Doxycycline for Rosacea: A Pharmacist Explains
Medically reviewed by Mary Choy, PharmDMedically reviewed by Mary Choy, PharmDRosacea is a chronic inflammatory skin condition that causes redness or flushing in areas of the face, such as the cheeks, forehead, and nose.Other common symptoms of rosacea include:Papules (raised bumps on the skin or pimples)Pustules (bumps on the skin filled with fluid or pus)Small blood vessels on the cheeks or noseDry skinThickening skin, usually of the noseBurning or stinging of the skinSore, red, or itchy eyesWhen people with darker skin tones develop rosacea, early signs (e.g., flushing) may be missed or mistaken for another condition. People with darker skin tones and rosacea may present with brown or violet tones and yellowish-brown, hard bumps.Some people have found success using doxycycline for rosacea. Doxycycline is a tetracycline antibiotic commonly prescribed for moderate to severe rosacea. Brand names include Vibramycin, Oracea, and Doryx.
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How Doxycycline Works for RosaceaDoxycycline is available as a prescription in capsule and tablet forms with a range of dosages.The Food and Drug Administration (FDA) has approved one brand of doxycycline product, called Oracea, for rosacea. It is the only systemic (body-wide) treatment the FDA approved for this use.Factors to consider if you decide to take Oracea or other forms of doxycycline for rosacea include:How it works: Doxycycline blocks compounds in the body, such as cytokines and white blood cells, to prevent inflammation and reduce skin lesions (bumps).Examples: Mix of immediate- and delayed-release (Oracea); immediate-release (Vibramycin, Monodox); extended-release (Doryx); low dose (Periostat)How it's used: Doxycycline is effective for a rosacea rash. People typically take it for eight to 16 weeks. FDA-approved Oracea can be used safely for up to nine months per the manufacturer.Side effects: Doxycycline's side effects include sun sensitivity, skin reactions, gastrointestinal effects like diarrhea, and yeast infections. Oracea has a lower rate of side effects. These can include diarrhea, colds, and sinus infections.
A Word on Antibiotic ResistanceHigher doses of doxycycline, such as of 100 milligrams (mg) a day or more, have an antibiotic effect and may contribute to antibiotic resistance. Antibiotic resistance can develop when bacteria learn to evade the antibiotics designed to kill them, making the medicines less effective. Low-dose doxycycline does not cause antibiotic resistance.
How Much Doxycycline Will I Need?The dose of doxycycline you will take for rosacea depends on whether you're taking traditional or modified-release forms.Immediate-release doxycycline (brand names include Vibramycin and Monodox), 100 to 200 mg per day, can be effective for rosacea.Doxycycline may also be prescribed at a lower dose of 20 mg twice a day with the brand-name drug Periostat.Modified-release doxycycline (Oracea) is administered at 40 mg once a day. Forty milligrams (40 mg) is considered an anti-inflammatory dose rather than an antibiotic dose, so it's a lower dose than you would take if you were using it as an antibiotic for an infection.How Effective is Doxycycline for Rosacea?Four subtypes of rosacea exist and are based on symptoms. Doxycycline is effective for the type known as papulopustular. This form of rosacea is often mistaken for acne and involves bumps that can be papules or pustules.A small clinical trial of 50 people showed that a 20 mg dose taken twice a day can mostly or completely clear skin lesions within four weeks. Doxycycline also reduced flushing by 50% in this study.However, a larger review of data concluded that low doses of doxycycline are unlikely to improve flushing.Oracea is effective for up to a year in reducing skin lesions on the face, both papules and pustules. It also works to lengthen the time between flares (relapses).Clinical trials have shown that Oracea is about twice as effective as a placebo (an ineffective substance given to people in control groups in clinical trials) in reducing lesions. For instance, in one trial, people who took a placebo had about six fewer bumps at the end of 16 weeks than before treatment, while those who took Oracea had 12 fewer bumps.
Reproduced with permission from © DermNet New Zealand and © Dr. Mashihul Hossain www.dermnetnz.org 2023.' title='A person's face with rosacea'>
Reproduced with permission from © DermNet New Zealand and © Dr. Mashihul Hossain www.dermnetnz.org 2023.
