How does doxycycline work? What the experts say

Not every acne treatment is topical. Sometimes, medication needs to go deeper to tackle the problem from the inside.

Doxycycline is one such treatment. It’s a potent anti-inflammatory oral antibiotic that treats many conditions, including lesions caused by acne and rosacea. Here we’ll explore doxycycline, how it’s used to treat acne, and the benefits and side effects of this drug.

What is doxycycline? 

Doxycycline is a powerful antibiotic used to treat certain bacterial infections. It’s been used to treat infections such as lyme disease and as a preventative against malaria. It’s also used to control inflammation in illnesses such as rheumatoid arthritis.¹

In skin care, medical providers typically prescribe doxycycline to treat rosacea, acne, and other skin infections. Doxycycline for acne is administered orally to help eliminate acne-causing bacteria. It’s used as an additive measure for moderate to severe acne alongside other treatments. It also helps treat the acne-like bumps that can be caused by rosacea.

Different forms, same powerful effect

Doxycycline belongs to a class of medications called tetracycline antibiotics. It’s available only by prescription as a generic or brand-name drug (Acticlate, Doryx, Doryx MPC). Doxycycline comes in multiple forms—tablets, delayed-release tablets, capsules, and suspension (liquid for oral or intravenous use)—but these forms aren’t interchangeable. Most often, the drug is prescribed for daily doses. 

What is doxycycline used for?

This medication belongs to a class of antibiotics used to treat various conditions, including acne and rosacea. Acne is a common skin condition (especially during teen years), while rosacea often appears later in life. Skin lesions, inflammation, and redness are symptoms of both, and they’re precisely what doxycycline conquers.

Here’s what doxycycline does: 

• Fights Cutibacterium acnes. Doxycycline reduces C. acnes, a type of acne-causing bacteria.² 

• Reduces inflammation. Studies show that doxycycline is effective in treating moderate inflammatory acne due to its anti-inflammatory effects.³ 

• Helps treat rosacea. The anti-inflammatory properties of doxycycline also help calm inflammation caused by rosacea⁴ and reduce acne-like lesions.⁵

• Improves red bumps, pimples, and redness. A review of the safety and efficacy of doxycycline for treating rosacea showed that multiple daily doses after an average of 4 weeks reduced inflammatory lesions and decreased redness (erythema) by 50%. Several other studies have had similar findings.⁶

Potential doxycycline side effects

It’s important to note that many potential drug interactions are associated with doxycycline use. That’s why it’s essential to share your complete medical history with your prescribing provider. 

Doxycycline is also phototoxic, meaning there’s a dose-dependent relationship between doxycycline and photosensitivity.⁷ So, apply a broad-spectrum sunscreen with at least SPF 30 every day (which you should already be doing anyway!) and wear sun-protective clothing when using this medication.

Potential doxycycline side effects include:

• Diarrhea

• Headache 

• Nausea and vomiting 

• Loss of appetite

• Temporary tooth discoloration

There are also more serious potential side effects. If you experience any of these, seek medical care right away: 

• Allergic reactions that cause a skin rash, itching, hives, or swelling of the face, lips, tongue, or throat

• Severe headache that may feel like pressure in the brain or cause blurry vision, nausea, or vomiting

• Redness, blistering, peeling, or loosening skin, including inside the mouth

• Severe joint pain

• Severe diarrhea or fever

This list is not exhaustive. Most frequently, doxycycline is associated with intestinal upset. Talk to your prescribing provider if you experience any side effects that worsen or do not go away.

How long is a doxycycline prescription? 

Medical providers prescribe doxycycline for the shortest duration possible, usually 3-4 months at the most.⁸ However, some people may require longer or repeated courses of antibiotics. After all, acne and rosacea are both chronic skin conditions that need ongoing treatment. 

There are simple solutions—including proper skin care and topical creams—that may reduce the length of time oral antibiotics are required:

1. Use all the medications in your treatment plan. Antibiotic resistance can develop with the use of antibiotics,⁹ so using all the medications in your treatment plan is essential. Other treatments may include topicals, such as benzoyl peroxide or adapalene gel.

2. Follow a simple skincare routine. We advocate a simple three-step routine that includes cleansing, moisturizing, and protecting during the day and treating at night. Avoid inflammation by using gentle products on acne- or rosacea-affected skin.

3. Stick to your maintenance plan. Don’t skip your skincare routine or follow-up appointments with your dermatology provider once your skin clears. Many skin concerns, including acne and rosacea, dissipate only to reappear later. Maintenance is the foundation for clearer, healthier skin.

Please note: Doxycycline should not be used by people who are allergic to certain antibiotics, are pregnant or breastfeeding, or are under 12.

Curology prescribes oral medications

Curology was founded by a board-certified dermatologist to make effective skincare more accessible. Our licensed dermatology providers will work with you to examine your skin, assess your skincare goals, and provide custom treatment options tailored to your needs.

We can help take the guesswork out of your skincare routine. If medically appropriate, your Curology provider may prescribe doxycycline to help accelerate healing and calm inflammation from acne or rosacea. 

Our in-house licensed dermatology providers are ready to help and guide you toward the treatment your skin needs. We also offer topical treatments with proven ingredients to treat acne, rosacea, and anti-aging concerns.* 

Our products are non-comedogenic, dye-free, and paraben-free. You can give them a try when you sign up for Curology!

P.S. We did the homework so you don’t have to:

1. Patel, R.S. and Parmar, M. Doxycycline hyclate. StatPearls. (2022 July 12)

2. Del Rosso, J.Q. Oral doxycycline in the management of acne vulgaris: Current perspectives on clinical use and recent findings with a new double-scored small tablet formulation. Journal of Clinical and Aesthetic Dermatology. (May 2015).

3. Zaenglein, A.L., et al. Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology. (2016 May 1).

4. Parish, J.L., et al. Doxycycline in contemporary dermatologic practice. Journal of the American Academy of Dermatology. (2011 February 1).

5. Valentín, S., et al. Safety and efficacy of doxycycline in the treatment of rosacea. Clinical, Cosmetic, and investigational Dermatology. (2009).

6. Valentín, S., et al. Safety and efficacy of doxycycline in the treatment of rosacea. Clinical, Cosmetic, and investigational Dermatology. Ibid.

7. Del Rosso, J.Q. Oral doxycycline in the management of acne vulgaris: Current perspectives on clinical use and recent findings with a new double-scored small tablet formulation. Journal of Clinical and Aesthetic Dermatology. Ibid.

8. American Academy of Dermatology. How long can I take an antibiotic to treat my acne? (n.d.).

9. American Academy of Dermatology. How long can I take an antibiotic to treat my acne? Ibid.

Meredith Hartle is a board-certified Family Medicine physician at Curology. She earned her medical degree at Kirksville College of Osteopathic Medicine in Kirksville, MO.

* Subject to consultation. Subscription is required. Results may vary. 

Written by

Curology Team

Medically reviewed by

Meredith Hartle, DO