Anti-inflammatory dose doxycycline (40 mg delayed release once daily) has been shown to be effective for the treatment of inflammatory rosacea. Unlike doxycycline administered at doses of 50 mg daily or greater, anti-inflammatory dose doxycycline is devoid of antibiotic activity. As rosacea has not been shown to be caused by a bacterium and is a chronic disease, the absence of antibiotic selection pressure is of clinical significance.
A study was designed to evaluate the efficacy of anti-inflammatory dose doxycycline compared with doxycycline 100 mg daily for the treatment of rosacea for 16 weeks.
Ninety-one patients with papulo-pustular rosacea were enrolled and randomized to treatment with either doxycycline 40 mg delayed release plus metronidazole 1% gel or doxycycline 100 mg plus metronidazole 1% gel. All medications were taken once daily. At the end of the treatment period, there was no statistical difference in lesion reduction between the two groups. Furthermore, there were no statistically significant differences in the investigator global assessment of rosacea severity or in erythema scores at Week 16.
The results of this comparative study demonstrate that anti-inflammatory dose doxycycline demonstrates the same onset and extent of clinical efficacy based on inflammatory lesion reduction and global assessments as doxycycline 100 mg daily. However, adverse events, especially gastrointestinal side effects, were markedly higher in the group receiving doxycycline 100 mg daily.
Nurses in the specialized field of dermatology will gain insight into the disease state and treatment options, which will be useful information for patient consultations.
Aroni, K., Tsagroni, E., Kavantzas, N., Patsouris, E., & Ioannidis, E. (2007). A study of the pathogenesis of rosacea: How angiogenesis and mast cells may participate in a complex multifactorial process. Archives of Dermatological Research, 300, 125-131.
Golub, L. M., Lee, H. M., Ryan, M. E., Giannobile, W. V., Payne, J., et al. (1998). Tetracyclines inhibit connective tissue breakdown by multiple non-antimicrobial mechanisms. Advances in Dental Research, 12(2), 12-26.
Landow, K. (2002). Unraveling the mystery of rosacea. Postgraduate Medicine, 112, 51-58, 82.
Pelle, M. T., Crawford, G. H., & James, W.D. (2004). Rosacea: II. Therapy. Journal of the American Academy of Dermatology, 51(4), 499-512.
Walker, C., & Bradshaw, M. (2007, October). The effect of oral doxycycline 100 mg once-daily for 14 days on the nasopharyngeal flora of healthy volunteers: A preliminary analysis. Poster presented at 26th Anniversary Fall Clinical Dermatology Conference, Las Vegas, NV.
Walker, C., & Webster, G. (2007, October). The effect of anti-inflammatory dose doxycycline 40 mg once-daily for 9 months on bacterial flora: Subset analysis from a multicenter, double-blind, randomized trial. Poster presented at 26th Anniversary Fall Clinical Dermatology Conference, Las Vegas, NV.
Yamasaki, K., Di Nardo, A., Bardan, A., Murakami, M., Ohtake, T., Coda, A., et al. (2007). Increased serine protease activity and cathelicidin promotes skin inflammation in rosacea. Nature Medicine, 13(8), 975-980.