How Quickly Does Doxycycline Work for Rosacea?It can take weeks or months for doxycycline to work for rosacea. In one study, over half the people surveyed reported that Oracea started to work in two weeks.Another trial showed that people who took Oracea plus a topical medicine had reduced skin lesions starting at four weeks.What Are the Major Side Effects of Doxycycline?Doxycycline is associated with side effects that affect the digestive tract and the skin. These are considered dose-dependent, meaning they are more likely to occur at higher doses. Side effects of doxycycline include the following:Gastrointestinal (GI) effects, such as nausea, vomiting, diarrhea, gastritis, and vaginal yeast infections, or more serious effects, such as inflammation or ulcers in the esophagusSkin reactions, such as itching, rashes, and sun sensitivity, or severe reactions, including Stevens-Johnson syndromeTooth discoloration (staining) if used by childrenHemolytic anemia (red blood cells are destroyed faster than they're made)Oracea is less likely to cause gastrointestinal effects or skin reactions. Rarely, it may cause side effects that include:Cold or sinus infectionFlu-like symptomsHigh blood pressure (hypertension)What Should You Avoid When Taking Doxycycline?It would be best if you avoided the following when taking doxycycline for rosacea or another condition:Pregnancy: Doxycycline and other medicines in the tetracycline class may harm the fetus.Breastfeeding: Doxycycline enters breast milk. It can cause effects like tooth discoloration and block bone growth in babies and children.A lot of sunlight: Doxycycline can cause severe sunburn. If you take doxycycline, wear extra sunscreen and avoid excess sun exposure and tanning beds. These effects are less likely but may still occur with Oracea.Taking higher doses or longer than prescribed: Taking doxycycline in these ways may increase the risk of antibiotic resistance.Penicillin antibiotics: Doxycycline interacts with penicillins, making them less effective.Retinoids: Taking oral retinoids, such as Accutane (isotretinoin), with doxycycline may increase pressure in the brain.Iron supplements: These keep doxycycline from being absorbed by the body.Stomach medicines: Medicines like antacids, proton pump inhibitors (PPIs), and Pepto-Bismol (bismuth subsalicylate) keep doxycycline from being absorbed.What Other Treatments Work for Rosacea?It's important to know that rosacea is a chronic condition with no cure. Treatments aim to keep symptoms at bay and prevent flare-ups.If doxycycline does not work for you or you can't take it for any reason, remember there are many other options for managing rosacea.Other MedicationsBesides doxycycline, prescription medications include the following:Azelaic acid (brand names Finacea and Azelex) reduces redness and lesions caused by mild to moderate rosacea.Mirvaso (brimonidine) gel constricts (shrinks) blood vessels to reduce redness and flushing of the skin.Rhofade (oxymetazoline) cream works within hours to reduce persistent redness.Sodium sulfacetamide/sulfur is an anti-inflammatory skin cleanser. However, it should not be used if you have kidney disease.Soolantra (ivermectin) cream is an option for moderate to severe rosacea with lesions.Topical metronidazole is available as a gel, cream, and lotion for redness and lesions.Note that, unlike doxycycline, these medicines are all topical, meaning they're applied to the skin.LasersAnother alternative treatment for rosacea is lasers. These therapies use light to treat symptoms like redness, small blood vessels on the face, or thickening skin.You may need up to three treatments to see an effect. Keep in mind that you may also need follow-up laser treatments down the road as new blood vessels are produced. Your dermatologist may suggest one of the following laser treatments:Ablative laserIntense pulsed lightPulsed dye laserDietOne intervention that may help is modifying your diet. Consider limiting foods that trigger rosacea and adding anti-inflammatory foods to your meals. Foods and beverages that may trigger rosacea or make symptoms worse include the following:Alcohol, especially wineChocolateCoffeeFried foodsMilkSpicesSugarFoods that are part of the Mediterranean diet may improve rosacea symptoms and include the following:FishNutsOlive oilVegetablesThis improvement may be due, in part, to their anti-inflammatory effects.SupplementsSome people use supplements for rosacea. Among these are:Curcumin: It has anti-inflammatory and antioxidant effects, which may help prevent flushing and redness.Omega-3 fatty acids: These are anti-inflammatory and may help prevent spider veins on the face.Tea tree oil: When combined with permethrin cream, tea tree oil may help target mites (parasites) in the skin that can trigger rosacea.Vitamin C: This vitamin is an antioxidant that may reduce skin redness. It's best to consume it as part of a healthy diet unless you're deficient. Taking a vitamin C supplement promotes overall wellness if you have low levels.Zinc: Taking zinc by mouth hasn't been proven to help, but applying a 5% zinc sulfate solution may benefit rosacea.Your healthcare provider can help you navigate your options and find the most appropriate therapy for you.
ExplainerRemember that there is only minimal evidence to support using these or other supplements for rosacea. If you decide to go this route, discuss it with a registered dietitian or pharmacist for best results.Furthermore, in the United States, the Food and Drug Administration (FDA) does not regulate supplements like prescription drugs. This means some supplement products may not contain what the label says. When choosing a supplement, look for third-party tested products and consult a healthcare provider, registered dietitian nutritionist (RDN or RD), or pharmacist.
SummaryDoxycycline is an antibiotic used to treat moderate to severe rosacea. It is most effective for lesions on the face. Doxycycline can improve these skin lesions in a few weeks to months.At high doses, doxycycline is associated with gastrointestinal side effects and skin reactions, including sensitivity to sunlight. Lower doses of doxycycline, including the brand-name product Oracea, reduce the likelihood of these side effects.If you take doxycycline for rosacea, you'll need to avoid excess sunlight, along with certain medications and supplements. Do not use doxycycline if pregnant or breastfeeding. Be sure to discuss your concerns with your healthcare provider or pharmacist.If doxycycline is not a good option for you, ask your healthcare provider about other topical (applied to the skin) prescriptions, supplements, or laser therapy. Read the original article on Verywell Health.
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