome 1 Clear or almost clear 12 weeks.
4.1
4.1. Analysis
Comparison 4 Minocycline 100 mg od versus 100 mg/50 mg od, Outcome 1 Lesion counts ‐ reduction from baseline after 60 days therapy.
4.2
4.2. Analysis
Comparison 4 Minocycline 100 mg od versus 100 mg/50 mg od, Outcome 2 Overall clinical improvement ‐ dr‐assessed.
4.3
4.3. Analysis
Comparison 4 Minocycline 100 mg od versus 100 mg/50 mg od, Outcome 3 Participant evaluations ‐ 10 cm visual analogue scales.
5.1
5.1. Analysis
Comparison 5 Minocycline 50 mg bd/100 mg od versus (oxy)tetracycline 250 mg 4 times a day/bd, Outcome 1 Cook grading scale ‐ number of participants improved by at least two grades.
5.2
5.2. Analysis
Comparison 5 Minocycline 50 mg bd/100 mg od versus (oxy)tetracycline 250 mg 4 times a day/bd, Outcome 2 Decrease in inflamed lesion count from baseline.
5.3
5.3. Analysis
Comparison 5 Minocycline 50 mg bd/100 mg od versus (oxy)tetracycline 250 mg 4 times a day/bd, Outcome 3 At least moderate improvement according to participant.
5.4
5.4. Analysis
Comparison 5 Minocycline 50 mg bd/100 mg od versus (oxy)tetracycline 250 mg 4 times a day/bd, Outcome 4 At least moderate improvement according to assessor.
5.5
5.5. Analysis
Comparison 5 Minocycline 50 mg bd/100 mg od versus (oxy)tetracycline 250 mg 4 times a day/bd, Outcome 5 Samuelson lesion grade as assessed by physician.
5.6
5.6. Analysis
Comparison 5 Minocycline 50 mg bd/100 mg od versus (oxy)tetracycline 250 mg 4 times a day/bd, Outcome 6 Samuelson lesion grade as assessed by participant.
5.7
5.7. Analysis
Comparison 5 Minocycline 50 mg bd/100 mg od versus (oxy)tetracycline 250 mg 4 times a day/bd, Outcome 7 Number of participants converting to Pillsbury grade I.
5.8
5.8. Analysis
Comparison 5 Minocycline 50 mg bd/100 mg od versus (oxy)tetracycline 250 mg 4 times a day/bd, Outcome 8 Overall improvement.
5.9
5.9. Analysis
Comparison 5 Minocycline 50 mg bd/100 mg od versus (oxy)tetracycline 250 mg 4 times a day/bd, Outcome 9 Khanna acne lesion score: absolute reduction from baseline.
6.1
6.1. Analysis
Comparison 6 Minocycline versus lymecycline, Outcome 1 Lesion count ‐ absolute change from baseline.
6.2
6.2. Analysis
Comparison 6 Minocycline versus lymecycline, Outcome 2 Lesion count ‐ percentage change from baseline.
6.3
6.3. Analysis
Comparison 6 Minocycline versus lymecycline, Outcome 3 Lesion count ‐ number of participants achieving > 25% reduction.
6.4
6.4. Analysis
Comparison 6 Minocycline versus lymecycline, Outcome 4 Lesion count ‐ number of participants achieving > 50% reduction.
6.5
6.5. Analysis
Comparison 6 Minocycline versus lymecycline, Outcome 5 Leeds grade.
6.6
6.6. Analysis
Comparison 6 Minocycline versus lymecycline, Outcome 6 Global assessment ‐ number of participants with overall improvement.
7.1
7.1. Analysis
Comparison 7 Minocycline versus doxycycline, Outcome 1 Number of participants with > 50% reduction in IL count.
7.2
7.2. Analysis
Comparison 7 Minocycline versus doxycycline, Outcome 2 Global efficacy rating.
7.3
7.3. Analysis
Comparison 7 Minocycline versus doxycycline, Outcome 3 Cure.
8.1
8.1. Analysis
Comparison 8 Minocycline 100 mg/200 mg per day versus josamycin 500 mg/1000 mg, Outcome 1 Pustules change in P&K severity grade 8 weeks.
8.2
8.2. Analysis
Comparison 8 Minocycline 100 mg/200 mg per day versus josamycin 500 mg/1000 mg, Outcome 2 Nodulo‐cysts change in P&K severity grade 8 weeks.
