Lymecycline is probably the most commonly prescribed oral antibiotic in the treatment of acne. In brief, acne can be treated with a variety of topical drugs, which are applied to the skin. Lymecycline is recommended in the treatment of moderate to severe acne usually alongside another topical drug. Is lymecycline for acne the best treatment for you?
What is Lymecycline?
Lymecycline is a drug, which belongs to a group of antibiotics called tetracyclines. In the UK, lymecycline is mainly used (licensed) for the treatment of (BNF, 2022):
- Other infections, for example, chlamydia, rickettsia and mycoplasm, caused by tetracycline-sensitive organisms.
The legal classification of lymecycline
Lymecycline is a prescription-only medication (POM), and thus it needs to be prescribed by a doctor or another qualified prescriber for the supply to happen. Lymecycline is usually prescribed in its generic form as lymecycline 408mg capsules or occasionally as a branded medication called Tetralysal 300 mg capsules. Both drugs are the same medicines.
How does lymecycline help with acne?
Acne is a skin condition in which dead skin cells are mixed with an oily substance produced by hair follicles called sebum. This process leads to the formation of a plug in the hair follicle and consequently blocks skin pores. Blocked skin pores may produce blackheads or whiteheads. Bacteria which is present inside blocked pores multiply and contribute to the main symptoms of acne. Antibacterial drugs such as lymecycline, kill bacteria and stop acne development.
Oral antibiotics are effective in the treatment of moderate to severe acne (Strauss et al 2007). The use of lymecycline or other antibiotics for acne is usually prescribed for a maximum of 3 months (NICE, 2020).
How to get lymecycline for acne treatment
Two main routes of getting lymecycline for acne (or other treatment) are:
- Consultation with NHS GP or another qualified prescribed who may issue a prescription.
- Use of private services (usually online) which almost equals to buying lymecycline for acne.
Getting lymecycline for acne on NHS
The first option is the most common route of getting lymecycline for acne treatment and most likely the cheapest option if a patient is excluded from paying for NHS prescriptions (e.g. 18 years and under and in full-time education). As per NICE’s guide on acne vulgaris management lymecycline can be considered in the treatment of moderate to severe acne.
The NICE guide recommends the following acne treatments:
- combination of adapalene with topical benzoyl peroxide (Epiduo gel or cream) for any acne severity
- combination of topical tretinoin with topical clindamycin (Treclin gel) for any acne severity
- combination of topical benzoyl peroxide with topical clindamycin (Duac Once Daily Gel) for mild to moderate acne
- combination of topical adapalene with topical benzoyl peroxide (Epiduo gel or cream), together with either oral lymecycline or oral doxycycline for moderate to severe acne
- topical azelaic acid (Finacea® or For Skinoren®) with either oral lymecycline or oral doxycycline for moderate to severe acne.
- Best Duac alternative medicines.
- Duac vs Epiduo for the treatment of acne
Oral antibiotics, such as lymecycline are recommended for the treatment of moderate to severe acne very often when topical preparations failed to deliver satisfactory results. Oral antibiotics are usually prescribed alongside skin creams or gels which do not contain an antibiotic. This is to minimise antibiotic resistance, a process by which bacteria become resistant to the treatment with antibiotics.
Optional treatment of acne at this stage is the use of an oral contraceptive, like Dianette (Co-cyprindiol).
Getting lymecycline for acne privately
It is possible to buy lymecycline from registered online pharmacies or by consulting a doctor privately (online or face to face) The advantage of online services is the convenience of the service which may take less time to get the treatment than seeing an NHS doctor.
Patients usually need to complete an online questionnaire (consultation), which is then reviewed by a doctor or another qualified prescriber, for example, a pharmacist. Once approved, medication is posted to the patient’s home or a private prescription is issued to the patient which can be fulfilled in any community pharmacy.
The main disadvantage of online services to buy lymecycline for acne is the cost of the whole process. When visiting a pharmacy, patients need to pay for the cost of medication supplied plus markup fees, regardless of the patient’s age. The total cost depends on the medication prescribed, the quantity prescribed and the current wholesaling price of the medication. Additionally, patients pay fees for the consultation and issuing of private prescriptions. All of the above may be simply consolidated into one charge).
How much does it cost to buy lymecycline for acne?
Online prices for lymecycline can be different from one to another website. One of the cheapest options I found online was around £15 per box of lymecycline (28 capsules). This price included the cost of medication, the review of the treatment by a doctor and the price of the drug.
How much would you pay for a lymecycline from a high street pharmacy?
