The
skin disorder known as acne vulgaris (also known as acne) is very widespread
and affects a lot of young people and adults throughout their lifespan [1,2].
Up to 20% of patients with severe acne experience lifelong scarring, and many
acne patients express feelings of sadness, anxiety, emotional tension, or poor
self-image [3]. For the treatment of moderate to severe inflammatory acne, oral
antibiotics are prescribed [4,5]. A popular second-line antibiotic for acne
vulgaris is minocycline. Its side-effect profile is well recognized, and
dosages of 100 mg daily are frequently recommended. For certain patients, daily
doses of up to 200 mg are necessary to treat their acne [6,7]. Like other
tetracyclines, minocycline can occasionally result in increased intracranial
pressure, hepatitis, and nephritis as well as gastrointestinal disturbances,
candida infections, and hepatitis [8-10]. Minocycline is strongly lipophilic,
very soluble, very permeable, and completely metabolized [11]. Minimal effects
of food on absorption are achieved via high solubility and permeability
[12,13]. Due to the high absorption rate, Minocycline is safe and advantageous
in many ways, including the ability to be taken with meals, which may boost
patient compliance, the need for smaller dosages, and the fact that less active
medication is left in the GI tract [14]. But a thorough analysis of the
literature reveals that Minocycline is not superior to other tetracyclines in
treating acne. Minocycline has a superior pharmacokinetic profile than
first-generation tetracyclines and is less phototoxic than doxycycline [15].
However, this study is aimed to evaluate the safety and efficacy of minocycline
for the treatment of moderate to severe acne vulgaris in adult patients.
Pharmacology: Minocycline
has been used therapeutically as a second-generation, semi-synthetic
tetracycline with antibacterial activity which retains the efficacy against
both gram-positive and gram-negative bacteria, for more than 40 years [16,17].
Open clinical studies have supported the use of Minocycline in the treatment of
non-infectious forms of dermatitis, including inflammatory acne, rosacea,
bullous dermatoses, and neutrophilic dermatoses [18,19]. It is easily absorbed
from the digestive tract, strongly protein bound, fat soluble, and unlike other
tetracyclines, does not bind calcium from dairy products [20]. However,
Minocycline is linked to systemic side effects that might lead to medication
termination. These side effects include gastrointestinal disruption, hypersensitivity
reaction, weakness, vertigo, and pigmentation [21,22].
Methodology
A
cross-sectional descriptive study was performed among adult patients (above 18
years) came for the treatment of acne vulgaris in the tertiary care hospital
Dhaka District from June 2021 to June 2022 were selected by purposive sampling.
Thereafter, they were scrutinized according to eligibility criteria and 82
patients receiving minocycline at doses of 50 mg daily, 50/100 mg on alternate
days, and 100 mg daily were enrolled in the study to determine the drug's
effectiveness and safety. Patients were followed on every month. The severity
of each adverse effect was evaluated, and any treatments were recorded. The
dosage, time of commencement, and total cumulative dose of Minocycline at which
a side effect manifested itself were all noted. Additionally performed tests
included full blood count, blood urea, electrolytes, and liver function. After
collection, the data were checked and cleaned, followed by editing, compiling,
coding and categorizing according to the objectives and variable to detect
errors and to maintain consistency, relevancy and quality control. The choice
of treatment was made by the patient after a full discussion with the
multidisciplinary team consisting of Transfusionists. The data for this study
about had been accumulated from patients’ medical information. Statistical
evaluation of the results used to be got via the use of a window-based computer
software program devised with Statistical Packages for Social Sciences (SPSS-24).
Results
The
second-line antibiotic Minocycline is frequently used to treat acne vulgaris.
Its side-effect profile is well understood, and it is frequently recommended at
doses of 100 mg daily. In this study, however, the dose was increased to 100 mg
in some circumstances.