8.3
8.3. Analysis
Comparison 8 Minocycline 100 mg/200 mg per day versus josamycin 500 mg/1000 mg, Outcome 3 Erythema change in severity score 8 weeks.
8.4
8.4. Analysis
Comparison 8 Minocycline 100 mg/200 mg per day versus josamycin 500 mg/1000 mg, Outcome 4 Seborrhea change in severity score 8 weeks.
8.5
8.5. Analysis
Comparison 8 Minocycline 100 mg/200 mg per day versus josamycin 500 mg/1000 mg, Outcome 5 Evaluation of clinical efficacy 8 weeks.
9.1
9.1. Analysis
Comparison 9 Minocycline 50 mg bd versus Diane™ (cyproterone acetate 2 mg/ethinyloestradiol 50 mcg), Outcome 1 Participant‐subjective evaluation.
10.1
10.1. Analysis
Comparison 10 Minocycline100 mg bd versus compound A, Outcome 1 Inflamed lesion count ‐ percentage change from baseline.
11.1
11.1. Analysis
Comparison 11 Minocycline 100 mg daily versus zinc gluconate 30 mg bd, Outcome 1 Lesion count ‐ percentage change from baseline 90 days.
11.2
11.2. Analysis
Comparison 11 Minocycline 100 mg daily versus zinc gluconate 30 mg bd, Outcome 2 Investigator global severity ‐ successful treatment (2/3 reduction in IL).
11.3
11.3. Analysis
Comparison 11 Minocycline 100 mg daily versus zinc gluconate 30 mg bd, Outcome 3 Overall opinion on efficacy (100 mm VAS).
12.1
12.1. Analysis
Comparison 12 Minocycline 50 mg bd versus clindamycin 1% lotion bd, Outcome 1 Overall improvement ‐ participant‐assessed.
13.1
13.1. Analysis
Comparison 13 Minocycline 50 mg bd versus fusidic acid 2% lotion bd, Outcome 1 Participants achieving > 40% reduction in lesion counts.
13.2
13.2. Analysis
Comparison 13 Minocycline 50 mg bd versus fusidic acid 2% lotion bd, Outcome 2 Lesion count changes from baseline.
13.3
13.3. Analysis
Comparison 13 Minocycline 50 mg bd versus fusidic acid 2% lotion bd, Outcome 3 Overall clinical response.
14.1
14.1. Analysis
Comparison 14 Minocycline 50 mg bd versus zineryt bd (erythromycin 4%/zinc 1.2% lotion), Outcome 1 12‐week lesion count ‐ change from baseline.
14.2
14.2. Analysis
Comparison 14 Minocycline 50 mg bd versus zineryt bd (erythromycin 4%/zinc 1.2% lotion), Outcome 2 12‐week percentage of baseline lesion counts.
14.3
14.3. Analysis
Comparison 14 Minocycline 50 mg bd versus zineryt bd (erythromycin 4%/zinc 1.2% lotion), Outcome 3 Number of participants attaining > 45% reduction in lesion counts from baseline.
14.4
14.4. Analysis
Comparison 14 Minocycline 50 mg bd versus zineryt bd (erythromycin 4%/zinc 1.2% lotion), Outcome 4 Leeds grade ‐ change from baseline.
15.1
15.1. Analysis
Comparison 15 Minocycline 100 mg ER od versus benzoyl peroxide bd, Outcome 1 Overall improvement ‐ participant assessed at least moderate improvement at 18 weeks.
15.2
15.2. Analysis
Comparison 15 Minocycline 100 mg ER od versus benzoyl peroxide bd, Outcome 2 Overall improvement ‐ assessor at least moderate improvement at 18 weeks.
15.3
15.3. Analysis
Comparison 15 Minocycline 100 mg ER od versus benzoyl peroxide bd, Outcome 3 Lesion count ‐ change from baseline.
16.1
16.1. Analysis
Comparison 16 Minocycline 100 mg ER od versus erythromycin/benzoyl peroxide (ery/BP) bd, Outcome 1 Overall improvement ‐ participant assessed at least moderate improvement at 18 weeks.
16.2
16.2. Analysis
Comparison 16 Minocycline 100 mg ER od versus erythromycin/benzoyl peroxide (ery/BP) bd, Outcome 2 Overall improvement ‐ assessor at least moderate improvement at 18 weeks.
