What Should I Know before Starting Doxycycline and Retin-A Micro (Tretinoin) for Acne?

Written by Adrian Blackwell, MD

Are doxycycline and Retin-A good for acne? Is it safe to take doxycycline and Retin-A (tretinoin)?

Who should use doxycycline and Retin-A (tretinoin) for acne?

Acne is a very common problem — some people need to take medicine for it. With so many medicines used to treat acne, how does anyone know what to use and what medicine or combination of medicines is best?

As with any treatment, it is important to aim at the cause of the problem. This is why the combination of doxycycline and Retin-A (tretinoin) tends to be good for many people. When used together, these two medicines treat most of the various causes of acne.

Who needs to see their doctor in person for acne treatment?

It is always good to discuss all of your health questions and concerns with your family doctor. Most people will find success with simple and safe drugs like doxycycline and Retin-A (tretinoin).

If you have severe acne (a lot of pimples all over your body) or you do not have success with these medicines, then it would be better if you spent some more one-on-one time with your personal doctor or a skin and acne specialist (a dermatologist). Those who have other skin conditions that need treatment (eczema, psoriasis, rosacea, etc.) are better managed by face-to-face doctor visits as well.

Also, doxycycline can potentially interact with other prescription medicines. So for those who have other medical problems and take multiple prescription medicines, it is best to figure out a good acne treatment plan with a doctor in person. Doxycycline can cause flare-ups of certain diseases like lupus, so it is important to let your doctor know about all of your medical conditions before starting acne treatment.

What is Retin-A (tretinoin)?

Retin-A is a form of vitamin A. It comes in a gel or cream that you rub on top of your skin. This medicine is available in three different strengths for your doctor to choose, and it is common to start at the lowest dose. Retin-A attacks the root cause of acne in several ways. Retin-A is very powerful, but it must be used daily, and it takes a couple of months for it to become fully effective.

What is doxycycline?

Doxycycline is an antibiotic from the tetracycline family. It is used to treat bacterial infections. You may see several different names for this medicine. Some common brand names are Acticlate, Morgidox, Periostat, Vibra-Tabs, Doryx, Monodox, or Vibramycin. It is also known as doxycycline hyclate or doxycycline monohydrate.

These are all the same medicine, and all have equal effect. The only difference is that the hyclate form has a slightly different chemical structure than the monohydrate version; doxycycline hyclate has been around longer than the monohydrate version and is typically less expensive, but not by much. Typically only 1 to 3 months of doxycycline are needed to get the acne under control.

Are doxycycline and Retin-A (tretinoin) safe for women who are pregnant or might become pregnant?

Retin A

This medicine has not been studied in pregnant women. The safest thing to do is to avoid this medicine if you are pregnant or you plan on becoming pregnant. As with any medication where the pregnancy safety data is not clear, it is best for women to take a pregnancy test before starting this medicine and to use contraception while on this medicine.

Although there is no proven link, there have been reported cases of birth defects in babies from mothers who took this medicine while pregnant. It is not clear if these instances were from the medicine or simply a coincidence (the full details on this and other safety information can be found here).

Doxycycline

This medicine should be avoided by women who are pregnant and by those who are trying to get pregnant. This medicine can cause permanent discoloration of the teeth in young children. A pregnancy test should be taken before starting this drug, and then a form of birth control should be used during the entire time you are taking doxycycline.

Are doxycycline and Retin-A Micro (tretinoin) safe to use if I am breastfeeding a baby?

Retin-A Micro (tretinoin)

It is unknown if this drug makes its way into a mother’s breast milk. Many medicines do pass into breast milk, so the safest thing is to avoid this medicine while breastfeeding since we do not know what could happen to a nursing child.

Doxycycline

This antibiotic does pass into a nursing mother’s milk supply. Since we know this medicine can cause a life-long discoloration of children’s teeth, it is recommended to avoid this antibiotic for women who are breastfeeding a child.

If I have eczema, can I use Retin-A (tretinoin) for my acne?

You need to be very careful if you have eczema and you want to use Retin-A. Retin-A can cause severe irritation for people with eczema. You never want to put Retin-A on eczema sores or on any open cuts or wounds. You can use Retin-A, but you need to know that you could have a bad reaction to it and that it can cause your skin to break out or hurt very much. This will not be permanent and will get better when you stop using the Retin-A.

What are the side effects of doxycycline and Retin-A (tretinoin)?

Retin-A is usually tolerated very well and only has a few side effects, none of which are serious. Doxycycline has a much longer list of possible side effects, but it is still a safe medicine to use. Many people take doxycycline without any problems or experience only mild side effects.

These medicines can cause any or all of the following:

Common side effects of Retin-A (tretinoin)

  • Skin pain (21%)
  • Dry skin (5–15%)
  • Itchy skin (2–35%)
  • Skin irritation (1–50%, but irritation severe enough to make someone stop using the medicine is < 3%).
  • Skin redness (2–51%)
  • Temporary hyper- or hypopigmentation — your skin can slightly increase or decrease in color (< 10%).

Again, the good news here is that these side effects are not common and are not serious or permanent. And the interesting part is that the side effects (skin pain, irritation, etc.) usually get better after using the medicine for at least 2 weeks.

