A recent study has shed light on the association between doxycycline, a commonly prescribed oral tetracycline for acne, and the increased susceptibility to seasonal hyperpigmentation. The study, conducted by Katherine Young, BS, MEng, and colleagues at Harvard Medical School, suggests that individuals treated with doxycycline are more prone to acne-related hyperpigmentation during seasons with high sun exposure.
Despite the anti-inflammatory properties of oral tetracyclines, their independent association with an elevated risk of hyperpigmentation, especially in sun-exposed conditions, raises concerns.
The retrospective review involved 2,830 patients with acne (mean age, 29.9 years; 16.6% male) seen at Mass General Brigham between 1992 and 2022. Notably, patients prescribed doxycycline (n = 546) demonstrated a significant association with seasonal differences (P = .016), while those prescribed minocycline (n = 148) did not exhibit similar trends.
Patients treated with doxycycline experienced a higher number of hyperpigmentation diagnoses in the spring compared to the winter (P = .006), with the peak occurring in April. In contrast, acne patients who did not receive tetracyclines (n = 2,136) still displayed seasonal hyperpigmentation diagnoses, peaking in May (P < .001). Google searches for hyperpigmentation-related terms also indicated higher activity in the spring and summer compared to the fall and winter (P < .001).
The findings suggest that sunlight exposure may contribute to the risk of hyperpigmentation, as new diagnoses frequently occurred in the spring and summer, with a notable peak in early spring among doxycycline-treated patients.
The authors recommend early and robust photoprotection for individuals taking doxycycline, particularly before the spring season. In contrast, minocycline may emerge as a potential alternative for acne patients during seasons with increased sun exposure, as it demonstrated no significant evidence of seasonal variation and is considered less photosensitizing than doxycycline.
The study underscores the importance of considering alternative treatments to tetracyclines whenever feasible, offering valuable insights for clinicians managing acne patients in varying seasonal conditions.