16.3
16.3. Analysis
Comparison 16 Minocycline 100 mg ER od versus erythromycin/benzoyl peroxide (ery/BP) bd, Outcome 3 Lesion count ‐ change from baseline.
17.1
17.1. Analysis
Comparison 17 Minocycline 100 mg ER od versus erythromycin od/benzoyl peroxide (ery/BP) od, Outcome 1 Overall improvement ‐ participant assessed at least moderate improvement at 18 weeks.
17.2
17.2. Analysis
Comparison 17 Minocycline 100 mg ER od versus erythromycin od/benzoyl peroxide (ery/BP) od, Outcome 2 Overall improvement ‐ assessor at least moderate improvement at 18 weeks.
17.3
17.3. Analysis
Comparison 17 Minocycline 100 mg ER od versus erythromycin od/benzoyl peroxide (ery/BP) od, Outcome 3 Lesion count ‐ change from baseline.
18.1
18.1. Analysis
Comparison 18 Combination with 5% benzoyl peroxide/4% chlorhexidine, Outcome 1 Lesion count.
19.1
19.1. Analysis
Comparison 19 Minocycline versus placebo plus combination erythromycin/tretinoin gel (strength unspecified), Outcome 1 Global grade ‐ good/very good response.
20.1
20.1. Analysis
Comparison 20 Minocycline/azelaic acid (min/AA) versus isotretinoin, Outcome 1 Number of participants with good or very good response after 6 months.
20.2
20.2. Analysis
Comparison 20 Minocycline/azelaic acid (min/AA) versus isotretinoin, Outcome 2 Reduction in NIL: percentage change from baseline.
20.3
20.3. Analysis
Comparison 20 Minocycline/azelaic acid (min/AA) versus isotretinoin, Outcome 3 Reduction in IL: percentage change from baseline.
21.1
21.1. Analysis
Comparison 21 Minocycline 100 mg od maintenance, Outcome 1 Lesion count ‐ percentage change from baseline versus tazarotene.
21.2
21.2. Analysis
Comparison 21 Minocycline 100 mg od maintenance, Outcome 2 Overall disease severity score versus tazarotene.
21.3
21.3. Analysis
Comparison 21 Minocycline 100 mg od maintenance, Outcome 3 Overall clinical improvement ‐ Dr‐assessed versus tazarotene.
21.4
21.4. Analysis
Comparison 21 Minocycline 100 mg od maintenance, Outcome 4 Lesion count ‐ percentage change from baseline versus tazarotene/minocycline combination.
21.5
21.5. Analysis
Comparison 21 Minocycline 100 mg od maintenance, Outcome 5 Overall disease severity score versus tazarotene/minocycline combination.
21.6
21.6. Analysis
Comparison 21 Minocycline 100 mg od maintenance, Outcome 6 Overall clinical improvement ‐ Dr‐assessed versus tazarotene/minocycline combination.
22.1
22.1. Analysis
Comparison 22 Adverse drug reactions, Outcome 1 All reactions.
22.2
22.2. Analysis
Comparison 22 Adverse drug reactions, Outcome 2 Requiring therapy cessation.
22.3
22.3. Analysis
Comparison 22 Adverse drug reactions, Outcome 3 Gastro‐intestinal disturbances.
22.4
22.4. Analysis
Comparison 22 Adverse drug reactions, Outcome 4 Acute vestibular disturbances.
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Update of

References

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Sheehan‐Dare 1989 {published data only}
    1. Sheehan‐Dare RA, Papworth‐Smith J, Cunliffe WJ. A comparative study between topical clindamycin and oral minocycline in the treatment of acne vulgaris. Round Table Series ‐ Royal Society of Medicine 1989;19:24‐8.
    1. Sheehan‐Dare RA, Papworth‐Smith J, Cunliffe WJ. A double‐blind comparison of topical clindamycin and oral minocycline in the treatment of acne vulgaris. Acta Dermato‐Venereologica 1990;70(6):534‐7. - PubMed
Smit 1978 {published data only}
    1. Smit F. Minocycline versus doxycycline in the treatment of acne vulgaris. Dermatologica 1978;157(3):186‐90. - PubMed
Stainforth 1993 {published and unpublished data}
    1. Stainforth J, MacDonald‐Hull S, Papworth‐Smith JW, Eady EA, Cunliffe WJ, Norris JFB, et al. A single‐blind comparison of topical erythromycin/zinc lotion and oral minocycline in the treatment of acne vulgaris. Journal of Dermatological Treatment 1993;4(3):119‐22.
