Doxycycline for Rosacea Treatment

Background

Rosacea is a multiform, chronic inflammatory skin disease of the face that is more common in fair-skinned people. Possible symptoms include transient and persistent skin redness, papules and pustules, nodules, and skin thickening (“bulbous nose“). The exact causes are not fully understood. Treatment options include metronidazole, azelaic acid, doxycycline, isotretinoin, and nonpharmacologic measures.

Products

The drug containing doxycycline for the treatment of rosacea was approved in many countries in March 2012 in the form of modified-release hard capsules. It has been available in the United States since 2006 and in Germany since 2009 (Oracea, or Oraycea in some countries).

Structure and properties

Doxycycline is present in the drug as doxycycline monohydrate (C22H24N2O8 – H2O, Mr = 462.5 g/mol), a yellow crystalline powder that is very sparingly soluble in water due to its lipophilicity.

Effects

Doxycycline (ATC J01AA02) has anti-inflammatory properties and inhibits vascularization. The antibacterial effect of the antibiotic is not important in the treatment of rosacea, and doxycycline is used at a lower, subantimicrobial dose.

Indications

To reduce papulopustular lesions in adult patients with facial rosacea.

Dosage

According to the SmPC. Capsules of 40 mg are taken once daily in the morning with sufficient water. To avoid irritation and ulceration of the esophagus, the drug must be administered in an upright position, sitting or standing, with sufficient water. Certain foods may reduce the absorption of doxycycline, for example milk or some fruit juices. Avoid intense sun exposure during treatment because tetracyclines can make the skin sensitive to the sun (photosensitivity). Sunburn may therefore develop more quickly than normal. The use of a sunscreen should be considered.

Contraindications

Doxycycline is contraindicated in hypersensitivity, in children under 12 years of age, in the 2nd and 3rd trimesters of pregnancy, in concomitant retinoid treatment, and in achlorhydria. Due to the reduced dose, the drug is not suitable for the treatment of infectious diseases! Full details of precautions and interactions can be found in the Drug Information Leaflet.

Interactions

Certain drugs and foods may reduce the absorption of doxycycline. These include aluminum, zinc, magnesium, calcium, and iron ions; activated charcoal; colestyramine, bismuth, chelates, and sucralfate; and milk, milk products, and some fruit juices. A time interval of 2-3 hours should be observed. The same applies to medicines that increase stomach pH.

Adverse effects

The most common possible adverse effects include gastrointestinal disturbances such as diarrhea, upper abdominal pain, and dry mouth, as well as nasopharyngitis, fungal infections, hypertension, anxiety, and pain.