Hazard - P - B - T - Risk See below
Lymphcycline is secondarily recommended for moderate to severe papulopustular acne and is secondarily recommended for moderate to severe rosacea in the Wise list. Lymphcycline is rapidly hydrolysed to active tetracycline upon absorption. For further information, see tetracycline.
Comparative assessment of environmental risk and risk of resistance selection in human use of ivermectin, metronidazole, lymecycline and azelaic acid in Sweden (Report Goodpoint 2018). The risk is clearly highest for lymecycline based on measured concentrations of tetracycline in uncleaned waste water that exceeds experimental established selective levels for antibiotic resistance in bacteria. A similar but lower risk profile exists for metronidazole based on total use but with significantly lower empirical support for the efficacy The topical use of metronidazole results in a negligible risk of resistance selection in waste water treatment plants. The risk of effects of human use of ivermectin is also low, given an expected contribution to exposure in aquatic environments at subnanogram levels, and a majority of efficacy studies that show significantly higher levels of efficacy. Since there is (at least) a study that reports effects at 1 pg/L, however, one can not completely rule out risk. For azelaic acid there is nothing that indicates an environmental hazard.
Author: Health and Medical Care Administration, Region Stockholm