Stewart 2006 (MP010401) {published data only}
    1. Stewart DM, Torok HM, Weiss JS, Plott RT. Dose‐ranging efficacy of new once‐daily extended‐release minocycline for acne vulgaris. Cutis 2006;78(4 Suppl):11‐20. - PubMed
Waskiewicz 1992 {published data only}
    1. Waskiewicz W, Grosshans E. Treatment of acne vulgaris with cyclines of second generation: a comparison of doxycyline 50mg daily versus minocycline 100mg daily [Traitement de l'acné juvénile par les cyclines de deuxième génération: étude comparative randomisée doxycycline 50mg/jour versus minocycline 100mg/ jour]. Nouvelles Dermatologiques 1992;11:8‐11.

References to studies excluded from this review

Alberto 1990 {published data only}
    1. Alberto N, Abubakar AA. Clinical trial of minocycline in the treatment of Filipino patients with acne vulgaris. Philippine Journal of Internal Medicine 1990;28(6):457‐61.
Altieri 1989 {published data only}
    1. Altieri E, Venturini D. Clinical findings on the therapeutic activity of minocycline in acne vulgaris [Rilievi clinici sull'attività terapeutica della minociclina nell'acne giovanile]. Dermatologia Clinica 1989;9(2):107‐15.
Anonymous 2006 {published data only}
    1. Anonymous. Extended‐release minocycline (Solodyn) for acne. Medical Letter on Drugs & Therapeutics 2006;48(1248):95‐6. - PubMed
Arata 1969 {published data only}
    1. Arata J, Fujita S, Tokumaru S, Kodama H. Clinical experience with minocycline in the dermatological field (Japanese). Japanese Journal of Antibiotics 1969;22(6):480‐2. - PubMed
Arrese 1998 {published data only}
    1. Arrese JE, Goffin V, Avila‐Camacho M, Greimers R, Pierard GE. A pilot study on bacterial variability in acne. Assessment using dual flow cytometry on microbials present in follicular casts and comedones. International Journal of Dermatology 1998;37(6):461‐464. - PubMed
Barba 1989 {published data only}
    1. Barba JF, Jimenez Brito G, Hermoso I, Morales Ortiz R, Altamirano L. Effectiveness and safety of oral minocycline in treating acne vulgaris [Evaluación de la minociclina (minocin) en acné vulgaris inflamatorio]. Compendium de Investigaciones Clinicas Latinoamericanas 1989;9(3):99‐107.
Barba Gomez 1990 {published data only}
    1. Barba Gómez JF, Morales Ortiz R. An evaluation of minocycline (minocin) in inflammatory acne vulgaris [Evaluación de la minociclina (minocin) en acné vulagris inflamatorio]. Investigación Médica Internacional 1990;16(4):240‐4.
Becker 1974 {published data only}
    1. Becker FT. Treatment of tetracycline‐resistant acne vulgaris. Cutis 1974;14(4):610‐13.
Bodokh 1997 {published data only}
    1. Bodokh I, Jacomet Y, Lacour JP, Ortonne JP. Minocycline induces an increase in the number of excreting pilosebaceous follicles in acne vulgaris. A randomised study. Acta Dermato‐Venereologica 1997;77(4):255‐259. - PubMed
Bok 1985 {published data only}
    1. Bok LB. Practical experience with minocycline. Royal Society of Medicine Services International Congress & Symposium Series 1985;95:83‐6.
Clerico 1984 {published data only}
    1. Clerico R, Cantoresi F, Bianchini D. Therapeutic activity of minocycline in patients with acne vulgaris [Attività terapeutica della minociclina in pazienti affetti da acne volgare]. Dermatologia Clinica 1984;4(4):341‐9.
Cohen1985 {published data only}
    1. Cohen PM. A general practice study investigating the effect of Minocin 50 mg b.d. for 12 weeks in the treatment of acne vulgaris. Journal of International Medical Research 1985;13(4):214‐21. - PubMed
Coskey 1976 {published data only}
    1. Coskey RJ. Acne: treatment with minocycline. Cutis 1976;17(4):799‐801. - PubMed
Cullen 1978 {published data only}
    1. Cullen SI. Low‐dose minocycline therapy in tetracycline‐recalcitrant acne vulgaris. Cutis 1978;21(1):101‐4. - PubMed
    1. Cullen SI. Treatment of tetracycline resistant acne vulgaris with minocycline in a low dosage. Therapiewoche 1982;32(44):5347‐51.
