Treating Rosacea with Antibiotics: Benefits, Risks, Safety of Long Term Use

Understanding Rosacea and Its Triggers

Rosacea is a chronic skin condition that causes redness and visible blood vessels on the face. It often begins with flushing or blushing that comes and goes, but over time the redness can become more persistent. Rosacea typically affects the cheeks, nose, chin and forehead. Left untreated, it can worsen over time and lead to burning or stinging pain, swelling, and bumps and pimples. The exact cause of rosacea is unknown, but various factors can trigger flare-ups:

• Sun exposure
• Hot weather
• Wind
• Exercise
• Stress
• Spicy foods
• Alcohol
• Hot beverages
• Certain skin care products

While there is no cure for rosacea, treatments are available to control symptoms. One of the most common medical therapies prescribed for rosacea are oral antibiotics.

How Antibiotics Can Help Treat Rosacea

Oral antibiotics are often prescribed for inflammatory rosacea, which causes bumps, pimples and pus-filled pimples (pustules) to develop. Common antibiotics used for rosacea treatment include:

• Doxycycline
• Minocycline
• Tetracycline
• Erythromycin
• Clarithromycin
• Metronidazole

These medications work by reducing inflammation and suppressing bacteria on the skin that may play a role in rosacea flare-ups. Antibiotics help decrease redness, swelling and breakouts. They can also help reduce the stinging, burning and sensitivity that accompanies rosacea flare-ups.

For many patients, taking an oral antibiotic leads to significant improvement in rosacea symptoms. Antibiotics work best at controlling active breakouts and pus-filled pimples. Mild swelling and background redness may continue even with antibiotics, so they are often prescribed in combination with other rosacea treatments.

Potential Benefits of Antibiotics for Rosacea

• Decrease redness and background flushing
• Reduce painful burning and stinging
• Clear up inflammatory breakouts
• Prevent new blemishes and pimples
• Decrease swelling and irritation
• Improve overall rosacea symptoms

When taken consistently, antibiotics can keep rosacea flare-ups under control. Some patients notice a difference within a few weeks. However, it can take up to 2 months to see the full effects. Antibiotics may be used short-term just to get a flare-up under control, or long-term to maintain remission.

Potential Risks and Side Effects

While antibiotics can be very effective for treating inflammatory rosacea, they do carry some potential risks and side effects:

• Upset stomach, abdominal pain, nausea or diarrhea
• Vaginal yeast infections
• Increased sun sensitivity
• Skin reactions
• Allergic reactions in those with drug allergies
• Headaches or dizziness
• Tooth discoloration (with tetracycline)

There are also some long-term concerns with antibiotic use including antibiotic resistance, which makes them less effective over time. Taking antibiotics for months or years can also alter the balance of good and bad bacteria in the gut.

Who Should Take Antibiotics for Rosacea?

Your dermatologist may prescribe oral antibiotics if you have moderate to severe inflammatory rosacea with lots of red bumps, pimples or pustules. They generally are not prescribed for mild rosacea with just temporary flushing and blushing.

Antibiotics work best for papulopustular rosacea and phymatous rosacea, but may also be used for ocular rosacea involving the eyes. Antibiotics are not as effective for telangiectatic rosacea characterized mainly by dilated blood vessels.

Your doctor will consider your medical history, severity of symptoms, and any previous treatments when deciding if antibiotics are right for your rosacea. Antibiotics may be recommended if you:

• Have recurrent flare-ups with painful pustules
• Experience swelling, burning or stinging
• Have previously tried topical medications without success
• Need to get a flare-up under control quickly
• Have bumps, pimples and redness persisting for weeks or months

Antibiotics are often used in combination with topical treatments. Using both oral and topical medications can enhance results. Antibiotics may also be prescribed along with isotretinoin for severe, disfiguring rosacea.

What to Expect When Taking Antibiotics

If your dermatologist prescribes an oral antibiotic, be sure to take it exactly as directed. The dosage, frequency and duration will depend on the drug chosen and severity of your symptoms. Here's what to expect:

• Antibiotics are taken daily by mouth. Doxycycline and minocycline are most commonly taken once daily. Other antibiotics may be taken twice per day.
• A standard prescription is usually for 8 to 12 weeks. Longer treatment may be needed for severe flare-ups.
• You should start seeing results within 4 to 6 weeks. Maximal benefits may take up to 3 months.
• Take your antibiotic with food and a full glass of water to minimize side effects.
• Avoid sun exposure and wear sunscreen due to increased sun sensitivity.
• Finish the entire course even if symptoms improve.
• Call your doctor if side effects become bothersome.

Make sure to keep all follow up appointments with your dermatologist. He or she will monitor your response to antibiotics and determine if any medication adjustments are needed. Some people can successfully stop antibiotics and just use topical treatments for maintenance. Others may need to stay on oral antibiotics long-term if rosacea symptoms return once antibiotics are stopped.

Is Long-Term Antibiotic Use Safe?

The safety of long-term antibiotic use has been questioned, but recent studies have found no serious safety concerns when they are used continuously for rosacea treatment. In clinical trials, patients were monitored while taking tetracycline or doxycycline daily for several years with no increase in adverse effects compared to short-term use.

However, your doctor will still aim to use antibiotics at the lowest effective dose and monitor for any problems. You may need periodic blood work or other testing. Taking a daily probiotic supplement can help replenish healthy gut bacteria. Let your doctor know if you develop any side effects while on antibiotics long-term.

Are Antibiotics Right for You?

Antibiotics can provide great relief of symptoms for those with inflammatory rosacea and bothersome flare-ups. But they may not be right for everyone. Your dermatologist can help weigh the pros and cons to decide if a trial of antibiotics is warranted.

Be sure to discuss your full medical history and any concerns about long-term antibiotic use. For women prone to yeast infections, an anti-fungal medication may also be prescribed. Some people may respond better to topical treatments alone.

While antibiotics can be very useful in the management of rosacea, they are just one tool and not a cure. Ongoing treatment and lifestyle changes to avoid triggers will be needed. But antibiotics can greatly improve rosacea symptoms and quality of life when used properly under a dermatologists care.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.