Table 1: Demographics of the patients (n=30).
|
Demographic profile
|
n=30
|
%
|
|
Age groups (in
years)
|
|
|
|
18-28
|
14
|
46.67
|
|
29-38
|
9
|
30.0
|
|
39-45
|
7
|
23.33
|
|
Gender
|
|
|
|
Male
|
3
|
10.0
|
|
Female
|
27
|
90.0
|
|
Severity of
cases
|
|
|
|
Moderate
|
15
|
50.0
|
|
Moderately
severe
|
6
|
20.0
|
|
Severe
|
9
|
30.0
|
Table 2: Side effects reported by patients participated in the
study.
|
Side
effects
|
Minocycline
(50mg)
(n=15)
|
Minocycline
(50/100 mg)
(n=6)
|
Minocycline
(100mg)
(n=9)
|
|
Gastrointestinal symptoms
|
1(1.2%)
|
1(0.6%)
|
1(0.6%)
|
|
Vestibular dysfunction
|
1(0.6%)
|
-
|
-
|
|
Headache and visual disturbance (*BIH)
|
-
|
-
|
1(0.6%)
|
|
Vaginal candidiasis
|
-
|
1(0.6%)
|
-
|
|
Cutaneous symptoms (urticaria,
photosensitive rash, pruritus)
|
1(0.6%)
|
-
|
1(0.6%)
|
|
Pigmentation
|
1(1.2%)
|
1(0.6%)
|
2(1.2%)
|
|
Memory disturbance or poor concentration
|
1(0.6%)
|
-
|
-
|
|
*
BIH
= benign intracranial hypertension.
|
The
average duration of therapy was 3 months, ranging from 1 to 3 months, and the
average patient age was 22 years (between 18 and 45 years). In total, 30 adult
patients (3 men and 27 women) receiving treatment for acne vulgaris were
monitored over a period of three months.
The patients were evaluated for progress and any adverse reactions every
three months. The acne problem was effectively reduced during follow-up,
however some people experienced side effects from using minocycline for a
prolonged period of time. A 23 patients (38.33%) reported experiencing side
effects (Table 2). According to (Table 1) age group of the patients were
between the ages of 18-45 years. Most of the patients 14(46.67%) were in the
age group 18-28, 9(30%) were in 29-38 age group and 7(23.33%) were in 39-48 age
group. According to gender distribution, 3(10.0%) of these patients were male,
whereas 27(90.0%) were female. According to severity of cases, 15(50.0%) had
moderate, 6(20.0%) had moderately severe and 9(30.0%) had severe acne problem.
According to primary findings after clinical evaluation of each patient's acne
severity, 15(50.0%) were moderate cases who were prescribed 50mg of Minocycline
daily, 6(20.0%) were diagnosed as moderately severe who needed a dose of 50/100
mg on alternate days, and 9 patients with severe condition (30.0%) needed a
dose of 100 mg daily to treat their acnes. According to (Table 2), those
receiving 50 mg of Minocycline daily experienced gastrointestinal symptoms
2(1.2%), vestibular dysfunction 1(0.6%), cutaneous symptoms like urticaria and
pruritis 2(1.2%), pigmentation 2 (1.2%) and poor concentration 1(0.6%)
respectively. Patients who were taking 50/100 mg on alternate days developed
gastrointestinal symptoms 1(0.6%), vaginal candidiasis 1(0.6%), and
pigmentation in 2(1.2%) respectively. And those who were taking 100 mg daily
experienced gastrointestinal symptoms 1(0.6%), headache 1(0.6%), cutaneous
symptoms like photosensitive rash 1(0.6%) and pigmentation 6(3.6%)
respectively. There was no statistically significant difference in the side
effects that increased with dose (0.5 > P > 0.1).The only significant
side effects in patients receiving larger doses of minocycline was pigmentation
(P<0.01). Patients on 200 mg dose daily showed a 3.6% incidence in
pigmentation, compared with 2.4%. and 1.2% in those taking 50 mg/daily and
50/100 mg on alternate days, respectively (Figure 1).