Degitz 2008 {published data only}
    1. Degitz K, Ochsendorf F. Pharmacotherapy of acne. Expert Opinion on Pharmacotherapy 2008;9(6):955‐71. - PubMed
Degreef 1983 {published data only}
    1. Degreef H. Minocycline in the treatment of acne vulagris. Current Therapeutic Research 1983;33(1):8‐13.
Del Rosso 2004 {published data only}
    1. Rosso JQ. A status report on the use of subantimicrobial‐dose doxycycline: a review of the biologic and antimicrobial effects of the tetracyclines. Cutis 2004;74(2):118‐22. - PubMed
Donadini 1989 {published data only}
    1. Donadini A. Is topical antibiotic therapy associated with the same oral treatment useful in patients with acne? [Ha significato nell'acne l'impiego di un antibiotico topico nel corso di analoga terapia sistemica?]. Annali Italiani di Dermatologia Clinica e Sperimentale 1989;43(2):153‐69.
Eady 1990 {published data only}
    1. Eady EA, Cove JH, Holland KT, Cunliffe WJ. Superior antibacterial action and reduced incidence of bacterial resistance in minocycline compared to tetracycline‐treated acne patients. British Journal of Dermatology 1990;122(2):233‐44. - PubMed
Eady 1993 {published data only}
    1. Eady EA, Jones CE, Gardner KJ, Taylor JP, Cove JH, Cunliffe WJ. Tetracycline‐resistant propionibacteria from acne patients are cross resistant to doxycycline but sensitive to minocycline. British Journal of Dermatology 1993;128(5):556‐60. - PubMed
Fernandez‐Obregon 2000 {published data only}
    1. Fernandez‐Obregon AC. Azithromycin for the treatment of acne. International Journal of Dermatology 2000;39(1):45‐50. - PubMed
Funt 1985 {published data only}
    1. Funt LS. Oral ibuprofen and minocycline for the treatment of resistant acne vulgaris. Journal of the American Academy of Dermatology 1985;13(3):524‐5. - PubMed
Goto 1969 {published data only}
    1. Goto M. Evaluation of minocycline (7‐dimethylamino‐6‐demethyl‐6‐deoxytetracycline) in the dermatological field (Japanese). Japanese Journal of Antibiotics 1969;22(6):488‐92. - PubMed
Goulden 1996 {published data only}
    1. Goulden V, Glass D, Cunliffe WJ. Safety of long‐term high‐dose minocycline in the treatment of acne. British Journal of Dermatology 1996;134(4):693‐695. - PubMed
Gruber 1998 {published data only}
    1. Gruber F, Grubisic‐Greblo H, Kastelan M, Brajac I, Lenkovic M, Zamolo G. Azithromycin compared with minocycline in the treatment of acne comedonica and papulo‐pustulosa. Journal of Chemotherapy 1998;10(6):469‐73. - PubMed
Hughes 1989 {published data only}
    1. Hughes BR, Murphy CE, Barnett J, Cunliffe WJ. Strategy of acne therapy with long‐term antibiotics. British Journal of Dermatology 1989;121(5):623‐8. - PubMed
Jeanmougin 1987 {published data only}
    1. Jeanmougin M. Minocycline and benzoyl peroxide in the treatment of acne vulgaris: Results of a multicentre trial with 256 patients [Minocycline et peroxyde de benzoyle dans le traitement de l'acné: résultats d'une étude multicentrique sur 256 patients]. Comptes Rendus de Thérapeutique et de Pharmacologie Clinique 1987;5(50):3,5,7‐9,11.
Ketelbey 1988 {unpublished data only}
    1. Ketelbey JW. Acne and minocycline. New Zealand Medical Journal 1988;101(851):520. - PubMed
Kircik 2010 {published data only}
    1. Kircik LH. Doxycline and minocycline for the management of acne: a review of efficacy and safety with emphasis on clinical implications. Journal of Drugs in Dermatology 2010;9(11):1407‐1411. - PubMed
Kircik 2011 {published data only}
    1. Kircik LH. Commentary: Doxycycline vs. minocycline for the management of acne. Journal of Drugs in Dermatology 2011;10(9):966. - PubMed
Kligman 1998 {published data only}
    1. Kligman AM. Comparison of a topical benzoyl peroxide gel, oral minocycline, oral doxycycline and a combination for suppression of P. acnes in acne patients. Journal of Dermatological Treatment 1998;9(3):187‐191.