Common and mild to moderate side effects of doxycycline

This is a long list of possible side effects. Most people take these medicines with no problems at all, or with just a few minor side effects. The risk of getting one of these side effects is also included in parentheses after each side effect. If you take this medicine and start to have side effects, it is always best to stop using it and contact your doctor to come up with a good plan for you. You may experience none, one, some, or all of the following side effects while taking this medicine:

Skin side effects

  • Photosensitivity (1–2%)
  • Hyperpigmentation — this medicine can change the color of your skin (< 1%)
  • Skin rashes —maculopapular and erythematous rashes (< 1%)

Mouth and stomach side effects

  • Diarrhea (5%)
  • Upper-belly pain (2%)
  • Swelling of the belly (1%)
  • Belly pain (1%)
  • Dry mouth (1%)
  • Inflammation and pain of the tongue (< 1%)
  • Painful swallowing (< 1%)
  • Loss of appetite (< 1%)
  • Nausea and vomiting (< 1%)
  • Inflammation and damage to the food pipe (esophagus), inflammation and esophageal sores (ulcers) — this is rare (< 1%)

Effects on blood tests

  • Elevated blood sugar (1%)
  • Increase in BUN (blood urea nitrogen) (< 1%)
  • Eosinophilia (< 1%)
  • Increase in AST (aspartate aminotransferase) (2%)
  • Nose and mouth side effects
  • Inflammation of the soft tissue inside your nostrils and throat (5%)
  • Sinus inflammation (3%)
  • Congestion of your nose (2%)
  • Headache (1%)
  • Other possible side effects
  • An increase in your blood pressure (hypertension 3%)
  • Anxiety (2%)
  • Back pain (1%)
  • Fixed drug eruption — blisters around the anus or genitals (< 1%)
  • Tissue hyperpigmentation (< 1%)

More serious side effects of doxycycline

  • Mild allergic reactions (< 10%)
  • Serious allergic reactions like anaphylaxis and angioedema (< 1%)
  • Superinfection — taking antibiotics can put you at risk for getting other infections

    • Fungus infections in your mouth and elsewhere (2%)
    • Influenza (2%)
    • Clostridium difficile (C. diff) enterocolitis (< 1%)
  • Hypersensitivity reactions (< 1%)

    • Exfoliative dermatitis
    • Erythema multiforme
    • Stevens-Johnson syndrome (SJS)
    • Toxic epidermal necrolysis (TEN)
    • Drug reaction with eosinophilia and systemic symptoms (DRESS syndrome)
  • Benign intracranial hypertension (pseudotumor cerebri) — increased fluid and pressure inside your brain (< 1%)
  • Liver damage (< 1%)
  • Hemolytic anemia (< 1%)
  • Thrombocytopenia (< 1%)
  • Neutropenia (< 1%)
  • Lupus flare-ups (< 1%)
  • Pericarditis (< 1%)
  • Pancreatitis (< 1%)

Can I take doxycycline and Retin-A (tretinoin) with my other medications?

For the most part, yes: you can safely take most medicines with either one of these drugs. There are no major drug interactions reported for Retin-A. This is a very safe medicine to use, even with other medicines. However, there are some important exceptions to doxycycline. It is important to let your doctor know about any and all medicines that you take because they may have interactions that can have a big impact on your health. The major interactions that doxycycline has with other drugs are listed below:

  • Blood thinners — also known as “anticoagulants,”(e.g., Coumadin/warfarin) can be affected by doxycycline, and your body may require a different dose of your blood thinner while taking doxycycline.
  • Penicillin — penicillin is a common type of antibiotic. These drugs have the potential to block each other and may not work as well. It is advised not to take these two antibiotics at the same time.
  • Antacids, dairy, and medicines containing iron — your body does not absorb doxycycline very well if you are using these medicines or eating a lot of dairy.
  • Barbiturates and anti-seizure drugs — certain drugs are used to treat seizures, such as barbiturates, carbamazepine, and phenytoin. These drugs can make doxycycline less effective.
  • Penthrane (methoxyflurane) — this medicine is inhaled and is used to help with pain. It is rare but there have been a few people who have gone into serious kidney failure and even died while taking these two medicines at the same time.

Will my birth control still work if I take doxycycline?

Great question! We used to think that antibiotics could make birth control less effective. This is not true. To date, there has only been one antibiotic proven to make birth control less effective, rifampin. So unless you are taking rifampin (Rifadin), then you will continue to have the benefits of birth control as long as you are taking your birth control correctly.

Accurate information

In order for us to know if treating your acne with doxycycline and Retin-A (tretinoin) makes sense for you, it is very important that you provide full and accurate health information about yourself. If you have any questions about what something means, or how to get certain information, just message us in the secure chat or call us and we can help.

The views expressed in this article intend to highlight alternative studies and induce conversation. They are the views of the author and do not necessarily represent the views of HeyDoctor, and are for informational purposes only, even if and to the extent that this article features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment, and should never be relied upon for specific medical advice.

Check out the HeyDoctor app

With over 1,000 5-star reviews, we're one of the highest rated medical apps. See for yourself!