What is doxycycline?

Doxycycline is an antibiotic in the tetracycline family. This page relates specifically to its use for perioral dermatitis, where it is the most widely used tablet option.

How does it treat perioral dermatitis?

At the doses used in skin conditions, doxycycline works largely through its anti-inflammatory effect rather than by killing bacteria. That is why it helps an inflammatory rash like this one. It is taken once a day, which makes it easier to keep to than the twice-daily options.

Who this is suitable for

Adults with perioral dermatitis diagnosed by a healthcare professional, where the rash is moderate or widespread, heavily pustular, or has not responded to a topical treatment alone. Our prescribers will also consider your symptoms, allergies, medical conditions, pregnancy or breastfeeding status and current medicines.

When this is not the right starting point

Doxycycline is not suitable if you are pregnant, might be pregnant, or are breastfeeding – erythromycin is the usual alternative. It is also not suitable if you have lupus, porphyria, severe kidney or liver disease, or are taking an oral retinoid. See your GP or a dermatologist if the rash involves your eyes, is weeping, or you feel unwell with it.

Sun sensitivity

Doxycycline is the most photosensitising of the tetracyclines. Your skin will burn more easily, so a daily high-factor sunscreen is not optional while you are taking it, and you should avoid sunbeds.

Stopping steroid creams

Perioral dermatitis is very often caused by a steroid cream used on the face. Stopping the steroid is the single most important part of treatment, and the rash will usually flare for two to four weeks after you stop before it begins to settle. The antibiotic is used alongside that to shorten the flare.

Antibiotic stewardship

A course is usually four to six weeks. Treatment is reviewed at twelve weeks and not continued beyond that without an in-person review, to limit the risk of resistance.

How to take doxycycline for perioral dermatitis

If prescribed, take one 100mg capsule once a day. Try to take it at roughly the same time each day, and always follow your pharmacy label.

Take With Water: Swallow the capsule whole with a full glass of water.
Stay Upright: Stay sitting or standing for at least 30 minutes afterwards. Do not take it just before bed.
Food If Needed: It is absorbed slightly better on an empty stomach, but take it with food if it upsets your stomach.
Space It Out: Do not take it within two hours of milk, antacids, or iron, zinc, calcium or magnesium supplements.
Complete The Course: Keep taking it for the full course even once your skin improves.
Do Not Share: Do not share your medicine with anyone else.

If you miss a dose

Take it when you remember, unless it is nearly time for the next one. If it is nearly time, skip the missed dose and continue as normal. Do not take two capsules together to make up for one you missed.

If you vomit

If you are sick soon after taking a dose, contact a pharmacist or prescriber for advice, because you may not have absorbed the medicine. Do not automatically take an extra capsule.

Who should not take doxycycline

Anyone allergic to any tetracycline antibiotic
Anyone who is pregnant, might be pregnant, or is breastfeeding
Anyone under 12 years of age
Anyone with systemic lupus erythematosus (SLE)
Anyone with severe kidney or liver disease
Anyone with porphyria
Anyone taking an oral retinoid such as isotretinoin or acitretin, or high-dose vitamin A

Tell your prescriber if you take

Warfarin or another blood thinner, methotrexate, ciclosporin, lithium, medicines for diabetes, or any oral retinoid.

Off-label use

No medicine holds a UK licence specifically for perioral dermatitis. This treatment is prescribed off-label, which means your prescriber is using it outside the terms of its licence because the evidence supports it. You will be asked to confirm you understand this during your consultation.

Active ingredient

Each capsule contains 100mg of doxycycline, as doxycycline hyclate or monohydrate depending on the manufacturer.

Other ingredients

Inactive ingredients differ between manufacturers. Read the patient information leaflet supplied with your pack for the complete ingredient list, particularly if you have an allergy or intolerance. If you have a known allergy, tell us during your consultation so our clinicians can check the pack before we dispense.

Like all medicines, doxycycline can cause side effects, although not everyone gets them.

Common or recognised effects

Feeling sick or being sick
Diarrhoea or stomach discomfort
Headache
Increased sensitivity to sunlight
Thrush or another fungal overgrowth

Taking the capsule with food may help with nausea or stomach discomfort, and always taking it with a full glass of water while sitting or standing protects your gullet.

Stop taking doxycycline and call 999 or go to A&E if you develop

Swelling of the face, lips, tongue or throat, difficulty breathing, or a widespread itchy rash
A severe rash with blistering or peeling skin
A severe headache with blurred or double vision
Severe chest pain or pain on swallowing

Contact your GP or call NHS 111 promptly if you develop

Yellowing of the skin or eyes, or dark urine
Severe or bloody diarrhoea during or after the course
Thrush that does not settle with pharmacy treatment
A sunburn-like reaction after only brief sun exposure