Knaggs 1993 {published data only}
    1. Knaggs HE, Layton AM, Cunliffe WJ. The role of oral minocycline and erythromycin in tetracycline therapy‐resistant acne ‐ a retrospective study and a review. Journal of Dermatological Treatment 1993;4(2):53‐6.
Kurka 1976 {published data only}
    1. Kurka M, Orfanos CE. Which antibiotics are helpful in acne? A review of the literature and personal test results with minocyclin (klinomycin) [Welche antibiotika helfen bei akne?]. Zeitschrift fur Hautkrankheiten 1976;51(2):45‐54. - PubMed
Laux 1987 {published data only}
    1. Laux B. Treatment of acne vulgaris [Behandlung der acne vulgaris: vergleichende klinische studie mit doxycyclin 50mg/d versus minocyclin 100mg/d]. Ärztliche Kosmetologie 1987;17(5):366‐72.
Layton 1992 {published data only}
    1. Layton AM, Cunliffe WJ, Knaggs HE, MacDonald‐Hull SP. The role of minocycline in therapy resistant acne (Abstract). British Journal of Dermatology 1992;127(suppl. 40):31.
Leyden 1982 {published data only}
    1. Leyden JJ, McGinley KJ, Kligman AM. Tetracycline and minocycline treatment. Effects on skin‐surface lipid levels and Propionibacterium acnes. Archives of Dermatology 1982;118(1):19‐22. - PubMed
Leyden 1996 {published data only}
    1. Leyden JJ, Kaidbey K, Gans EH. The antimicrobial effects in vivo of minocycline, doxycycline and tetracycline in humans. Journal of Dermatological Treatment 1996;7(4):223‐225.
Leyden 1997a {published data only}
    1. Leyden JJ, Gans EH. The human in vivo antimicrobial effects of dual acne therapy: Oral Dynacin (minocycline HCl) plus topical Triaz (benzoyl peroxide special gel). Journal of Dermatological Treatment 1997;8(Suppl 2):S3‐6.
Leyden 2006(Part 1) {published data only}
    1. Leyden J, Thiboutot DM, Shalita A, Webster G, Washenik K, Strober BE, et al. Comparison of tazarotene and minocycline maintenance therapies in acne vulgaris: a multicentre, double‐blind, randomised parallel‐group study. Archives of Dermatology 2006;142(5):605‐612. - PubMed
Lowy 1982 {published data only}
    1. Lowy G. Minocycline and acne [Minociclina e acne]. Folha Medica 1982;85(1):539‐40.
Luderschimidt 1985 {published data only}
    1. Luderschmidt C, Nissen H, Neubert U, Knuechel M. Newer methods for measuring therapeutic response in acne. Royal Society of Medicine Services International Congress & Symposium Series 1985;95:131‐40.
Millar 1987 {published data only}
    1. Millar ED, Jolliffe DS, Leigh AP. A general practice study investigating the effect of minocycline (Minocin) 50 mg bd for 12 weeks in the treatment of acne vulgaris. British Journal of Clinical Practice 1987;41(8):882‐6. - PubMed
Minami 1969 {published data only}
    1. Minami K, Tashiro M. Comparison of clinical effects of minocycline and demethylchlortetracycline in the dermatological field (Japanese). Japanese Journal of Antibiotics 1969;22(6):493‐500. - PubMed
Miura 1969 {published data only}
    1. Miura Y, Mizumoto T, Shibaki H. Minocycline (Japanese). Japanese Journal of Antibiotics 1969;22(6):483‐7. - PubMed
Mizuno 1980 {published data only}
    1. Mizuno K. Clinical experiences of minocycline on acne (Japanese). Nishinihon Journal of Dermatology 1980;42(5):874‐7.
Mobacken 1993 {published data only}
    1. Mobacken H. Oral tetracycline‐treatment of acne. Rapid facial improvement, but back lesions are more difficult to treat (Swedish). Lakartidningen 1993;90(34):2755‐7. - PubMed
Monk 2011 {published data only}
    1. Monk E, Shalita A, Siegel DM. Clinical applications of non‐antimicrobial tetracyclines in dermatology. Pharmacological Research 2011;63(2):130‐45. - PubMed
Montero 1972 {published data only}
    1. Montero ED. Minocycline (therapeutic evaluation in various skin conditions) [Minociclina (ensayo therapeutico en diversas dermatosis)]. Medicina Cutanea 1972;6:105.
