pharmacokinetic comparative study. Although the composite results supported bioequivalence, there were some profound individual differences. Several of the 36 patients in the study had notable serum concentration spikes with MCN ER, while Biphasic MCN ER remained pharmacokinetically consistent.63 Additional, larger studies may be warranted to analyze the clinical and pharmacokinetic differences of MCN ER and Biphasic MCN ER to ascertain if MUPS technology is promoting a more reliable and consistent drug release. Biphasic MCN ER also employs true “functional scoring,†in adherence to strict FDA guidelines, ensuring even distribution of MCN across the tablet, which enables accurate dosing when using whole, as well as manually or mechanically split tablets,64 so that 1 mg/kg dosing may be closely followed.
The Future of MCN
Similar to the 40th anniversary of topical tretinoin in 2013,65 2021 marks the 50th anniversary of another longstanding dermatological therapeutic, minocycline. It remains central in our armamentarium for multiple reasons. Inherent characteristics such as excellent absorption, long half-life, high lipophilicity, and marked anti-inflammatory properties complement its continued efficacy against C. acnes. Now, with a half century track record of beneficial utility, new formulations and delivery systems continue to point to a bright foreseeable future for MCN.
The Future of MCN
Similar to the 40th anniversary of topical tretinoin in 2013,65 2021 marks the 50th anniversary of another longstanding dermatological therapeutic, minocycline. It remains central in our armamentarium for multiple reasons. Inherent characteristics such as excellent absorption, long half-life, high lipophilicity, and marked anti-inflammatory properties complement its continued efficacy against C. acnes. Now, with a half century track record of beneficial utility, new formulations and delivery systems continue to point to a bright foreseeable future for MCN.
DISCLOSURES
Drs. Baldwin and Ward are consultants for EPI Health, Charleston
S.C. who owns and markets Minoliraâ„¢ (Biphasic MCN ER).
REFERENCES
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2. Drug Evaluation Data: Minocycline. Drug Intell Clin Pharm. 1972;6(3):108-110.
3. Scheinfeld N. Confluent and reticulated papillomatosis: a review of the literature. Am J Clin Dermatol. 2006;7(5):305-13.
4. Gathers RC, Lim HW. Central centrifugal cicatricial alopecia: past, present, and future. J Am Acad Dermatol. 2009;60(4):660-8.
5. Bernier C, Dr no B. Minocycline. Ann Dermatol Venereol. 2001;128(5):627-37.
6. Cunha BA. Minocycline versus doxycycline for methicillin-resistant Staphylococcus aureus (MRSA): in vitro susceptibility versus in vivo effectiveness. Int J Antimicrob Agents. 2010;35(5):517-8.
7. Cunha BA. Minocycline, often forgotten but preferred to trimethoprimsulfamethoxazole or doxycycline for the treatment of community-acquired methicillin-resistant Staphylococcus aureus skin and soft-tissue infections. Int J Antimicrob Agents. 2013;42(6):497-9.
8. Garrido-Mesa N, Zarzuelo A, G lvez J. Minocycline: far beyond an antibiotic. Br J Pharmacol. 2013;169(2):337-352.
9. Nelson ML, Levy SB. The history of the tetracyclines. Ann N Y Acad Sci. 2011;1241:17-32.
10. Nelson ML. Chemical and biological dynamics of tetracyclines. Adv Dent Res. 1998;12(2):5-11.
11. Zaenglein AL, Pathy AL, Schlosser BJ, et al. Guidelines of care for the management of acne vulgaris [published correction appears in J Am Acad Dermatol. 2020;82(6):1576]. J Am Acad Dermatol. 2016;74(5):945-73.e33.
12. J.H. Cove, W.J. Cunliffe, K.T. Holland. Acne vulgaris: is the bacterial population size significant? Br J Dermatol. 1980;102:277-280.
13. 13. K. Mourelatos, E.A. Eady, W.J. Cunliffe, S.M. Clark, J.H. Cove. Temporal changes in sebum excretion and propionibacterial colonization in preadolescent children with and without acne. Br J Dermatol. 2007;156:22-31.
14. B. Shaheen, M. Gonzalez. A microbial aetiology of acne: what is the evidence? Br J Dermatol. 2011;165:474-485.
15. Del Rosso JQ. A status report on the use of subantimicrobial-dose doxycycline: a review of the biologic and antimicrobial effects of the tetracyclines. Cutis. 2004;74(2):118-122.
16. Sapadin AN, Fleischmajer R. Tetracyclines: nonantibiotic properties and their clinical implications. J Am Acad Dermatol. 2006;54(2):258-265.
17. Jeremy AH, Holland DB, Roberts SG, Thomson KF, Cunliffe WJ. Inflammatory events are involved in acne lesion initiation. J Invest Dermatol. 2003;121(1):20-27.
18. Metiko B, Brooks K, Burkhart CG, Burkhart CN, Morrell D. Is the current model for acne pathogenesis backwards? J Am Acad Dermatol. 2015;72(6):e167.
