A randomized controlled open label comparative clinical study of cephalexin versus doxycycline in patients with acne vulgaris in a hospital based population of South India

Prithwijt Banerjee, Somnath Maity, Aditya Bubna, Manisha Das


Background: Oral antibiotics are frequently used for acne vulgaris. Cephalexin has documented some success against acne vulgaris in earlier studies. Here the efficacy and safety of Cephalexin have been compared against the standard therapy of Doxycyline.

Methods: From September 2010 to June 2011, 100 patients of moderate Acne vulgaris were randomized into two groups to receive oral Doxycyline (100mg once daily) or Cephalexin (500mg thrice daily) in an open label manner for eight weeks. All participants were allowed to use topical 5%Benzoyl peroxide gel twice daily. Efficacy was measured in terms of reduction in the number of facial comedones and inflammatory lesions from baseline after eight weeks.

Results: 44 patients from Cephalexin group and48 patients from Doxycyline group completed the study. Both drugs have significantly decreased comedone count as well as the inflammatory lesion count after eight weeks. However, Doxycycline appeared better in terms of Comedone count (14.5±3.07 versus 12.9±4.31, p=0.045) as well as inflammatory lesion count (8.64.1±2.14 versus 7.67±2.46, p=0.047) at the end. The total adverse event was slightly more with Cephalexin (6.81% versus 6.25%, p= 0.912), where Diarrhoea remained the commonest adverse effect (4.54%).

Conclusions: Although for the first time oral Cephalexin has displayed efficacy against moderate acne vulgaris in a prospective clinical study, it appeared inferior to Doxycycline over eight weeks. Therefore, it becomes an option only when other oral antibiotics are contraindicated or not tolerated.


Acne vulgaris, Benzoyl peroxide, Cephalexin, Doxycycline

Full Text:



Burton JL, Cunliffe WJ, Stafford I, Shuster S. The prevalence of acne vulgairs in adolescence. British Journal of Dermatology. 1971;85:119-26.

Lawley LP, McCall CO, Lawley TJ. Eczema, Psoriasis, Cutaneous infections, Acne, and Other Common Skin Disorders. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J eds. Harrison’s Principles of Internal Medicine. 18th Ed. New York: McGraw Hill; 2012:1:403-404.

Kathani Amin MD, Christy С R, Daniel J, Eric S. Common and alternate oral antibiotic therapies for acne vulgaris: a review. Journal of Drugs in Dermatology. 2007;6:873-80.

Oudenhoven MD, Kinney MA, McShane DB, Burkhart CN, Morrell DS. Adverse effects of acne medications: recognition and management. Am J Clin Dermatol. 2015.Aug;16(4):231-42.

Wu SF, Kinder BN, Trunnell TN, Fulton JE. Role of anxiety and anger in acne patients: a relationship with the severity of the disorder. Journal of the American Academy of Dermatology. 1988 Feb 1;18(2):325-33.

Cotterill JA, Cunliffe WJ. Suicide in Dermatological patients. British Journal of Dermatology. 1997;137:246-50.

Tan JK. Psychological impact of acne vulgairs. Skin therapy. 2004;9:1-39.

Ochsendorf F. Systemic antibiotic therapy of acne vulgaris. J Dtsch Dermatol Ges. 2006;4828-41.

Strauss JS, Krowchuk DP, Leyden JJ, Lucky AW, Shalita AR, Siegfried EC, et al. Guidelines of care for acne vulgaris management. J Am Acad Dermatol. 2007;56:651-63.

Rathi S. Acne vulgaris treatment: the current scenario. Indian J Dermatol. 2011:56(1):7-13.

Tanghetti EA, Popp KF. A current review of topical benzoyl peroxide: new perspectives on formulation and utilization. Dermatol Clin. 2009Jan;27(1):17-24.

Fenner JA, Wiss K, Levin NA. Oral Cephalexin for acne vulgaris: Clinical experience with 93 patients. Pediatric Dermatology. 2008;25(2):179-83.

Leyden, J. Current issues in antimicrobial therapy for the treatment of acne. Journal of the European Academy of Dermatology and Venereology, December 2001;15(3):51-5.

Sykes NL, Webster GF. Acne. A review of optimum treatment. Drugs 1994;48:59-70.

Sheeler RD. Cephalosporin for acne vulgaris. J Am Acad Dermatol. 1986;16:1091.

Kurokawa I, Nishijima S, Kawabata S. Antimicrobial susceptibility of Propionibacterium acnes isolated from acne vulgaris. Eur J Dermatol. 1999 Jan-Feb;9(1):25-8.

Nishijima S, Kurokawa I, Kawabata S. Sensitivity of Propionibacterium acnes isolated from acne patients: comparative study of antimicrobial agents. J Int Med Res. 1996 Nov- Dec;24(6):473-7.

Cunliffe WJ, Gould DJ. Prevalence of facial acne vulgaris in late adolescence and in adults. BMJ. 1979;1:1109-10.

Picardi A, Abeni D, Melchi CF, Puddu P, Pasquini P. Psychiatric morbidity in dermatological outpatients: an issue to be recognized. Br J Dermatol. 2000;143:983-91.

Kellet SC, Gawkrodger DJ. The psychological and emotional impact of acne and the effect of treatment with isotretinoin. Br J Dermatol. 1999;140:273-82.

Keri J, Shiman M. An update on the management of acne vulgaris. Clinical, Cosmetic and Investigational Dermatology. 2009;2:105-10.

