Why antibiotics for rosacea

Howard Murad, MD murad. The signs and symptoms of rosacea vary substantially from one patient to another, and treatment must be tailored for each individual case. For patients with redness and pimples, doctors often prescribe oral antibiotics such as tetracycline and topical therapy to bring the condition under immediate control, followed by long-term use of the topical therapy alone to maintain remission.

When appropriate, laser treatment or other surgical procedures may be used to remove visible blood vessels, reduce extensive redness or correct disfigurement of the nose. Eye symptoms are commonly treated with oral antibiotics and ophthalmic therapy, but if left untreated, can lead to blindness. Rosacea patients are advised to identify and avoid lifestyle and environmental factors that may aggravate their individual conditions.

Patients may also benefit from gentle and appropriate skin care, and cosmetics may be used to reduce the effect of rosacea on appearance.

It is unknown exactly why antibiotics work against rosacea, but it is widely believed that it is due to their anti-inflammatory properties, rather than their bacteria-fighting capabilities.

Macrene Alexiades-Armenakas, MD drmacrene. Yes, in patients whose rosacea does not clear on topical treatment and lasers, antibiotics may be necessary for some time.

Once clear, I wean patients off of antibiotics. Dennis Gross, MD dennisgrossmd. Sometimes lifestyle changes and over-the-counter remedies are enough to keep rosacea at bay, so I would recommend that to a patient before antibiotics. However, if a patient has been adhering to a regimen for at least a month and has not seen visible results then I do recommend a prescription topical, oral antibiotics or light acid peels.

Oral medications such as tetracycline, doxycycline, and minocycline, all have been proven to keep rosacea's bacterial component under control and also seem to have an anti-inflammatory benefit. Topical products such as metronidazole and clindamycin work in much the same way. Light peels help to keep the skin antiseptic and combat bacteria. I am always concerned about overusing antibiotics and antibiotic resistance; however, when indicated in rosacea they can be extremely helpful when topical treatment alone is ineffective.

Situations where I recommend antibiotics include an acute flare-up of perioral dermatitis , a flare-up of inflammatory papules and pustules in spite of topical treatment, and ocular rosacea with blepharitis. Neil Sadick, MD sadickdermatology. Typically, I would only recommend antibiotics in cases where a patient has inflammatory pustule lesions and significant redness.

There is always a concern regarding overuse of antibiotics and resistance. Marta Rendon, MD drrendon. Yes, in certain circumstances oral antibiotics are indicated to treat rosacea.

Antibiotics are used in moderate to severe pustular rosacea. Often the dose of the antibiotics is a very low dose that is not effective as an antibiotic but is effective as an anti-inflammatory. Antibiotics are discontinued as soon as possible in order to limit any possible antibiotic resistance.

The oral antibiotics are used along with topical medications in order to facilitate this. Greenberg, MD lasvegasdermatology. Yes, if there is severe inflammation, I would recommend an antibiotic, be it a topical or pill form.

Resistance is always an issue with antibiotic therapy; however, I would not let that issue dictate my therapy for an individual patient. Sarah Swanson sarahswansonskincare. Adverse effects include irritation, burning, dry skin, pruritus and erythema. Vascular laser therapy specifically targets haemoglobin in vessels, and hence, effectively treats facial erythema and telangiectasia.

Laser treatment is generally not as effective for the treatment of papulopustular lesions. Intense pulsed light IPL has also been reported to be effective in the treatment of rosacea. Adverse effects of IPL, which patients must be informed about, include blistering purpura, rarely loss of pigmentation, ulceration and scarring. IPL and vascular laser treatment are not curative; recurrence is the norm and intermittent re-treatment is often necessary.

Phymatous rosacea can be disfiguring and difficult to treat. Results have been more effective in patients who are treated early. Oral isotretinoin is used to reduce nasal volume in early disease; however, after discontinuing the medication, recurrence is often seen. Unfortunately, mucinous and fibrotic changes are unresponsive to isotretinoin.

Topical metronidazole eg Flagyl, Metrogel for inflammatory lesions or brimonidine eg Mirvaso for erythema. Vascular laser therapy eg pulsed dye laser, intense pulsed light for erythema and telangiectasia. If limited or no response at 8—12 weeks, consider antimicrobial dose of doxycycline — mg daily. If limited or no response at 8—12 weeks, consider antimicrobial antibiotic dose of doxycycline — mg daily. Rosacea is a common, chronic problem.

The subtype of rosacea and its associated clinical features determine which therapeutic modalities a clinician will use.

Often, patients require a combination of therapies for effective treatment, as different subtypes co-exist, and because of the recalcitrant and persistent nature of rosacea.

Provenance and peer review: Commissioned, internally and externally peer reviewed. Australian Family Physician. Search for: Search AFP. Filter Relevance Date.

