Minocycline and lupuslike syndrome in acne patients

Background: Recently several case reports described the association between minocycline and lupuslike syndrome. Minocycline, one of the tetracyclines, is widely used to treat acne. We aimed to examine the association of expos ure to minocycline and other tetracyclines with the development of lupuslik e syndrome. Methods: We conducted a nested case-control study in a cohort of 27 688 acn e patients aged 15 to 29 years, using data automatically recorded on genera l practitioners' office computers in the United Kingdom. Controls were matc hed to cases on age, sex, and practice. The main outcome was lupuslike synd rome defined as the occurrence of polyarthritis or polyarthralgia of unknow n origin, with negative rheumatoid factor or latex agglutination test, posi tive or unmeasured antinuclear factor, elevated or unmeasured erythrocyte s edimentation rate, and absence of or unmeasured antinative DNA antibody lev els. Results: We identified 29 cases and selected 152 controls. Current single u se of minocycline was associated with an 8.5-fold (95% confidence interval [CI], 2.1-35) increased risk of developing lupuslike syndrome compared with nonusers and past users of tetracyclines combined. The risk of past exposu re to any of the tetracyclines was closely similar to nonuse (relative risk , 1.3; 95% CI, 0.5-3.3). Current use of doxycycline, oxytetracydine, or tet racycline combined was associated with a 1.7-fold (95% CI, 0.4-8.1) increas e of risk. The risk increased with longer use. Conclusion: Current use of minocycline increased the risk of developing lup uslike syndrome 8.5-fold in the cohort of young acne patients. The effect w as stronger in longer-term users. However, the absolute risk of developing lupuslike syndrome seems to be relatively low.