Seasonal Patterns in Tetracycline-Associated Hyperpigmentation Among Patients With Acne Vulgaris

Our results suggest that among TCN- and isotretinoin-naive acne patients, new diagnoses of hyperpigmentation preferentially occur in the spring and summer, with an earlier spring peak in doxycycline-treated patients, supporting sunlight exposure as a potential risk factor for hyperpigmentation. Accordingly, doxycycline may lead to earlier hyperpigmentation relative to TCN-naive patients due to doxycycline-induced photosensitivity. Increased photosensitivity following months of decreased sun exposure or lack of consistent sunscreen application early in the year may also contribute, given that incidence in spring appeared to be higher than in summer when sun exposure would be predicted to be higher. We found no significant evidence of seasonal variation among acne patients taking minocycline, which is thought to be equally effective in treating acne and less photosensitizing than doxycycline.⁶ This may suggest a potential benefit of using minocycline over doxycycline during months with more sun exposure, as well as considering other alternatives to tetracyclines whenever possible. For those taking doxycycline, early and aggressive photoprotection prior to the spring may be of benefit. 

Google Trends analysis revealed greater search interest in the spring and summer, shortly after new diagnoses of hyperpigmentation. These parallel trends independently support the seasonal periodicity of acne-related hyperpigmentation, underscoring the importance of photoprotection counseling. This work is limited by its retrospective nature and reliance on prescription and diagnosis coding data. Future studies are needed to enhance generalizability to other regions, photosensitizing drugs, and skin phototypes.

 

YRS is an advisory board member/consultant and has received honoraria from Incyte Corporation, Castle Biosciences, Galderma, and Sanofi outside of the submitted work. AM receives consulting fees from Pfizer, hims, Digital Diagnostics, Concert, Lilly, Abbvie, Equillium, and Boehringer Ingelheim. AM also owns equity in hims, Figure 1, Acom, Seebe.  He receives licensing fees and royalties from Pfizer, Concert, and Lilly. He serves on the medical advisory board for hims, Figure 1, and Digital Diagnostics. AM oversees clinical trials for Lilly and Concert, and he is an associate editor at JAMA Dermatology.

IRB Approval Status: Reviewed and approved by the Mass General Brigham Institutional Review Board; approval #2021P000768.