Ng 2002 {published data only}
    1. Ng CH, Tam MM, Celi E, Tate B, Schweitzer I. Prospective study of depressive symptoms and quality of life in acne vulgaris patients treated with isotretinoin compared to antibiotic and topical therapy. Australasian Journal of Dermatology 2002;43(4):262‐8. - PubMed
Nishijima 1996 {published data only}
    1. Nishijima S, Kurokawa I, Kawabata S. Sensitivity of Propionibacterium acnes isolated from acne patients: comparative study of antimicrobial agents. Journal of International Medical Research 1996;24(6):473‐7. - PubMed
Ochsendorf 2010a {published data only}
    1. Ochsendorf F. Minocycline in acne vulgaris: benefits and risks. American Journal of Clinical Dermatology 2010;11(5):327‐41. - PubMed
Pablo 1975 {published data only}
    1. Pablo GM, Fulton JE. Sebum: analysis by infrared spectroscopy. II. The suppression of fatty acids by systemically administered antibiotics. Archives of Dermatology 1975;111(6):734‐5. - PubMed
Pavone 1994 {published data only}
    1. Pavone P. Azithromycin versus minocycline in the treatment of acne vulgaris [Azitromicina versus minociclina nel trattamento dell' acne volgare]. Chronica Dermatologica 1994;4(5):867‐72.
Randazzo 1981 {published data only}
    1. Randazzo SD, Lo Presti V, Caruso A. Clinical evaluation of combined minocycline streptokinase‐streptodornase treatment in acne [Valutazione clinica del trattamento con minociclina piu streptochinasi‐streptodornasi nell'acne volgare]. Annali Italiani di Dermatologia Clinica e Sperimentale 1981;35(1):67‐77.
Reisner 1983 {published data only}
    1. Reisner RM. Antibiotic and anti‐inflammatory therapy of acne. Dermatologic Clinics 1983;1(3):385‐97.
Rocco 1998 {published data only}
    1. Rocco D, Pagnini U, Rocco A. Effect of cefuroxime axetil in the treatment of papulo‐pustular acne [L'acetossietilcefuroxime nel trattamento dell'acne papulo‐pustulosa]. Giornale Italiano di Dermatologia e Venereologia 1998;133(6):465‐8.
Rossman 1981 {published data only}
    1. Rossman RE. Minocycline treatment of tetracycline‐resistant and tetracycline‐responsive acne vulgaris. Cutis 1981;27(2):196‐7, 201, 207. - PubMed
Sanchez 2006 {published data only}
    1. Sanchez AT, Olivera RMP, Sanchez GMDO, Dorantes GL. Quality of life and psychological symptoms in patients with severe acne in treatment with isotretinoin [Calidad de vida y sintomas psicologicos en pacientes con acne severo tratados con isotretinoina]. Dermatologia Revista Mexicana 2006;50(4):121‐6.
Savage 2010 {published data only}
    1. Savage LJ, Layton AM. Treating acne vulgaris: systemic, local and combination therapy. Expert Review of Clinical Pharmacology 2010;3(4):563‐80. - PubMed
Schulz 1984 {published data only}
    1. Schulz H, Stauder G. Oral minocycline treatment for acne vulagris and for rosacea [Orale minocyclintherapie der akne vulgaris und der rosacea]. Zeitschrift für Allgemeinmedizin 1984;60(24):1033‐7.
Shalita 2011 {published data only}
    1. Shalita AR, Webster GF, Wortzman MS, Nelson DB. Doxycycline vs. minocycline for the management of acne. Journal of Drugs in Dermatology 2011;10(9):965‐6. - PubMed
Sloan 2008 {published data only}
    1. Sloan B, Scheinfeld N. The use and safety of doxycycline hyclate and other second‐generation tetracyclines. Expert Opinion on Drug Safety 2008;7(5):571‐7. - PubMed
Takeuchi 1980 {published data only}
    1. Takeuchi S, Morishita M. Treatment of acne vulgaris with minomycin capsules (50mg) (Japanese). Nishinihon Journal of Dermatology 1980;42(5):870‐3.
