New Antibiotic Used to Fight Acne May Also Work for Perioral Dermatitis Interview with:
Emmy Graber, MD, MBA
President, The Dermatology Institute of Boston
Affiliate Clinical Instructor, Northeastern University

Dr. Emily Graber

­  What is the background for this study?

Response:     Periorificial dermatitis (POD) is an eczematous-like eruption of erythematous papules and pustules around the orifices of the face such as the mouth, nose or eyes. Typically, treatment involves discontinuation of the offending agent, if any, as well as administration of oral doxycycline. However, doxycycline is a broad-spectrum tetracycline that may result in pronounced gastrointestinal side effects, especially in patients with inflammatory bowel disease (IBD) as well as potentially cause gut flora dysbiosis (disruption of the gut microbiome).

In this case report, a patient seeking treatment for POD also has underlying Crohn’s disease. Sarecycline, a narrow-spectrum tetracycline, was used with careful consideration due to the patient’s underlying IBD. The hope was that sarecycline would have a similar effect on POD as doxycycline, without the side effects associated with broad-spectrum antibiotics. What are the main findings?

perioral dermatitis DermNet NZ image
Example of perioral dermatitis DermNet NZ image

Response: Sarecycline is specifically designed as a narrow-spectrum tetracycline antibiotic. Having a narrow-spectrum activity, sarecycline targets clinically relevant Gram-positive bacteria such as Cutibacterium acnes, while having reduced activity on Gram-negative bacilli and anaerobic enteric bacteria commonly found in the normal gut flora. Furthermore, narrow-spectrum antibiotics, such as sarecycline have low propensity to induce resistance.  Broad-spectrum tetracyclines have been linked to IBD such as Crohn’s disease, particularly doxycycline. What should readers take away from your report?

Response:     In the past, tetracycline-class drugs demonstrated anti-inflammatory properties, with the presumption that sarecycline shares a similar action. This 31 year-old patient was treated with sarecycline for POD and showed almost complete resolution after only thirteen (13) days of treatment.

The results of this treatment suggests that sarecycline has a similar mechanism of anti-inflammatory properties as doxycycline. The patient denied GI upset or any other symptoms related to Crohn’s disease. What recommendations do you have for future research as a result of this work?

Response:     Although sarecycline is currently only FDA-approved for the treatment of moderate to severe acne vulgaris, it shows promise in the treatment of POD, with less risk of causing gastrointestinal issues and gut flora dysbiosis. The importance of antibiotic stewardship is also highlighted in the report. There is a growing concern regarding antibacterial resistance, particularly with broad-spectrum antibiotics. Sarecycline showed very low spontaneous mutation frequency in C.acnes.

Sarecycline has the potential of being a responsible option for the treatment of inflammatory skin conditions such as perioral dermatitis. Is there anything else you would like to add?

Response:      Further investigation into the possible use of sarecycline for inflammatory skin conditions is warranted. More research on the anti-inflammatory mechanism of sarecycline could help explain the pathophysiology behind POD. This was the first published case to demonstrate successful use of sarecycline for POD, showing tolerability even in patients with IBD.

Any disclosures? 

            “Dr. Graber serves as a consultant for 3Derm, Alcimed, Allergan, Almirall, Hovione, Sebacia and SolGel and has received grants/research funding from Ortho Dermatologics, Hovione and Sebacia. Catherine Kay has no potential conflicts.”

Successful Treatment of Periorificial Dermatitis With Novel Narrow Spectrum Sarecycline 
JDD Published online December 26, 2020
Emmy Graber MD MBAa, Catherine RS Kay BSb

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