Issues by year. Volume 46, Issue 5, May Background Rosacea is a chronic and common cutaneous condition characterised by symptoms of facial flushing and a broad spectrum of clinical signs.

The clinical presentation for rosacea is varied, and there are four primary subtypes, which may overlap — erythrotelangiectatic, inflammatory, phymatous and ocular.

It is important to recognise the different subtypes because of the differences in therapy. Objective The objective of this article is to provide evidence-based clinical updates to clinicians, specifically general practitioners GPs , to assist with their everyday practice, and effective assessment and treatment of rosacea.

Discussion Therapeutic modalities are chosen on the basis of the subtypes and clinical features identified; often a combination of these therapies is required. Genetic vascular reactivity Rosacea is thought to have a genetic component, with a higher incidence found in fair-skinned individuals of Celtic or northern European descent.

Clinical manifestations The clinical presentation for rosacea is varied. Erythrotelangiectatic vascular rosacea ETR is characterised by flushing and vasodilation and, over time, this leads to the development of permanent erythema, then telangiectasia on the affected areas. Box 1. Triggers associated with worsening rosacea symptoms 1 Trigger Emotional stress Hot or cold weather Sun exposure Wind Exercise Hot drinks Alcohol consumption Spicy foods Dairy products Hot baths or showers Certain skin care products Certain cosmetics Medications eg topical steroids, niacin, beta blockers Box 2.

Erythrotelangiectatic rosacea overlapping with papulopustular rosacea Figure 1B. Phymatous rosacea with the characteristic skin thickening, irregular surface and bulbous nose Ocular rosacea Ocular manifestations of rosacea often precede the development of cutaneous signs, but can also occur concurrently.

Differential diagnosis There are many skin conditions that share similar features to those of rosacea. Seborrhoeic dermatitis Seborrhoeic dermatitis presents with scaling and erythema, often on the eyebrows, nasolabial folds, scalp and pre-sternal areas.

Periorofacial dermatitis Periorofacial dermatitis usually presents with inflammatory papules around the mouth, eyes and nasal area. Acne Acne vulgaris is typically seen in the younger age group, and is characterised by comedonal lesions, papules, pustules and cysts, often on the face, but some acne may affect the back and chest.

Keratosis pilaris Keratosis pilaris is a facial disease that can be difficult to differentiate from rosacea, and may occur in patients simultaneously. Systemic lupus erythematosus Patients with systemic lupus erythematosus SLE experience a malar erythema, which is difficult to differentiate from rosacea.

Treatment Rosacea is managed mainly with general measures Box 2 and treatments targeted at the specific presenting symptoms Table 1. Systemic treatment Oral antibiotics Oral antibiotics reduce the inflammatory lesions, such as papules and pustules, as well as the ocular symptoms of rosacea.

Specific measures for phymatous rosacea Phymatous rosacea can be disfiguring and difficult to treat. Rosacea: I. Etiology, pathogenesis, and subtype classification. J Am Acad Dermatol ;51 3 —41; quiz 42— Rosacea: Classification and treatment. J R Soc Med ;90 3 — An epidemiological study of rosacea. Acta Derm Venereol ;69 5 — A study on the epidemiology of rosacea in the U.

Br J Dermatol ; 3 — New insights into rosacea pathophysiology: A review of recent findings. Fine-structural identification of autonomic nerves and their relation to smooth muscle. Prog Brain Res ;— Mite-related bacterial antigens stimulate inflammatory cells in rosacea. The significance of Demodex folliculorum density in rosacea. Int J Dermatol ;37 6 — A rosacea support group, either in person or online, can connect you with others facing the same types of problems — which can be comforting.

You're likely to start by seeing your family doctor. Or when you call to set up an appointment, you may be referred to a skin disease specialist dermatologist.

If your condition affects your eyes, you may be referred to an eye specialist ophthalmologist. Preparing a list of questions will help you make the most of your appointment time. For rosacea, some basic questions to ask your doctor include:.

Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. This content does not have an English version. This content does not have an Arabic version. Diagnosis No specific test is used to diagnosis rosacea. More Information Light therapy for rosacea? Request an Appointment at Mayo Clinic. Share on: Facebook Twitter. Show references Kang S, et al.

In: Fitzpatrick's Dermatology. McGraw-Hill; Accessed June 13, Habif TP. Acne, rosacea, and related disorders. Saunders Elsevier; Accessed May 19, Dahl MV. Rosacea: Pathogenesis, clinical features and diagnosis. Ferri FF. In: Ferri's Clinical Advisor Elsevier; Maier LE. Management of rosacea. Mayo Foundation for Medical Education and Research; Interventions for rosacea.

Cochrane Database of Systematic Reviews. Accessed June 14, Aldrich N, et al. Genetic vs environmental factors that correlate with rosacea: A cohort-based survey of twins. JAMA Dermatology.