August 2026, Volume 4, Issue 8

Author

Arjun Gowda T S, Nagabushan H, Deepadarshan K and Chandan N G

Abstract

Background: Acne vulgaris is a common chronic inflammatory disorder with significant psychosocial impact, for which systemic antibiotics combined with a topical retinoid are standard therapy. This study compared oral doxycycline and oral azithromycin, each with topical adapalene, for effectiveness, safety, and quality of life in moderate to severe acne. Methods: In this prospective comparative study at a tertiary care centre, 114 patients received oral doxycycline 100 mg twice daily (n = 57) or oral azithromycin 500 mg once daily for three consecutive days per week (n = 57), each with daily topical adapalene 0.1% for 8 weeks. Acne severity was assessed by the Global Acne Grading System (GAGS), quality of life by the Cardiff Acne Disability Index (CADI), and adverse drug reactions assessed. Results: Significant reductions in GAGS scores (doxycycline 28.00 to 9.93; azithromycin 27.61 to 10.07; p < 0.001) and CADI scores (doxycycline 8.95 to 4.47; azithromycin 9.19 to 4.65; p < 0.001) were seen in both groups, with no significant between-group difference in GAGS (p = 0.438) or CADI (p = 0.855) reduction. Adverse drug reactions were mild, self-limiting, and related to gastrointestinal tract, with no significant difference between groups (doxycycline 12.3%, azithromycin 7.0%; p = 0.53). Conclusion: Oral doxycycline and oral azithromycin, each with topical adapalene, produced comparable effectiveness and quality-of-life improvement in moderate to severe acne with no significant between-group difference, and both were well tolerated. The choice between them can be individualised.