Antibiotics are often prescribed to treat rosacea. You may be wondering how antibiotics help rosacea and why doctors prescribe them so much?
Antibiotics are useful during the late or more severe stages of rosacea. A number of antibiotics are available that can help rosacea symptoms (more information below).
Oral antibiotics including tetracycline, doxycycline and minocycline can help reduce rosacea’s inflammation. Topical antibiotics such as metronidazole can also reduce inflammation and redness.
Exactly how antibiotics help rosacea redness is not known. Most research suggests that rosacea is a chronic inflammatory condition of the skin. Therefore, antibiotics are useful for rosacea mainly because they’re anti-inflammatory.
However, doctors do generally not recommend the use of antibiotics for long periods. This is due to the potential of negative side effects. These include antibiotic resistance, yellowing of the teeth (tetracycline) and chronic disruption of the probiotic environment of the gut, which can lead to inflammation of the gut with abdominal pain and diarrhea.
Most Prescribed Antibiotics for Rosacea
The following antibiotics help rosacea redness because they are anti-inflammatory:
- Metronidazole (Metrogel)
Most often used as a topical antibiotic and anti-inflammatory. It is well-tolerated and can be used for longer periods as a topical treatment. The oral form of metronidazole (Flagyl) is often used to treat parasitic infections. These include Giardia infections of the small intestine, amebic infections and vaginal infections caused by trichomonas. Flagyl is also effective against inflammation caused by the bacterium H. pylori. Some evidence suggests that H. pylori can cause some stomach and intestinal ulcers.
Tetracycline is one of the most effective antibiotics. It works by blocking the production of proteins by bacteria. Tetracycline is often used to treat bacterial infections including pneumonia and other respiratory tract infections. Tetracycline can also treat urinary tract infections and certain skin, eye and intestinal infections. It is often a first-line defense for severe (and late-stage) acne rosacea. Common side effects include yellowing of the teeth, vomiting, upset stomach, kidney problems and sunburning easily. If you use tetracycline, do not use it for more than 4-6 weeks.
Doxycycline belongs to the tetracycline family. It can treat a number of bacterial infections. Doctors prescribe doxycycline for the treatment of acne, rosacea, malaria and Lyme disease. Side effects of doxycycline are yellowing of the teeth and making birth control pills less effective. It can also cross into breast milk and can affect bone and tooth development in a nursing infant.
- Azelaic Acid (Fiancea)
Wheat, rye and barley are natural sources of azelaic acid. A certain type of yeast that lives on the skin (M. furfur) makes azelaic acid naturally. Azelaic acid is often used to treat mild to moderate acne. It slows the production of keratin, which bacteria use to grow.
Dermatologists also prescribe azelaic acid as a topical treatment for rosacea. Azelaic Acid also inhibits the enzyme tyrosinase, which results in lower pigment formation. Patients taking azelaic acid should always wear sunscreen.
Do Antibiotics Help Rosacea Symptoms?
You may be asking: should you use antibiotics for rosacea?
It is generally not recommended to treat rosacea with antibiotics on a long-term basis due to the many negative side effects. Most doctors would prescribe an oral tetracycline drug and a topical such as Metrogel and Azelaic Acid to get symptoms under control. Topical antibiotics treatments can be used for longer periods.
Recent studies suggest that rosacea is a chronic inflammatory condition. Increased amounts of a protein called cathelicidin and its breakdown products play a major role the disease process. Cathelicidins stimulate the immune system and increase inflammation. Doxycycline and azelaic acid can effectively curb this immune system stimulation.
In conclusion, many patients successfully manage rosacea by certain lifestyle changes and over-the-counter remedies. Lifestyle changes can include a diet low in histamine-containing foods, a diet low in gluten, taking probiotics and reducing stress.
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Reinholz, M., Ruzicka, T. and Schauber, J. (2012). Cathelicidin LL-37: An Antimicrobial Peptide with a Role in Inflammatory Skin Disease. Annals of Dermatol24: 126–135.
Di Nardo, A., Holmes, A.D., Muto, Y., Huang, E.Y., Preston, N., Winkelman, W.J. and Gallo, R.L. (2016) Improved clinical outcome and biomarkers in adults with papulopustular rosacea treated with doxycycline modified-release capsules in a randomized trial.J Am Acad Dermatol.74: 1086-92.
Image: Brett Hondow