Sarecycline May Be Effective in Periorificial Dermatitis Treatment

Perioral dermatitis

Image credit: DermNet

A recent review published in the Journal of Clinical and Aesthetic Dermatology examined medical records of patients who had received a diagnosis of periorificial dermatitis (POD) and were treated with sarecycline to understand the potential benefits of the narrow-spectrum antibiotic.¹

POD typically presents with erythematous papules or papulopustules near the perioral, perinasal, and/or periorbital area and more commonly affects women between 18 and 45 years old. According to Swenson et al, topical corticosteroid use is a suspected cause of POD, and first-line treatment includes stopping all use of topical corticosteroids. Second-line treatment of POD typically consists of topical and systemic agents such as antibiotics, as there is no FDA-approved treatment specifically for POD.

According to Swenson et al, topical treatments that have been effective in some studies include metronidazole, clindamycin, erythromycin, azelaic acid gel, tacrolimus, and pimecrolimus. However, when topical therapies are not enough, oral antibiotics are often prescribed.

“Tetracycline class of antibiotics, particularly doxycycline 50 to 100mg twice daily and minocycline 50 to 100mg twice daily, are often the antibiotic of choice if the patient is over the age of eight years old, and not pregnant or breastfeeding. Antibiotics, particularly the tetracycline class, are very commonly indicated by dermatologists for the treatment of POD, and a typical course of oral tetracyclines for POD is approximately eight weeks,” wrote Swenson et al.

Sarecycline is a narrow-spectrum, third-generation tetracycline-class oral antibiotic, compared to doxycycline and minocycline as second-generation tetracycline-class antibiotics. Sarecycline consists of 4, six-carbon rings, similar to the other tetracyclines, yet sarecycline’s structure includes a longer C7 moiety to allow great stabilization and the ability to fight tetracycline-resistant mechanisms, according to the study authors. Additionally, sarecycline is the only narrow-spectrum antibiotic approved by the FDA for the treatment of acne vulgaris.

Swenson et al noted that a low propensity to develop resistance to sarecycline has been demonstrated in Cutibacterium acnes (C. acnes), Staphylococcus aureus (S. aureus), and Staphylococcus epidermidis (S. epidermidis). The study authors wrote that tetracyclines, specifically minocycline, have vestibular adverse effects, however, recent studies have shown that sarecycline cannot cross the blood-brain barrier compared to minocycline and sarecycline’s lower lipophilicity may explain the decrease in adverse vestibular effects.² According to Swenson et al, the most common adverse effect of sarecycline in phase 3 clinical trials was nausea (2.1%).

Antibiotic resistance is another important conversation in dermatology, and sarecycline was specifically developed for the treatment of acne and was designed to have high selectivity against C. acnes, which makes sarecycline less likely to cause antibiotic resistance, according to the study authors.

Methods

Swenson et al reviewed medical records of patients at the Dermatology Institute of Boston who received a diagnosis of POD and were prescribed sarecycline for treatment. Seventeen patient charts were identified by searching for the ICD-10 code L71.0 and “Seysara.” Collected patient information included date of birth, sex, duration of therapy, sarecycline dosage, if POD resolved following treatment with sarecycline, if recurrence occurred and how long after sarecycline was discontinued, adverse effects, whether a biopsy was performed to confirm POD, and if there was a concomitant topical therapy used throughout treatment with sarecycline. Inclusion criteria for the review included patients who had a diagnosis of POD, were prescribed sarecycline, and had a documented follow-up.

From February 1, 2016, to February 7, 2022, 14,749 patient charts were reviewed. Out of the 224 patients diagnosed with POD, 17 were prescribed sarecycline. Out of the 17 patients prescribed sarecycline, 5 patients were excluded due to the diagnosis being changed at later visits and 6 patients were lost to follow-up. Overall, 6 patients were eligible for the study.

Out of the 6 patients, 4 were women and 2 were men with overall age ranges from 26 to 58 years old. The course of therapy ranged from 30 to 180 days and the dosages of sarecycline were 100mg and 150mg tablets. Overall, all 6 patients achieved treatment success of their POD with sarecycline and reported no adverse effects. Two patients reported that their POD returned 6 months and 18 months after discontinuing treatment with sarecycline.

Practical Use

“Given the lack of FDA-approved treatments indicated for POD, the need to explore alternative treatment approaches is warranted. Of the six subjects in this study, all had shown improvement after treatment with sarecycline. Although the sample size was small, the use of sarecycline for the treatment of POD was shown to be efficacious for all patients, which suggests the use of sarecycline as a potential treatment option for POD that should be further explored,” wrote Swenson et al.

Although tetracycline-class antibiotics have proven effective for the treatment of POD and other conditions such as acne, the adverse effects of broad-spectrum antibiotics should be considered when evaluating patients. Nausea, vomiting, and diarrhea are the most common adverse effects associated with broad-spectrum tetracycline-class antibiotics, according to the study authors, and doxycycline may cause the development of irritable bowel syndrome and inflammatory bowel disease.

When considering antibiotic resistance, narrow-band antibiotics can target a specific type of bacteria rather than targeting both gram-positive and gram-negative bacteria. Therefore, sarecycline’s targeting of C. acnes decreases the risk of antibiotic resistance.

“The observations gleaned from this case series highlight the many potential benefits to treatment with sarecycline over the alternative tetracycline-class antibiotics. There is an absolute need for more large-scale clinical studies evaluating treatment options for POD, with special attention to the impact on antibiotic resistance and its implications on public health. Based on the efficacy and tolerability of sarecycline in large-scale acne studies, sarecycline may be an appropriate novel treatment option for POD and should be explored further with larger randomized, controlled studies,” concluded Swenson et al.

References

1. Swenson K, Stern A, Graber E. A retrospective review of a cohort of patients with periorificial dermatitis treated with sarecycline. J Clin Aesthet Dermatol. 2024;17(6):50-54.
2. Grada A, Del Rosso JQ, Moore AY, et al. Reduced blood-brain barrier penetration of acne vulgaris antibiotic sarecycline compared to minocycline corresponds with lower lipophilicity. Front Med (Lausanne). 2022;9:1033989. doi:10.3389/fmed.2022.1033980