# Repurposing Historic Drugs for Neutrophil-Mediated Inflammation in Skin Disorders
## 4 Tetracyclines
### Neutrophil Dermatoses  
Tetracyclines have shown efficacy in PG by helping to control inflammation, acting as immunosuppressive agents, and promoting ulcer healing. If no response is observed within six to eight weeks, treatment should be discontinued [74]. Doxycycline is favored due to its anti-inflammatory properties, favorable side-effect profile, and its ability to reduce the need for systemic immunosuppression, although most reports highlight the benefit of minocycline. The efficacy data for minocycline are primarily based on case reports where it has been used successfully as monotherapy or as a glucocorticoid-sparing agent [75; 76]. Minocycline is considered a valid option for limited PG, where it may be used for monotherapy after an insufficient response to initial treatments. While efficacy data are limited, its relatively favorable side-effect profile supports its use before proceeding to more aggressive immunosuppressive therapies. Tetracyclines are also effective as adjunct therapies, such as in parameoplastic PG, where minocycline, combined with low-dose steroids, offers an approach that minimizes the risks of immunosuppression in patients with metastatic malignancy [77]. Minocycline has also been reported to successfully treat atypical bullous PG and vegetative PG, especially in mild, non-aggressive variants and over a shorter duration [75]. [PERSON] et al. reported a case of PG in the penis, resistant to treatment with high doses of prednisolone, in which the addition of minocycline achieved remission, supporting minocycline as a valid strategy for difficult locations [78].  
Systemic steroid therapy, colchicine, and dapso are typically employed in the treatment of LCV; however, tetracyclines represent an effective therapeutic option due to their mechanism of action inhibiting neutrophichic chemotaxis and phagocytosis, which play a critical role in the pathogenesis of this condition [6; 79].  
In erythema, elevatum diutium tetracyclines are currently used successfully, and side effects are minimal, even in prolonged treatments. [80].  
The action of tetracyclines on neutrophil chemotaxis provides a rationale for their use in pustular psoriasis, but efficacy data are currently sparse. [PERSON] and [PERSON] reported that two out of six female patients with a variant of generalized pustular psoriasis showed a positive response to tetracycline therapy [81].  
Tetracyclines are largely used in the clinical management of moderate forms of HS: they offer dual benefits in HS treatment, acting both as antibiotics and anti-inflammatory agents. However, a small randomized controlled trial compared topical clindamycin at 0.1% b.i.d. with tetracycline 500 mg b.i.d. in a double-blind, double-dummy study: the trial found no significant differences in physicians' or patients' assessment of overall effect, soreness, nodules, or abscesses [82].  
The management of [PERSON]'s disease is complex and requires a multidisciplinary approach, with treatment plans tailored to the severity of the condition and the specific organs affected. While tetracyclines could potentially be helpful due to their anti-inflammatory properties, they have not yet been widely reported in the literature as a treatment option for [PERSON]'s disease [83; 84].