Treating Rosacea with Antibiotics: What You Should Know

Rosacea is a skin disease that mainly affects the face and is characterised by chronic inflammation. Oral and topical antibiotics like minocycline, doxycycline, and metronidazole are frequently used as treatments.

Although the exact aetiology of rosacea is still unknown, doctors believe that bacterial development may be the catalyst for the inflammation that underlies the disorder. Because of this, doctors occasionally prescribe antibiotics along with lifestyle modifications to treat it.

Oral antibiotics are usually saved for situations in which topical treatments are ineffective or flare-ups are extremely severe. Topical antibiotics, on the other hand, may be used as a first-line treatment. What you should know about using antibiotics to treat rosacea is provided below.

How do antibiotics help with rosacea?

Although the actual aetiology of rosacea is still unknown, scientists think it may be partially caused by reactions to:
  • staphylococcus (bacteria)
  • helicobacter pylori (bacteria)
  • demodex folliculorum (mites)
Even while staph bacteria and mites (Demodex) are commonly found on the skin, people with rosacea are believed to be more susceptible to them, which can lead to flare-ups. On the other hand, H. pylori is a common stomach bacteria that can affect and cause inflammation in those who have rosacea.

Antibiotics are frequently used to treat Demodex mites as well as bacterial infections. Because of this, physicians occasionally recommend topical or oral antibiotics to eradicate any bacteria that might be causing or exacerbating the symptoms of rosacea.

Antibiotics, like all drugs, have potential negative effects, particularly when used continuously. Because of this, dermatologists will usually prescribe them for as little time as possible which doesn't compromise their effectiveness.

Antibiotics should ideally eradicate any bacteria, mites, or other organisms that irritate the skin and cause symptoms of rosacea.

You might need to take another dose if the symptoms come back later. It's crucial to remember that this therapy could not be a long-term, sustainable cure because antibiotic resistance can develop.

Rather, the use of antibiotics is advised in conjunction with other medical therapies, specific skincare, and lifestyle modifications; further details are provided below.

Types of antibiotics for rosacea

The Food and Drug Administration (FDA) has approved a few regularly used antibiotics to treat rosacea. They include:

Metronidazole (topical)

On the skin, topical metronidazole eradicates bacteria and parasites. It can be recommended as a cream, gel, or lotion to treat mild to moderate cases of rosacea. It's usually used twice a day in affected regions, but just to be sure, you should always do as your doctor says.

Although usually minor, side effects can include:
  • itching
  • dryness
  • irritation
  • burning
In rare cases, it may cause:
  • yeast infections
  • cold symptoms
  • upper respiratory infections
The first metronidazole treatment may appear to temporarily exacerbate rosacea symptoms. On the other hand, side symptoms usually disappear after a few days.

Doxycycline (oral)

As a tetracycline antibiotic, oral doxycycline works by preventing bacteria from producing the proteins necessary for growth. It's frequently used to treat severe pustules and papules, which are signs of rosacea. Moreover, it can prevent skin thickening from getting worse and irreversibly damaging the skin.

Usually, it is taken once or twice a day.

Possible adverse consequences consist of:
  • nausea
  • vomiting
  • sun sensitivity
  • dizziness
  • headache
  • drowsiness
  • upset stomach
  • teeth discolouration
  • rapid heart rate
On occasion, a low dosage of doxycycline may be administered as well, enabling the drug to be used for a longer amount of time with reasonable safety.

Minocycline (oral or topical)

Another tetracycline antibiotic that may be administered to treat moderate to severe rosacea is oral or topical minocycline. This antibiotic is frequently administered to treat inflammatory acne.

The topical formulation is available as a cream but is usually supplied as a foam. It is recommended to be used one or two times daily.

Minocycline 100 milligrammes is the safest and most effective treatment for people who have papules and pustules, according to a 2023 assessment of over 1,700 rosacea cases.

The following are examples of minocycline side effects:
  • dizziness
  • skin discolouration
  • changes in urine colour
  • nausea
  • vomiting
  • diarrhea
  • headaches
  • numbness or tingling
  • tongue swelling
  • tinnitus
Generally speaking, the following side effects ought to be minor and pass after a few days.

Rarely, more severe adverse effects could include:
  • chest pain
  • seizures
  • facial swelling
  • blurry vision
  • joint pain
  • rashes
  • hives
  • issues breathing
  • increased bleeding
  • blood in stool
You ought to consult a physician straight away if you encounter any of the negative effects listed above. Seek emergency attention right away if you have breathing difficulties, convulsions, or chest pain.

Other treatment options

Apart from antibiotics, a physician might also suggest:
  • azelaic acid foam or gel to lessen inflammation, papules, and pustules
  • topical gels to narrow blood vessels and lessen redness, such as brimonidine
  • to eliminate visible blood vessels, use intense pulsed light (IPL) therapy or laser treatments.
  • oral low-dose isotretinoin (Accutane) therapy in extreme situations

Lifestyle measures

Similar to several inflammatory disorders, rosacea symptoms can be markedly alleviated by adopting healthy lifestyle practices, such as:
  • keeping a notebook to record and steer clear of typical triggers, such as severe weather and spicy foods
  • relaxation methods such as yoga, meditation, or breathwork can help reduce stress.
  • attending cognitive behavioural therapy (CBT) to address issues like flushing and anxiety.
  • consuming a balanced diet rich in anti-inflammatory foods that is recommended by Rosacea
  • regularly applying SPF 30 or higher and reducing your exposure to UV
  • preventing drug interactions with beta-blockers and vasodilators, for example
  • using natural treatments to relieve discomfort, such as aloe vera

When should I speak with a doctor?

Your dermatologist may recommend antibiotics if first-line therapies are ineffective for your rosacea symptoms. Oral antibiotics might be required if topical ones don't work.

Generally speaking, it's a good idea to see a doctor if you have any conditions that significantly lower your quality of life daily. So, see a doctor right away if at-home remedies or a lifestyle change don't relieve rosacea symptoms like flushing, irritation, or papules.

Treatment for more severe rosacea symptoms, such as skin thickness, should be sought as soon as possible because they may not go away.


When used in conjunction with appropriate eating habits, stress management techniques, and avoidance of triggers, antibiotics are frequently beneficial in treating the symptoms of rosacea. It's also advised to use azelaic acid and lots of SPF in your skin care regimen.

Antibiotics have adverse effects, thus it is only advised to use them temporarily.

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