INTRODUCTION
Pseudotumor cerebri (PTC), also referred to as idiopathic intracranial hypertension (IIH), is a clinical syndrome characterized by elevated intracranial pressure (ICP) in the absence of identifiable structural abnormalities on neuroimaging or pathological findings in cerebrospinal fluid (CSF) analysis. The condition typically presents with a constellation of symptoms including persistent headache, papilledema, visual disturbances, and pulsatile tinnitus. Although PTC predominantly affects young, overweight women, most commonly between 20 and 45 years of age, it is not limited to this demographic and may occur across a wide range of ages and body mass indices. The increased prevalence among obese women of reproductive age suggests a multifactorial pathophysiology in which metabolic and hormonal factors may play a role.
Several medications have been implicated as potential triggers of secondary intracranial hypertension, including tetracycline antibiotics. Minocycline, a second-generation tetracycline widely prescribed in dermatological practice, particularly for the treatment of acne vulgaris, has been infrequently reported in association with PTC. Despite its well-established efficacy and favorable dermatological profile, concerns have emerged regarding its neurological safety, especially in the context of prolonged use or in patients with predisposing risk factors [1–49].
OBJECTIVE
The primary objective of this review is to examine the association between minocycline use and the development of pseudotumor cerebri in patients treated for dermatological conditions. Specifically, this study aims to synthesize current evidence regarding minocycline-associated elevations in intracranial pressure and to assess the resulting neurological and ophthalmological consequences. By analyzing available clinical data, this review seeks to emphasize the importance of early recognition, risk stratification, and appropriate management of this potentially serious adverse effect.
MATERIAL AND METHODS
Literature review approach
A systematic literature review was conducted to investigate the association between minocycline use and pseudotumor cerebri. The search encompassed several key databases, including PubMed, Embase, and the Cochrane Library. Relevant Medical Subject Headings (MeSH) terms and keywords such as “minocycline”, “pseudotumor cerebri”, “idiopathic intracranial hypertension”, and “neurological effects” were employed to retrieve pertinent studies.
Inclusion and exclusion criteria
Studies were eligible for inclusion if they reported neurological adverse effects associated with minocycline use, with a particular focus on cases of PTC in dermatological contexts. Included publications comprised case reports, case series, and observational studies providing detailed clinical information on minocycline exposure, symptom onset, diagnostic findings, management, and outcomes. Studies were excluded if they were irrelevant to the research question, duplicated previously reported data, lacked full-text availability, involved animal models, or failed to provide sufficient clinical detail to support an association between minocycline use and PTC.
Data extraction and quality assessment
A focused search of PubMed, Scopus, and Google Scholar was conducted for articles published between January 2000 and July 2025. Only English-language studies involving human subjects were considered. From 145 identified records, 42 articles underwent full-text review, of which 18 met the inclusion criteria, collectively describing 27 individual patient cases.
For each case, the following data were extracted: patient demographics (age, sex, body mass index when available), minocycline exposure (dose, duration, and indication), time to symptom onset, comorbidities (including obesity, hypertension, oral contraceptive use, and isotretinoin exposure), clinical manifestations (headache, papilledema, visual disturbances, pulsatile tinnitus), diagnostic findings (lumbar puncture opening pressure, MRI and MRV results), therapeutic interventions, and clinical outcomes.
Minocycline doses ranged from 50 mg twice daily to 200 mg daily, most commonly prescribed for acne vulgaris and less frequently for rosacea. Symptom onset typically occurred between 6 weeks and 4 months after treatment initiation. Neuroimaging findings were often unremarkable on MRI, while MR venography frequently demonstrated transverse sinus narrowing or stenosis. The overall quality of evidence was assessed using the Oxford Centre for Evidence-Based Medicine framework, with most included studies classified as Level IV evidence (case reports and case series).
RESULTS
Overview of findings
The reviewed literature consistently documented an association between minocycline therapy and the development of pseudotumor cerebri. Case reports and series described elevated ICP occurring during or after minocycline exposure, with clinical presentations and outcomes varying across patients.
Clinical manifestations and complications
The most frequently reported symptoms included persistent headache, papilledema, and visual disturbances. In several cases, patients developed severe complications, such as progressive visual loss requiring urgent neurological or ophthalmological intervention. These findings highlight the potential severity of minocycline-associated PTC despite its rarity.
Timing and duration of symptoms
The latency between minocycline initiation and symptom onset varied considerably. Some patients developed symptoms shortly after starting therapy, whereas others presented after prolonged exposure. This variability suggests that individual susceptibility and coexisting risk factors may significantly influence disease onset.
Response to discontinuation
In the majority of reported cases, discontinuation of minocycline resulted in partial or complete resolution of symptoms. However, a subset of patients experienced persistent neurological or visual deficits, underscoring the importance of early detection and prompt intervention.
DISCUSSION
Implications for clinical practice
The findings of this review underscore the importance of heightened clinical awareness regarding the potential neurological adverse effects of minocycline in dermatological practice. Although minocycline remains an effective and widely used therapy for acne, its association with PTC necessitates careful patient selection and monitoring.
Variability in symptom onset
The wide range in symptom onset emphasizes the need for individualized risk assessment. Factors such as female sex, obesity, concurrent use of oral contraceptives or isotretinoin, and underlying comorbidities may increase susceptibility to minocycline-associated PTC. Awareness of these factors may facilitate earlier recognition and diagnosis.
Long-term monitoring and management
Given the risk of persistent visual impairment, clinicians should educate patients about early warning symptoms of increased ICP and ensure prompt referral to neurology and ophthalmology when PTC is suspected. A multidisciplinary approach is often essential for optimal management and prevention of irreversible complications.
CONCLUSIONS
The association between minocycline use and pseudotumor cerebri highlights the need for vigilance in dermatological practice. While minocycline remains an effective treatment for acne, its potential to induce elevated intracranial pressure warrants cautious use and thorough patient counseling. Early recognition of symptoms, prompt discontinuation of the drug, and interdisciplinary management are critical to minimizing long-term neurological and visual sequelae. Further research is needed to clarify the underlying mechanisms of minocycline-induced PTC and to better define its true incidence in clinical practice.
A detailed summary of reported cases, including demographic characteristics, treatment details, clinical features, diagnostic findings, risk factors, and outcomes, is provided in table 1.
Table 1
Summary of published reports on minocycline-induced intracranial hypertension
