According to "Harrison's Principles of Internal Medicine," acne rosacea is a chronic inflammation that primarily affects the middle of the face--the cheeks, nose, forehead and chin. It occurs most often in adult women, but the most severely affected are men. An estimated 16 million Americans have rosacea, but only a small fraction are being treated. According to the Mayo Clinic, physicians use oral antibiotics to treat rosacea because of their anti-inflammatory properties. Oral antibiotics work faster than topical agents and may also reduce the excess vascularity, or formation of blood vessels, that plays a major role in the development of symptoms.
Tetracycline
Tetracycline has long been the gold standard treatment of severe rosacea. Several forms of tetracycline are available, including doxycycline and minocycline, both given in an oral dose of 100mg to 200mg daily.
In 2006, the FDA approved doxycycline, also known by the brand name Oracea, for the treatment of inflammatory lesions of rosacea in adults. It is a once-daily 40mg capsule containing 30mg of immediate release and 10mg of delayed release beads. It allows for blood levels of doxycycline to stay within a narrow band: high enough to act as an anti-inflammatory medication, but below the antimicrobial level.
In the May 2007 "Journal of the American Academy of Dermatology," as stated by Dr. JQ Del Rosso, the results of two Phase III, double-blind, placebo-controlled clinical trials of Oracea in patients with rosacea showed a 61 percent and 46 percent mean reduction in inflammatory lesions compared with 29 percent and 20 percent, respectively, for the placebo, which was statistically significant.
Anti-inflammatory dose doxycycline offers a non-antibiotic, anti-inflammatory treatment option.
Erythromycin
Erythromycin is another commonly used antibiotic to treat rosacea; it is effective for treating papulopustular rosacea, but patients often complain of gastrointestinal side-effects.
Azithromycin
In "The International Journal of Dermatology," February 2008, Dr. Maryam Akhyani, stated that a randomized, open, clinical trial compared the efficacy of azithromycin with doxycycline in the treatment of rosacea. Sixty-seven patients were randomized to either azithromycin 500mg thrice weekly in the first, 250mg thrice weekly in the second, and 250mg twice weekly in the third month. The other group was given doxycycline 100 mg/day for the three months. Statistically significant improvement was obtained with both drugs. Neither drug was shown to be more effective than the other.
References
- "Harrison's Principles of Internal Medicine"; Dr. Dennis Kasper; 2005
- Mayo Clinic: Rosacea Treatments and Drugs
- "Journal of the American Academy of Dermatology"; Two randomizedphase III clinical trials evaluating anti-inflammatory dose doxycycline administered once daily for the treatment of rosacea; Dr. JQ Del Rosso; May 2007.
- "International Journal of Dermatology": Comparison of efficacy of azithromycin vs. doxycycline in the treatment of rosacea: a randomized open clinical trial; Dr. M. Akhyani; Mar 2008.
