Several antibiotics have been used to treat rosacea for many years. Either taken orally or applied topically to the skin. You would imagine that antibiotics would only be prescribed when a bacterial infection is observed or suspected but this is not always the case. Since a bacterial cause has not been established for rosacea it is clear that prescribing antibiotics more widely must mean there is an additional beneficial effect and it appears that there is also an anti-inflammatory property which may play the largest role in relieving symptoms.
The type of antibiotics that we have seen prescribed for rosacea treatment include tetracycline, clarithromycin, doxycycline, metronidazole and tretinoin.
- Tetracycline has been used for 40+ years and is therefore the most commonly prescribed antibiotic.Taken orally. Caution: It may make the skin very sensitive to the sun. Pregnant and breast-feeding women should not take tetracycline.
- Clarithromycin seems to help with inflammation of capillaries and underlying skin tissue which can lead to erthyma (reddening of the skin which is caused by blood vessel dilation), telangiectasia (dilated superficial blood vessels), and facial swelling. Clarithromycin provides dramatic results when prescribed for steroid rosacea (an induced condition brought on by the use of topical steroid creams)* *Many experts criticise those dermatologists who prescribe steroid creams claiming that they should not be prescribed for Rosacea.An interesting fact that we will be covering in detail in a future article is that it has been found that a significant number of rosacea patients also have a bacterial parasite in the stomach called Helicobacter pylori which is also affected by Clarithromycin albeit at higher doses.
- Doxycycline has had good reports from dermatologists possibly because of patient compliance when it comes to taking the medication. Doxycycline does not have to be taken on an empty stomach as some other antibiotics do. Doxycycline prevents susceptible bacteria from multiplying rather than killing them outright, otherwise referred to as bacteriostatic rather than bactericidal. Caution: Some patients report increased sensitivity to the sun on this antibiotic. Doxycycline may rob the effectiveness of birth control pills and is generally not considered safe for women who are pregnant.
- Metronidazole is available in both oral and topical forms. A common treatment plan includes oral tetracycline and a metronidozole gel. In fact we have seen a number of rosacea patients who after the rosacea was brought under control with oral antibiotics and metronidozole continued to maintain symptom suppression with using the metronidozole gel alone. Caution avoid alcohol while taking oral Metronidazole and again do not take if pregnant.
- Tretinoin is sometime prescribed for severe cases of rosacea or cases that resist other therapies.It does more than fight bacteria, it has been shown to increase production of dermal collagen and increases blood flow to the skin because new blood vessels are formed. Tretinoin reduces the production of melanin (a skin pigment substance that gives the skin its colour), and distributes it more evenly throughout the skin. Caution it can make the skin red, dry and sensitive to sunlight. It has been reported that isotretinoin can cause birth defects, so women who take it must be on birth control pills during treatment.
The list of antibiotics though comprehensive does not include all of the possible types and brand names which may be prescribed for rosacea but will hopefully serve as a guide.