Supply of lymecycline from a high street pharmacy could be the cheapest option. Currently (November 2022) the wholesaling cost of lymecycline is just under £5 per box of 28 capsules. With a 40% dispensing mark up one could expect to pay around £7 per box of lymecycline (excluding the cost of a private prescription, which needs to be obtained by the patient). Some pharmacies may charge a minimum private prescription cost, which may be higher than £7.
In both situations, the main factor that drives the supply cost of lymecycline privately is the wholesaling cost of the medication. If medication goes out of stock (supply issues on the market), which is a common occurrence, the wholesaling price may double to triple, driving the above costs higher.
How to take lymecycline for acne?
Lymecycline cannot be used by children under 8 years of age due to the risk of permanent dental (teeth) staining and enamel hypoplasia, damage of the enamel – the surface of the teeth (eMC, 2022).
Oral antibiotics like lymecycline are usually prescribed at 3-monthly intervals. The treatment is usually stopped after 12 weeks to avoid antibiotic resistance.
What is the dose of lymecycline?
Children over 12 years of age may be given an adult dose of lymecycline.
- The usual dose for the treatment of acne is one capsule daily.
Is lymecycline effective for acne?
The effectiveness of lymecycline in the treatment of acne has been confirmed by different studies. For example, the effectiveness and safety of lymecycline was investigated in a 12-week study of patients with moderate to moderately severe acne vulgaris (Bossuyt et al., 2003). The effectiveness of lymecycline was compared to another tetracycline, minocycline. Although licensed for acne, minocycline is rarely prescribed in the UK.
After 12 weeks reduction of inflammatory lesions was evaluated. For lymecycline, the average reduction of inflammatory lesions was 63% and the total lesion count decreased by 54%. Most patients (87%) tolerated treatment with lymecycline well.
Lymecycline: common side effects
As with all other drugs, side effects are grouped according to the frequency they may occur, for example from rare to common or very common side effects. Common side effects associated with the use of lymecycline include (BNF, 2021):
- Abdominal pain
- Skin reactions
- Photosensitivity reactions (skin reaction to the sunlight)
There is a number of side effects with an unknown frequency which apply to the tetracycline group of antibiotics, which may occur when taking lymecycline, for example:
- Difficulty in swallowing (dysphagia)
- Inflammation of the oesophagus (oesophagitis)
- Teeth discolouration
- Candidiasis (oral or vaginal thrush)
Please refer to the product information leaflet for more details on side effects.
Alternative options for acne treatment
Topical preparations are considered to be the first-line treatment of acne. These usually include a combination product of antibiotic with benzoyl peroxide, for example, Duac Once Daily gel.
It is also possible to purchase benzoyl peroxide over the counter without a prescription. benzoyl peroxide is sold for the treatment of acne from pharmacies as branded product called Acnecide 5% gel.
Other drugs, which can be considered instead of lymecycline are doxycycline, another oral antibiotic or combined oral contraceptive, for example, Co-cyprindiol (Dianette®). Similar to lymecycline treatment, doxycycline would be prescribed alongside another topical drug.
For severe acne, treatment with oral isotretinoin may be considered (not a standard treatment of acne). Isotretinoin can only be prescribed after a referral to a specialist is made.
BNF (2022). Lymecycline. Available at: https://bnf.nice.org.uk/drug/lymecycline.html Accessed on 23/11/2022
Bossuyt L, Bosschaert J, Richert B, Cromphaut P, Mitchell T, Al Abadie M, Henry I, Bewley A, Poyner T, Mann N, Czernielewski J. Lymecycline in the treatment of acne: an efficacious, safe and cost-effective alternative to minocycline. Eur J Dermatol. 2003 Mar-Apr;13(2):130-5. PMID: 12695127. Available at: https://pubmed.ncbi.nlm.nih.gov/12695127/ Accessed on 23/11/2022
eMC (2022). SmPC: Tetralysal 300mg Hard Capsules. Available at: https://www.medicines.org.uk/emc/product/926 Accessed on 24/11/2022.
NICE (2022). Acne vulgaris: Scenario: Management of acne vulgaris in primary care. Available at: https://cks.nice.org.uk/topics/acne-vulgaris/management/primary-care-management/ Accessed on 23/11/2021
Strauss JS, Krowchuk DP, Leyden JJ, American Academy of Dermatology/American Academy of Dermatology Association, et al. Guidelines of care for acne vulgaris management. J Am Acad Dermatol. 2007;56(4):651–663 Available at: https://doi.org/10.1016/j.jaad.2006.08.048 Accessed on 23/11/2022