Bowe WP. Antibiotic resistance and acne: where we stand and what the future holds. J Drugs Dermatol. 2014 Jun;13(6):s66-70.

Johnson BA. Use of systemic agents in the treatment of acne vulgaris. American Family Physician. 2000;42:1823-30,1835-6.

Di Caprio R, Lembo S, Di Costanzo L, Balato A, Monfrecola G. Anti-inflammatory properties of low and high doxycycline doses: an in vitro study. Mediators Inflamm. 2015;2015:329418.

Kramer PA, Chapron DJ, Benson J, Mercik SA. Tetracycline absorption in elderly patients with achlorhydria, Clinical Pharmacology and Therapeutics. 1978;23(4):467-72.

Klein NC, Cunha BA. Tetracyclines, Medical Clinics of North America. 1995;79(5):789-801.

Bahrami F, Morris DL, Pourgholami MH. Tetracyclines: drugs with hugetherapeutic potential. Mini Rev Med Chem. 2012 Jan;12(1):44-52.

Sapadin AN, Fleischmajer R. Tetracyclines: nonantibiotic properties and their clinical implications. J Am Acad Dermatol. 2006 Feb;54(2):258-65.

Dormn G, Cseh S, Hajd I. Matrix metalloproteinase inhibitors: a critical appraisal of design principles and proposed therapeutic utility, Drugs. 2010;70(8):949-64.

Meyer-Hoffert. Reddish, scaly, and itchy: how proteases and their inhibitors contribute to inflammatory skin diseases, Archivum Immunologiaeet Therapiae Experimentalis. 2009;57(5):345-54.

Sinclair W, Jordaan HF. Global Alliance to Improve Outcomes in Acne.Acne guideline 2005 update. S Afr Med J. 2005 Nov;95(11 Pt 2):881-92.

Skidmore R, Kovach R, Walker C, Thomas J, Bradshaw M, Leyden J, et al. Effects of subantimicrobial-dose doxycycline in the treatment of moderate acne. Arch Dermatol. 2003 Apr;139(4):459-64.

Toossi P, Farshchian M, Malekzad F, Mohtasham N, Kimyai-Asadi A. Subantimicrobial-dose doxycycline in the treatment of moderate facial acne. J Drugs Dermatol. 2008 Dec;7(12):1149-52.

Moore A, Ling M, Bucko A, Manna V, Rueda MJ. Efficacy and Safety of Subantimicrobial Dose, Modified-Release Doxycycline 40 mg Versus Doxycycline 100 mg Versus Placebo for the treatment of Inflammatory Lesions in Moderate and Severe Acne: A Randomized, Double-Blinded, Controlled Study. J Drugs Dermatol. 2015 Jun 1;14(6):581-6.

Kubba R, Bajaj AK, Thappa DM, Sharma R, Vedamurthy M, Dhar S, et al. Indian Acne Alliance (IAA). Acne in India: guidelines for management - IAA consensus document. Indian J Dermatol Venereol Leprol. 2009 Jan;75(1):1-62.

Miyachi Y, Yoshioka A, Imamura S, Niwa Y. Effect of antibiotics on the generation of reactive oxygen species. J Invest Dermatol. 1986 Apr;86(4):449-53.

Veinberg G, Vorona M, Shestakova I, Kanepe I, Lukevics E. Design of beta-lactams with mechanism based nonantibacterial activities. Curr Med Chem. 2003 Sep;10(17):1741-57.

Wilcox HE, Farrar MD, Cunliffe WJ, Holland KT, Ingham E. Resolution of inflammatory acne vulgaris may involve regulation of CD4+ T-cell responses to Propionibacterium acnes. Br J Dermatol. 2007 Mar;156(3):460-5.

Bayerl C. Acne therapy in pregnancy. Hautarzt. 2013 Apr;64(4):269-73.

Pugashetti R, Shinkai K. Treatment of acne vulgaris in pregnant patients. Dermatol Ther. 2013 Jul-Aug;26(4):302-11.

Kong YL, Tey HL. Treatment of acne vulgaris during pregnancy and lactation. Drugs. 2013 Jun;73(8):779-87.

Meredith FM, Ormerod AD. The management of acne vulgaris in pregnancy. Am J Clin Dermatol. 2013 Oct;14(5):351-8.

Chien AL, Qi J, Rainer B, Sachs DL, Helfrich YR. Treatment of Acne in Pregnancy. J Am Board Fam Med. 2016 Mar-Apr;29(2):254-62.

Giordano PA, Elston D, Akinlade BK, Weber K, Notario GF, Busman TA, et al. Cefdinir vs. cephalexin for mild to moderate uncomplicated skin and skin structure infections in adolescents and adults. Curr Med Res Opin. 2006 Dec;22(12):2419-28.

Sardana K, Gupta T, Kumar B, Gautam HK, Garg VK. Cross-sectional Pilot Study of Antibiotic Resistance in Propionibacterium Acnes Strains in Indian Acne Patients Using 16S-RNA Polymerase Chain Reaction: A Comparison Among Treatment Modalities Including Antibiotics, Benzoyl Peroxide, and Isotretinoin. Indian J Dermatol. 2016 Jan-Feb;61(1):45-52.

Walsh TR, Efthimiou J, Dréno B. Systematic review of antibiotic resistance in acne: an increasing topical and oral threat. Lancet Infect Dis. 2016 Mar;16(3):e23-33.

Bowe WP. Antibiotic resistance and acne: where we stand and what the future holds. J Drugs Dermatol. 2014 Jun;13(6):s66-70.