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Doxycycline and Rosacea. Approaches to the treatment of rosacea acne exacerbations

Doxycycline and Rosacea

Treatment approaches for rosacea acne exacerbations

Photographs show the appearance of a woman’s face with rosacea-like elements of rash and skin redness before and 3 weeks after 3 sessions of laser therapy. Treatment resulted in a reduction in the number of papules and normalization of skin coloration.

Images used with permission of the Journal of the American Academy of Dermatology (J Am Acad Dermatol 2015;73:333-6.)

If you experience an exacerbation of papulopustular rosacea, which causes a dramatic increase in rosacea acne on the skin, you should know that there are many effective treatments for rosacea.

A dermatological treatment plan may include taking medications and performing cosmetic procedures.

Topical medications

Azelaic acid

To be used twice a day, morning and evening. The results of 6 scientific studies indicate that from 70 to 80% of people who used the drug with azelaic acid in the composition, noted a decrease in redness of the skin. For some, their face even returns to normal color and appearance.

The first application of azelaic acid causes an intense burning and tingling sensation. This is a normal reaction to the active ingredient of the cream or gel, provided that the sensations diminish considerably or disappear entirely after 1 or 2 applications. If you continue to use the product and the discomfort does not go away, it is better to stop treatment and consult a dermatologist.

Another feature of azelaic acid is its ability to whiten the skin. If you have dark spots on your face, this effect will only be a plus. But still, a noticeable brightening of the skin is better to report to your dermatologist.


Available as a gel and cream. Has been used for more than 60 years for the treatment of rosacea. Numerous clinical studies show that metronidazole actively controls both persistent redness in rosacea and acne-like rashes.

Administration of metronidazole in courses. After a course of using the drug, the result achieved remains until the next exacerbation of the disease, that is, for a long time enough. One study reported that only 23% of patients developed an exacerbation of rosacea within 6 months after treatment with metronidazole.

Can be used alone or in combination with other medicines. Metronidazole provides faster and more consistent results when used in combination therapy. Possible side effects may include itching, irritation or dry skin.

Sodium sulfacetamide and sulfur

These ingredients can be found in over-the-counter skin care products, such as cleansers. It is also included in a number of topical medications.

These active ingredients of cosmetic products and drugs have been used for the treatment of papulopustular rosacea for over 6 decades. During this time, they have proven to be effective and safe. However, be sure to warn your doctor about any kidney problems or hypersensitivity to sulfur. These drugs are also not prescribed during pregnancy and in preparation for conception.

In clinical drug trials, researchers note that sodium sulfacetamide and sulfur are successful in dealing with both rashes and persistent skin redness. Reduction in the number of rash elements is seen in 65-78% of patients after 6-8 weeks of treatment, with erythema decreasing in 66-83% of cases. To improve the results of therapy, it is advisable to follow your doctor’s advice precisely and avoid factors that trigger the progression of rosacea.

The use of drugs with sulfur and sodium sulfacetamide can cause a number of unwanted changes: itching, dryness, the appearance of temporary redness or irritation of the skin. All of these unpleasant symptoms usually disappear over time if the person continues to use the medication.


It is a form of vitamin A that can cause skin irritation with rosacea. Prescribed drugs during the remission phase of rosacea to prevent the progression of the disease and the appearance of new rashes.

Valuable «bonus» The use of retinoids is their ability to slow the aging process and give the skin a youthful and blooming appearance. However, you should not prescribe these drugs yourself. It is better to ask your dermatologist if retinoids will be effective in your particular case.


For half a century, dermatologists have been prescribing the antibiotic tetracycline to their rosacea patients. This medication can quickly reduce inflammation and associated redness. In trials, most study participants had a marked reduction in the number of rash elements within 1 month.

Minocycline, doxycycline or erythromycin are also used to treat rosacea. Antibiotics are only prescribed for worsening conditions. As soon as the progression of rosacea can be stopped, other drugs are used to consolidate the results.

Frequent and prolonged use of antibiotics can provoke a serious health problem such as antibiotic resistance. The importance of this problem is now increasing worldwide. Disease-causing bacteria lose sensitivity to antibiotics, which makes therapy more difficult and less effective. Low-dose doxycycline can be used to treat rosacea to prevent the development of antibiotic resistance.

Low-dose doxycycline

Doxycycline – Is an antibiotic. But in low doses, it has no effect on bacteria. But it is good for rosacea papulopustular rash. Based on data from numerous clinical trials, the U.S. Food and Drug Administration has approved low-dose doxycycline for the treatment of pink acne.

Prescribing doxycycline in low doses is not harmful to health and does not cause as many side effects as the course use of other antibiotics. The only restrictions are pregnancy and breastfeeding in women.


It is indicated only for the treatment of complicated cases of papulopustular rosacea. It works well against rashes and persistent redness of the skin, but can cause birth defects in newborns. Because of this, it can only be taken as prescribed by a doctor.


Light and laser therapy

Light and laser treatment can effectively treat skin rashes and redness, but there are a number of things a rosacea patient needs to take into account when undergoing these procedures. Insurance does not cover the cost of this treatment. Each of the sessions will cost hundreds of dollars, and up to 5 treatments may be needed to achieve a satisfactory result. To maintain the results of phototherapy and laser therapy, supportive treatment is necessary.

It’s important to understand that the effectiveness of hardware treatments depends largely on the professional who conducts the photo and laser therapy sessions. The degree of side effects, such as scaling, increases greatly if the person who carries out the procedure does not have the necessary knowledge and skills. Only a certified specialist, a physician with sufficient experience in laser therapy for rosacea, can guarantee a satisfactory result.

How to increase the efficacy of the treatment?

You should not refuse to see a dermatologist after the condition has improved. Examination of the skin, performed during a consultation with a specialist, allows the doctor to determine the optimal duration of treatment, adjust appointments if necessary.

The reason for the correction of ongoing therapy may include the desire of the doctor to reduce the likelihood of long-term side effects from the drugs and procedures used. Your dermatologist can also recommend certain changes in your daily habits in order to prolong the remission you have achieved.