Danlalane, Did you do any research on doxycycline or did you make a logical conclusion that it might work? Thanks.
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Hey @Jay did a lot of research and reading on Doxy, primarily for infection risk remediation for my hip implant, but lots of other associated benefits made it worth it for me to experiment with. Possible Arthritis reduction (which runs in my family pretty severely), Alzheimer’s, hair loss, and some others. Worth doing some reading if you are curious.
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Danlalane, I’ll check, but my interest only runs so far as it’s possible benefit for rapamaycin acne. Thanks.
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Hi Jay,
I’m saying that 2% erythromycin topical ointment works well for acne caused by sirolimus. I don’t know what a rapamycin rash is or what causes it. There are studies investigating various treatments for acne caused by sirolimus. The acne is initially thought to be caused by mTORC1 inhibition so it isn’t technically a side affect rather a direct affect of mTOR inhibition.
The sites often become infected with a bacterium called acne vulgaris (others as well) that causes inflammation and persistence of the papule /pustule and treatment with antibiotics can speed the healing. Also, sirolimus seems to inhibit the immune systems ability to combat some types of skin infections.
https://www.sciencedirect.com/science/article/abs/pii/S0190962205046025
Some people on the site take oral doxycycline (a derivative of tetracycline) that can treat these infections but taking oral antibiotics chronically can have a number of unwanted consequences such as GI flora disruption and subsequent diarrhea etc as well as creating a change in the skin microbiome that may allow expansion of a subset of bacteria in the skin microbiome that may not be healthy and may lead to infections with resistant bacteria that could be more harmful and difficult to treat with other antibiotics.
I’d recommend a topical antibiotic that can be applied to the area of infection and 2% erythromycin ointment is a narrow spectrum antibiotic that can treat acne vulgaris with minimum disruption to the skin microbiome.
59VW (MD PhD).
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59vw, Hmmm … that is very interesting. Thanks. By the way, does 59vw refer to a 1959 Volkswagen Beetle?
re 59vw yes it does refer to a 1959 Volkswagen Beetle. It’s just my internet handle when I don’t want to be overly visible. I restored the car in my 30’s and love the community.
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So, is the antibiotic or anti inflammatory property of Doxy or both?
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I suspect both in that they are related. Lots of research on doxy and acne. Been prescribed to adolescents for literally decades for that use case.
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After more than a 7 month break, which I took due to persistent acne, I’m now resuming rapamycin. I was on 5-7mg per week, but I’m now starting out with 3mg fortnightly this time. I’ll slowly raise the dosage to see if I can find a tolerable threshold.
I found after two months off rapamycin, my acne had all but subsided. The texture of my skin became smoother after a period of sloughing that started a couple weeks after ceasing rapamycin.
I tried a bunch of different OTC remedies for the acne when I was previously on rapamycin, but none really resolved the issue.
Hopefully the slower pulse will work. As I recall, though, my acne didn’t happen immediately when I first started rapamycin. It only began after about five months into taking rapamycin. I’ll post back later with updates.
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grapefruit is what some take to hopefully make the rapa more effective(being a cyp3…inhibitor) and since rapa is what is very expensive there is a need for it possibly if it works but would be better off taking ketoconazole a few minutes or maybe even up to an hour prior to taking the rapa as that is more of a sure thing to increase peak and area under curve as is a more potent cyp3…inhibitor
That’s not quite accurate. People use grapefruit juice to intensify the effect. It’s metabolically equivalent to taking ~150% or more of the same dose (at least, that’s what the anecdotal evidence suggests). So, if one is getting bad side effects, intensification is the first thing you should eliminate. If, as I suspect, the acne is due to opportunistic bacterial infection, then reducing the intensity of the medication is obvious as a way to reduce immune vulnerability and hopefully reduce the acne.
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if that then one would decrease the rapa dose as that is a lot more expensive and keep the cyp3… inhibition
I don’t know enough about the chemical implications to know if that would work. I get my Rapa from India, so it’s not expensive enough that I would do that. Obviously, if the grapefruit juice intensifies the effect, you still need the baseline of rapamycin to work at all. But, since there doesn’t seem to be a very known heuristic of the exact dosage or the exact percentage intensification of the grapefruit juice, I’ve refrained from using grapefruit juice so as to better control my own dosage.
As for addressing the acne, for myself, I decided to go back to 1 mg/wk, and titrate up 1 mg every 2 weeks so that I can identify a point where the balance between Rapa and acne is manageable.
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That is what I did with success so far.
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Awesome! How high have you gotten? (Dosage I mean)…
Started 6 mg today. No significant acne with 2 or 4.
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59vw, Since you’ve mentioned 2% erythromycin topical ointment, what are your thoughts about 2% azithromycin topical ointment or 1% clindamycin gel? Thanks.
Jay,
Topical erythromycin, azithromycin, and clindamycin are all tried and true acne treatments. I would guess that 2% azithromycin gel would be equivalent to 2% erythromycin. I should say that I think part of the efficacy of the 2% erythromycin gel is the gel component. I use it at night and it forms a thin clear “skin” over the application area that dries and stays in place all night long. If applied to a general area (eg forehead) it seems to prevent new infections and it is quite effective at treating existing infections and reducing their inflammation. As stated above I use and started with 2% erythromycin gel because it had been shown to be effective in patients on rapamycin for kidney transplant. I don’t have any personal experience with topical clindamycin although it is a standard for adolescent acne. Provided you are not allergic topical meds are very safe so you shouldn’t have much problem convincing a doctor to prescribe it for you.
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59vw, That’s very good information. Thanks. By the way, I’m a gearhead for the last six decades. My first and only big project was combining parts from two 1964 Corvairs into one working car for college. The only significant engine work was replacing the compression rings and transferring the engine to the least damaged body.
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Yes I am 57 years old and I have seen some pimples on my legs and arms. Not a big deal but enouth to search in internet if this can be a side effect. I am also using a Rapa body cream so maybe this is related.
regards