Thiboutot 2011 {published data only}
    1. Thiboutot D. Rethinking treatment of acne in the severe patient. Journal of Drugs in Dermatology 2011;10(6):s8‐s12. - PubMed
Thielitz 2009 {published data only}
    1. Thielitz A, Gollnick H. Overview of new therapeutic developments for acne. Expert Review of Dermatology 2009;4(1):55‐65.
Unna 1989 {published data only}
    1. Unna PJ, Ischler T. Pragmatic treatment of juvenile acne [Pragmatische therapie der acne juvenilis]. Zeitschrift für Allgemeinmedizin 1989;65(34):860‐4.
Villano 1984 {published data only}
    1. Villano PA. Minocycline in the treatment of acne vulgaris [La minociclina nel trattamento dell'acne volgare]. Dermatologia Clinica 1984;4(1):71‐4.
Zaenglein 2006 {published data only}
    1. Zaenglein AL, Thiboutot DM. Expert committee recommendations for acne management. Pediatrics 2006;118(3):1188‐99. - PubMed

References to studies awaiting assessment

Kawana 2007 {published data only}
    1. Kawana S, Ueno T, Shimoda T. Efficacy of long‐term administration of roxithromycin (Rulid) in treatment of acne: comparison with minocycline hydrochloride. Nishinihon Journal of Dermatology 2007;69(4):424‐7.
Revuz 1990 {published data only}
    1. Revuz J, Amblard P, Dreno B, Lorette G, Ortonne JP, Puissant A. Efficacy of zinc gluconate in the treatment of inflammatory acne [Efficacite du gluconate de zinc dans le traitement de l'acne inflammatoire]. Abstr Dermatol 1990;77:2‐4.
Revuz 1993 [pers comm] {unpublished data only}
    1. Revuz J ( 11, Chaussée de la Muette, Paris, France). [personal communication] [Evaluation comparative en double aveugle de trois strategies de traitement de l'acne avec minocycline microgranules 100mg/jour associee au peroxyde de benzoyle (unpublished)]. Letter to S Garner (NICE, London, UK) 11 October 1993.
Yoon 2005 {published data only}
    1. Yoon YH, Ro BI, Seo SJ, Kim MN, Hong CK. Comparison of cost and effectiveness between isotretinoin versus minocycline in the treatment of patients with acne. Korean Journal of Dermatology 2005;43(9):1200‐6.

References to ongoing studies

EUCTR2008‐002642‐32‐GB {published data only}
    1. EUCTR2008‐002642‐32‐GB. A Placebo Controlled, Single‐Blind, Pilot Clinical Evaluation of the Effect of a Novel Antibiotic Preparation on the Cutaneous Microflora and Clinical Signs in Acne Patients. //apps.who.int/trialsearch/trial.aspx?trialid=EUCTR2008‐002642‐32‐GB Accessed 16 April 2012.
NCT00240513 {published data only}
    1. NCT00240513. Study Comparing Acne in Patients Taking Oral Minocycline to Patients Taking Minocycline Plus Topical Tretinoin. clinicaltrials.gov/ct2/show/NCT00240513?term=NCT00240513&rank=1 Accessed 16 April 2012.
NCT00392223 {published data only}
    1. NCT00392223. Efficacy And Safety Of Azithromycin SR Compared With Minocycline In Acne. clinicaltrials.gov/ct2/show/NCT00392223?term=NCT00392223&rank=1 Accessed 16 April 2012.
NCT00988026 {published data only}
    1. NCT00988026. Safety and Efficacy Comparison of Minocycline Microgranules Versus Lymecycline in the Treatment of Mild to Moderate Acne (MXMIN‐001). clinicaltrials.gov/ct2/show/NCT00988026 Accessed 16 April 2012.
NCT01206348 {published data only}
    1. NCT01206348. Combination Treatment for Moderate to Severe Acne. clinicaltrials.gov/ct2/show/NCT01206348?term=NCT01206348&rank=1 Accessed 16 April 2012.
NCT01362010 {published data only}
    1. NCT01362010. Clinical Study to Evaluate Tolerability and Safety of FXFM244 and to Monitor Clinical Effect in Acne Vulgaris Patients. clinicaltrials.gov/ct2/show/NCT01362010?term=NCT01362010&rank=1 Accessed 16 April 2012.

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