19. Del Rosso J, Gallo R, Thiboutot D, Webster G, Rosen T, Leyden J, Walker C, Zhanel G, Eichenfield L. (2016). Status report from the scientific panel on antibiotic use in dermatology of the American Acne and Rosacea Society. J Clin Aesthet Dermatol. 2016;9(5):11–17.
20. Zaenglein AL, Pathy AL, Schlosser BJ, et al. Guidelines of care for the management of acne vulgaris [published correction appears in J Am Acad Dermatol. 2020;82(6):1576]. J Am Acad Dermatol. 2016;74(5):945-73.e33.
21. Bienenfeld A, Nagler AR, Orlow SJ. Oral antibacterial therapy for acne vulgaris: An evidence-based review. Am J Clin Dermatol. 2017;18(4):469-490.
22. Ochsendorf, F. Minocycline in acne vulgaris. Am J Clin Dermatol. 2012;11(5): 327-341.
23. J.A. Fenner, K. Wiss, N.A. Levin. Oral cephalexin for acne vulgaris: clinical experience with 93 patients. Pediatr Dermatol. 2008;25:179-183.
24. Leyden JJ, Del Rosso JQ. Oral antibiotic therapy for acne vulgaris. J Clin Aesthet Dermatol. 2011;4(2):40-47.
25. Del Rosso JQ, Webster GF, Rosen T, et al. Status report from the scientific panel on antibiotic use in dermatology of the American Acne and Rosacea Society: Part 1: Antibiotic prescribing patterns, sources of antibiotic exposure, antibiotic consumption and emergence of antibiotic resistance, impact of alterations in antibiotic prescribing, and clinical sequelae of antibiotic use. J Clin Aesthet Dermatol. 2016;9(4):18-24.
26. Pag s F, Boutin JP, Meynard JB, et al. Tolerability of doxycycline monohydrate salt vs. chloroquine-proguanil in malaria chemoprophylaxis. Trop Med Int Health. 2002;7(11):919-924.
27. Carlborg B, Farmer JC. Esophageal corrosion tests with doxycycline monohydrate tablets. Curr Ther Res. 1983;34:110-116.
28. Leyden JJ, Del Rosso JQ. Oral antibiotic therapy for acne vulgaris: pharmacokinetic and pharmacodynamic perspectives. J Clin Aesthet Dermatol. 2011;4(2):40-47.
29. Baldwin H. Oral antibiotic treatment options for acne vulgaris. J Clin Aesthet Dermatol. 2020;13(9):26-32.
30. Seysara™ [Package Insert]. U.S. Food and Drug Administration website. https://www.accessdata.fda.gov/drugsatfdadocs/label/2018/209521s000lbl. pdf. Accessed April 21, 2021.
31. Moore AY, Del Rosso J, Johnson JL, Grada A. Sarecycline: A review of preclinical and clinical evidence. Clin Cosmet Investig Dermatol. 2020;13:553-560.
32. Zhanel G, Critchley I, Lin LY, Alvandi N. Microbiological profile of sarecycline, a novel targeted spectrum tetracycline for the treatment of acne vulgaris. Antimicrob Agents Chemother. 2018;63(1):e01297-18.
33. CSID:10257122, http://www.chemspider.com/Chemical-Structure.10257122. html (accessed 07:22, May 17, 2021).
34. CSID:16735907, http://www.chemspider.com/Chemical-Structure.16735907. html (accessed 07:44, May 17, 2021).
35. Church RF, Schaub RE, Weiss MJ. Synthesis of 7-dimethylamino-6-demethyl- 6-deoxytetracycline (minocycline) via 9-nitro-6-demethyl-6-deoxytetracycline. J Org Chem. 1971;36(5):723-725.
36. Del Rosso JQ, Kim G. Optimizing use of oral antibiotics in acne vulgaris. Dermatol Clin. 2009;27(1):33-42.
37. Cunha BA, Baron J, Cunha CB. Similarities and differences between doxycycline and minocycline: clinical and antimicrobial stewardship considerations. Eur J Clin Microbiol Infect Dis. 2018;37(1):15-20.
38. Gold MH, Baldwin H, Lin T. Management of comedonal acne vulgaris with fixed-combination topical therapy. J Cosmet Dermatol. 2018;17(2):227-231.
39. Tanghetti EA. The role of inflammation in the pathology of acne. J Clin Aesthet Dermatol. 2013;6(9):27-35.
40. Del Rosso JQ. Clinical implications of minocycline use in acne vulgaris: Focus on antimicrobial and anti-inflammatory properties. Cosmet Dermatol. 2008;21(8):437-440.
41. Golub LM, Lee H-M, Ryan ME, et al. Tetracyclines inhibit connective tissue breakdown by multiple non-antimicrobial mechanisms. Adv Dent Res. 1998;12(2):12-26.
42. Zeichner, J. An Update on the Use of Minocycline for the Treatment of Acne. Pract Dermatol. 2020;1:60-61.
43. Baldwin HE. Tricks for improving compliance with acne therapy. Dermatol Ther. 2006;19(4):224-236. 44. Xu H, Li H. Acne, the Skin Microbiome, and Antibiotic Treatment. Am J Clin Dermatol. 2019;20(3):335-344.
