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| Year : 2020 | Volume
: 66
| Issue : 1 | Page : 54 |
Doxycycline-induced staining of teeth and malar rash in a child
G Joshi, D Dhingra, SS Pandav, S Kaushik
Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| Date of Submission | 27-Jul-2019 |
| Date of Acceptance | 26-Aug-2019 |
| Date of Web Publication | 13-Jan-2020 |
Correspondence Address:
S Kaushik
Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jpgm.JPGM_454_19
How to cite this article:
Joshi G, Dhingra D, Pandav S S, Kaushik S. Doxycycline-induced staining of teeth and malar rash in a child. J Postgrad Med 2020;66:54 |
A 6-year-old girl had intractable glaucoma secondary to cataract surgery, and required Glaucoma Drainage Device (GDD) implantation. She subsequently had GDD tube exposure, for which the conjunctiva had to be resutured. At time of discharge, oral doxycycline (5 mg/kg/day od) was started for its anti-inflammatory properties to aid conjunctival healing.[1],[2],[3] Three weeks later, she presented with black staining of all her deciduous teeth and a malar rash on face ([Figure 1], Panel A). Parents had given the child the dose twice daily which had resulted in this adverse effect. Doxycycline was stopped immediately. Three months later, the teeth stains and skin rash had disappeared ([Figure 1], Panel B). Causality analysis done for this adverse event by Naranjo adverse drug reaction probability scale [4] gave a score of 7 suggestive of probable association of adverse event with drug use. | Figure 1: Panel A: Black staining of the teeth after 3 weeks of treatment with doxycycline (solid arrow) and malar rash over the tip of nose and cheeks (block arrow). Panel B: Disappearance of the rash and reversal of teeth staining after 3 months of stopping the drug
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Tetracyclines are responsible for teeth staining because of deposition of drug-calcium complexes in dentine and enamel, which darken on sun exposure. Doxycycline because of its weak calcium binding capacity (19%) compared to tetracycline (39.5%) has been found to be safe in children <8 years for short-term use without the side effects of visible teeth staining.[5],[6]
Doxycycline is a broad-spectrum antibiotic. The Centre for Disease Control (CDC) has recommended its use for treatment of acute and chronic Q fever and tick-borne rickettsial diseases in young children. In recent times, it has been frequently used as a part of the treatment for ocular surface diseases.[2] Its therapeutic value has been attributed to an ability to inhibit matrix metalloproteinase (MMP) activity and both MMP and interleukin (IL)-1 synthesis. In ophthlamic care, it has been used succesfully for conjunctival erosions over drainage devices, post-trabeculectomy bleb leaks,[3] dry eye, inclusion conjunctivitis, and corneal erosions.
This case snippet should serve to alert ophthalmologists who prescribe doxycycline in children. They should ensure that the parent has understood the correct dosage. Fortunately, in our patient, cessation of the drug resulted in a reversal of teeth stains and the disappearance of the malar rash.
Declaration of patient consent
The authors certify that appropriate patient consent was obtained.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| :: References | |  |
| 1. | Todd SR, Dahlgren FS, Traeger MS. No visible dental staining in children treated with doxycycline for suspected Rocky Mountain spotted fever. J Pediatr 2015;166:1246-51.  |
| 2. | Smith VA, Cook SD. Doxycycline-A role in ocular surface repair. Br J Ophthalmol 2004;88:619-25. |
| 3. | Kiranmaye T, Garudadri CS, Senthil S. Role of oral doxycycline and large diameter bandage contact lens in the management of early post-trabeculectomy bleb leak. BMJ Case Rep 2014;2014:bcr2014208008. |
| 4. | Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981;30:239-45. |
| 5. | Forti G, Benincori C. Doxycycline and the teeth. Lancet 1969;12:782. |
| 6. | Gaillard T, Briolant S, Madamet M, Pradines B. The end of dogma: The safety of doxycycline use in young children for malaria treatment. Malar J 2017;16:148. |
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