From the Guidelines
Antibiotics are used to treat rosacea primarily because they have anti-inflammatory properties that help reduce the redness, bumps, and pustules associated with this chronic skin condition, with low-dose doxycycline (40mg daily) being a particularly effective option due to its anti-inflammatory benefits without antibiotic effects, as shown in a 2024 study published in the journal Drugs 1. When considering treatment options for rosacea, it's essential to prioritize the patient's quality of life, morbidity, and mortality.
- For mild to moderate rosacea, topical antibiotics like metronidazole (0.75% or 1% gel or cream, applied twice daily) or azelaic acid (15-20% cream, applied twice daily) are typically the first-line treatments, as recommended by the global rosacea consensus (ROSco) panel in 2017 1.
- For more severe cases, oral antibiotics such as doxycycline (40-100mg daily) or minocycline (50-100mg daily) are often prescribed for 8-12 weeks, followed by maintenance therapy with topical treatments, with doxycycline being a viable treatment option for all severities of inflammatory papules/pustules, clinically inflamed phyma, and ocular features of rosacea, as stated in a 2017 study published in the British Journal of Dermatology 1. These medications work by inhibiting inflammatory cytokines and neutrophil chemotaxis rather than primarily targeting bacteria, which helps control symptoms and prevent flare-ups, as demonstrated in a 2024 review of the current treatment landscape for rosacea 1. Patients should use these medications consistently as prescribed, apply sunscreen daily, and avoid known triggers like spicy foods, alcohol, and extreme temperatures for best results, with general skincare and eye care underlying the treatment approach to managing cutaneous and ocular features, respectively, as emphasized by the ROSco panel in 2017 1.
From the Research
Treatment of Rosacea with Antibiotics
- Rosacea is a common chronic dermatosis that can be effectively controlled with therapy tailored to the specific subtype of rosacea [(2,3,4)].
- Antibiotics are often used to treat rosacea, particularly for papulopustular presentations [(2,3,5)].
- Topical antibiotics such as metronidazole, azelaic acid, and sulfacetamide/sulfur are generally effective for patients with mild rosacea [(2,3,4)].
- For moderate papulopustular rosacea, combination therapy with oral tetracyclines and topical agents is the first-line choice [(2,3,4)].
- Oral antibiotics such as doxycycline, macrolides, and metronidazole can be used to treat rosacea, with doxycycline being the most commonly prescribed [(6,5)].
- The use of antibiotics in the treatment of rosacea is supported by evidence, although further well-designed studies are needed to fully understand their effectiveness [(2,3,5)].
Specific Antibiotics Used
- Metronidazole is a commonly used antibiotic for the treatment of rosacea, both topically and orally [(2,3,6,4)].
- Doxycycline is a tetracycline antibiotic that is often prescribed for rosacea, particularly for papulopustular presentations [(2,3,6,5)].
- Azelaic acid is a topical antibiotic that can be used to treat rosacea, particularly for mild cases [(2,3,6,4)].
- Macrolides, such as azithromycin, can be used as an alternative to tetracyclines for the treatment of rosacea 5.