Rosacea is a chronic disease, and the goal of therapy is control rather than cure. It is characterized by exacerbations and remissions. Although there is no curative therapy for rosacea, the most widely used systemic agents to treat rosacea are the oral tetracycline derivatives. Doxycycline, which is a second-generation tetracycline, is used for the treatment or rosacea.
Theory
Although the cause of rosacea is unknown, there are two theories . According to Great Skin, the two most prominent theories are the autoimmune theory and the infectious theory. Factors that trigger innate immune responses may worsen the symptoms of rosacea. The infectious theory involves the hair follicle mites, which have been thought to play a role in the pathogenesis of the inflammatory lesions. Studies supporting this hypothesis have found increased numbers of mites in the skin of patients with rosacea compared with that of unaffected individuals. These mites increase bacteria on the skin and around the hair follicles. One of the treatments to rid the skin of the bacteria is Doxycycline, which is a broad spectrum antibiotic. Doxycycline inhibits the growth and reproduction of bacteria by inactivating enzymes located in the bacterial cell membrane.
Treatment of Rosacea
According to Uspharmacist, oral antibiotics have been a mainstay of rosacea therapy for many years. Currently, there is only one FDA-approved class of antibiotic for the treatment of rosacea, the tetracyclines. Doxycycline is effective for the treatment of rosacea. The number of FDA-approved antibiotics is limited, because there is a lack of evidence that rosacea is secondary to a bacterial infection.
Indications of Doxycycline
Uspharmacist reports that oral antibiotic treatment is indicated only in the treatment of inflammatory lesions of rosacea. There have been two studies in which doxycycline has significantly reduced inflammatory lesions. The inflammatory lesions are more likely to have been caused by bacteria, rather than an autoimmune response.
Doxycycline Dosing
The recommended dose of doxycycline is 50 to 100 mg by mouth once a day to twice a day. According to Uspharmacist, lower doses of doxycycline, such as 20 mg twice a day or 30 mg immediate-release plus 10 mg delayed-release taken once daily as a single pill, may also be effective for the treatment of rosacea and might cause less antibiotic resistance.
Maintenance Therapy
The chronic nature of rosacea requires that medical therapy be continued long-term, not just for flareups of the condition. Those who require oral medications should have the drug tapered to the lowest effective dose possible. Flares during maintenance may require resumption of or higher doses of antibiotics for several weeks on an as-needed basis.
