EFFICACY AND SAFETY OF LYMECYCLINE IN ACNE MANAGEMENT: A SYSTEMATIC REVIEW

This systematic review evaluates the efficacy and safety of lymecycline (Ln) for acne vulgaris, a chronic inflammatory skin disease affecting 20% of people worldwide. We assessed Ln versus other treatments (doxycycline, minocycline [Mn], isotretinoin [Iso]) while evaluating antibiotic resistance risks by including randomized controlled trials (RCTs) and observational studies of patients ≥12 years receiving study-specific Ln regimens, most commonly 300 mg/day, with treatment duration varying across studies and outcomes assessed using study-specific efficacy measures. PubMed and Google Scholar searches identified 765 records; after duplicate removal, 757 records were screened, and 11 studies were included. Two independent reviewers conducted study screening, data extraction, and risk of bias assessment using Cochrane RoB 2 for RCTs and the Newcastle–Ottawa Scale for observational studies. This review is registered in PROSPERO (CRD42024618517). The 11 included studies (1,834 participants; 8 RCTs, 3 cohorts) showed that Ln was comparable to Mn (50.6% vs. 52.2% inflammatory lesion reduction) but less effective than Iso (90.3±3.38 vs. 83.50±3.51); adverse-event findings varied across the comparative RCTs and did not consistently favor Ln; showed enhanced efficacy with adjuncts like benzoyl peroxide or adapalene (up to 74.1% lesion reduction); and provided sustained benefits with minimal relapse but raised resistance concerns. Among the 8 RCTs, 1 favored Ln, 2 showed broadly comparable efficacy, 2 favored comparator treatments, 2 demonstrated enhanced effects with Ln -based combination therapy, and 1 primarily assessed sebum fatty-acid changes rather than direct clinical acne efficacy. In conclusion, Ln is effective and well-tolerated for moderate-to-severe acne, especially in combination; while inferior to Iso, its safety supports first-line use, though resistance risks require prudent prescribing.