Doxycycline Resistance in Dermatology: A Narrative Review of Global Trends and Regional Insights from the Middle East

A BSTRACT Doxycycline has long been a cornerstone in dermatology because of its combined antimicrobial and anti-inflammatory actions. However, the rising rates of resistance – both globally and regionally, especially in the Middle East – are creating significant concerns about its continued clinical effectiveness. This review compiles and examines the latest global evidence on doxycycline resistance in dermatology over the past decade, focusing on data from Jordan and the wider Middle East. It discusses clinical uses, resistance mechanisms, epidemiological trends, and the possible implications for patient care. A comprehensive literature search was conducted in PubMed, Scopus, and Web of Science for studies published between 2000 and 2025. Search terms included “doxycycline resistance,” “acne vulgaris,” “ Cutibacterium acnes ,” “ Staphylococcus aureus ,” and “Middle East.” Priority was given to human studies with dermatological relevance, particularly those from Jordan and neighboring countries. Doxycycline remains widely prescribed for acne vulgaris, rosacea, hidradenitis suppurativa, and skin infections. Nonetheless, resistance rates to in C. acnes exceed 30% worldwide and have reached 37% in Jordan. Similar upward trends were also observed for S. aureus and Streptococcus pyogenes . Factors driving this include unregulated antibiotic access, prolonged empirical use, and molecular mechanisms, such as efflux pumps and ribosomal protection proteins. The growing prevalence of doxycycline resistance threatens effective treatment of common skin conditions, particularly in settings with limited antibiotic regulation. Strengthening stewardship programs, improving public education, encouraging diagnostic testing, and updating regional treatment guidelines are essential to safeguard its role in dermatology.