Minocycline for Acne and Autoimmune Disease

Abstract

Senior Members| December 01 2008 Minocycline for Acne and Autoimmune Disease AAP Grand Rounds (2008) 20 (6): 61–62. https://doi.org/10.1542/gr.20-6-61 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Minocycline for Acne and Autoimmune Disease. AAP Grand Rounds December 2008; 20 (6): 61–62. https://doi.org/10.1542/gr.20-6-61 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: acne vulgaris, autoimmune diseases, minocycline, autoimmunity Source: El-Hallak M, Giani T, Yeniay BS, et al. Chronic minocycline-induced autoimmunity in children. J Pediatr. 2008;153(3):314–319; doi:10.1016/j.jpeds.2008.03.013 To assess the association of minocycline with autoimmunity, investigators at the Boston Children’s Hospital and Harvard Medical School report a case series of patients who developed a variety of symptoms suggestive of rheumatologic disease while receiving minocycline for acne vulgaris. Study children were identified by reviewing the medical records of children undergoing ANCA (antineutrophil cytoplasmic antibody) testing at a pediatric rheumatology practice between 1996 and 2006. Minocycline-induced autoimmunity (MIA) was defined as a history of minocycline usage and clinical and laboratory findings suggestive of autoimmunity. Patients with MIA were divided into three categories on the basis of disease duration after discontinuation of minocycline: transient (if they responded to minocycline withdrawal or required less than one month of nonsteroidal antiinflammatory drugs [NSAIDs] or corticosteroids); intermediate (if they required one month to one year of treatment); or chronic (if they had active disease by clinical or laboratory criteria after the use of immunosuppressive medications for at least one year). Of 583 children tested, 33 met criteria for a diagnosis of MIA. Of these, data on 27 children (19 female) were analyzed. The mean age of study patients at onset of symptoms was 16.5±1.4 years and the mean duration of minocycline use before diagnosis was 13±10.8 months. Clinical manifestations were present for a mean of 4.3 months before a diagnosis of MIA was made. All patients presented with constitutional symptoms such as fever, weight loss, and malaise. Twenty-two study patients had polyarthralgia (81.4%) and 17 had polyarthritis (62%), primarily affecting hands and feet. Laboratory features included elevated sedimentation rate in 50% of patients and elevated C-reactive protein in 56%. Leukopenia was present in 26%, ANA was positive in 74%, and ANCA was positive in 67%. Fourteen patients had transient, six intermediate, and seven chronic disease. All seven patients with a chronic course had arthritis at presentation and required long-term immunosuppressive therapy with agents such as corticosteroids, methotrexate, and anti-tumor necrosis factor-α agents for treatment of symptoms, primarily arthritis. Most of the six patients with an intermediate course required therapy with corticosteroids and NSAIDs. The authors conclude that prescribing physicians should be aware that minocycline-induced autoimmunity may be associated with debilitating chronic symptoms. Drs. Schiff and Barton have disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Minocycline, introduced in 1972 as a treatment for acne vulgaris, is prescribed for an estimated 15 million pediatric patients annually in the US.1 In addition to its usefulness for acne, studies have demonstrated additional characteristics, including immunomodulatory, antiinflammatory, antiangiogenic, and antiapoptotic effects.2 Most side effects of minocycline are minor such as transient and self-limited rashes and gastrointestinal intolerance.3 Potentially more serious adverse effects, such as hypersensitivity reaction, pseudotumor cerebri, pancreatitis, and autoimmune manifestations including hepatitis, lupus, arthritis, and vasculitis, have been reported.1,4 Autoimmune manifestations... You do not currently have access to this content.