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Antibiotic Suggestions

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I seem to be allergic to doxycycline. I asked my

doctor for a prescription for a different antibiotic.

She said that, unfortunately, tetracyclines are the

only ones used to treat skin conditions.

Is this really true? This doesn't agree with what

I have read here.

Shane

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Hi. I understand that the tetracyclines are the first line treatment

and usually considered the best. But I believe that e-mycin and

clarithromycin (same family) may also be useful for rosacea.

Perhaps others in the group have tried them with success?

Another thing -- and maybe Marjorie can comment on this -- my

understanding is that antibiotics are used in rosacea not for their

anti-bacterial peoperties but for their anti-inflammatory effects.

(This applies to ocular rosacea too.) In other words, it's a sort of

off-label use, which is fairly effective in a lot of patients.

I hope replies will be directed to the group so we can all profit.

trackgalcal

> I seem to be allergic to doxycycline. I asked my

> doctor for a prescription for a different antibiotic.

> She said that, unfortunately, tetracyclines are the

> only ones used to treat skin conditions.

>

> Is this really true? This doesn't agree with what

> I have read here.

>

> Shane

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Yes, the doctor told me that the benefit of the antibiotic

is the anti-inflammatory effects. I might try the Doxy once

more, but it seems to actually cause my face to swell.

Maybe it is all in my imagination, but I don't think so.

Shane

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Guest guest

I am NOT a doctor, but what you say your doctor told you sounds incorrect to

me. I thought that antibiotics were used in R treatment exclusively for

controlling local skin infection. Correct me if Im wrong.

Re: Re: Antibiotic Suggestions

> Yes, the doctor told me that the benefit of the antibiotic

> is the anti-inflammatory effects. I might try the Doxy once

> more, but it seems to actually cause my face to swell.

> Maybe it is all in my imagination, but I don't think so.

>

> Shane

>

>

>

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Shane, if your physician subscribes or has hospital access to

UpToDate (www.uptodate.com), they give erythromycin 250 two-four

times a day as alternative therapy. More convenient formations of

erythromycin such as clarithromycin and zithromycin are mentioned in

several Medline references.

Other less common options I've come across include trimethoprim-

sulfamethoxazole (Bactrim), ampillicin, and cephalosporins. I don't

have the references, but they too can probably be accessed on Medline

by typing in the condition and the specific antibiotic.

While I'm not familiar with this article, the title sounds like a

reference your physician might want to consult:

Cutis 2000 Oct;66(4 Suppl):7-13

Systemic therapy for rosacea: focus on oral antibiotic therapy and

safety.

Del Rosso JQ.

Department of Dermatology, University of Nevada School of Medicine,

Las Vegas, Nevada, USA.

Although potentially significant adverse reactions and drug

interactions have been reported in association with erythromycin,

oral tetracyclines, and trimethoprim-sulfamethoxazole, overall these

agents are associated with excellent safety profiles, especially

considering their widespread use over many years. It must be

considered that when these antibiotics are used for the treatment of

rosacea and also for acne vulgaris, their use is on a long-term basis

rather than their typical short-course regimens for most infectious

diseases. As a result, dermatologists prescribing these agents may

feel assured that most patients will not encounter any significant

problems, but they do need to be aware of potential adverse reactions

to allow for early recognition and discontinuation of the offending

drug when needed. Early recognition also allows for favorable

management of adverse reactions. In addition, potentially significant

drug interactions may be recognized by obtaining a thorough medical

history and avoiding combinations of drugs that may interact

unfavorably. Fortunately, there are several choices that allow us to

individually select a treatment regimen that is optimal for the

individual patient, allowing for effective control of rosacea.

Publication Types:

Review

Review, Tutorial

PMID: 11455753 [PubMed - indexed for MEDLINE]

> I seem to be allergic to doxycycline. I asked my

> doctor for a prescription for a different antibiotic.

> She said that, unfortunately, tetracyclines are the

> only ones used to treat skin conditions.

>

> Is this really true? This doesn't agree with what

> I have read here.

>

> Shane

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Guest guest

> Hi. I understand that the tetracyclines are the first line

treatment

> and usually considered the best. But I believe that e-mycin and

> clarithromycin (same family) may also be useful for rosacea.

> Perhaps others in the group have tried them with success?

>

> Another thing -- and maybe Marjorie can comment on this -- my

> understanding is that antibiotics are used in rosacea not for their

> anti-bacterial peoperties but for their anti-inflammatory effects.

> (This applies to ocular rosacea too.)

That's the current thinking, trackgalcal. I found an old but

interesting study that demonstrates the efficiacy of antibiotics in

chemically-induced rosacea -- chemically-induced, so we know there's

no bacterial activity directly causing the resolution of these

symptoms:

J Invest Dermatol 1975 Dec;65(6):532-6

Anti-inflammatory effects of antimicrobial agents: an in vivo study.

Plewig G, Schopf E.

Antimicrobials are used emperically in a variety of inflammatory

dermatoses such as rosacea and dermatitis herpetiformis, although

these diseases are not believed to be of bacterial etiology. We have

used potassium iodide ointment to induce follicular pustules and have

found in this in vivo model properties of antimicrobials not related

to their antibacterial actions. Topical demethylchlortetracycline and

erythromycin (5%) lead to suppression of KI-induced inflammation

(erythema, pustules) and systemic use of these drugs as well as

diaminodiphenylsulfone produces the same effect.

PMID: 1194716 [PubMed - indexed for MEDLINE]

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Interesting study. Isn't potassium iodide the stuff they're handing

out to people living near nuclear power plants -- to prevent

thyroid cancer in case of nuclear meltdown??

trackgalcal

I found an old but

> interesting study that demonstrates the efficiacy of antibiotics

in

> chemically-induced rosacea -- chemically-induced, so we

know there's

> no bacterial activity directly causing the resolution of these

> symptoms:

>

>

> J Invest Dermatol 1975 Dec;65(6):532-6

>

>

> Anti-inflammatory effects of antimicrobial agents: an in vivo

study.

>

> Plewig G, Schopf E.

>

> Antimicrobials are used emperically in a variety of inflammatory

> dermatoses such as rosacea and dermatitis herpetiformis,

although

> these diseases are not believed to be of bacterial etiology. We

have

> used potassium iodide ointment to induce follicular pustules

and have

> found in this in vivo model properties of antimicrobials not

related

> to their antibacterial actions. Topical demethylchlortetracycline

and

> erythromycin (5%) lead to suppression of KI-induced

inflammation

> (erythema, pustules) and systemic use of these drugs as well

as

> diaminodiphenylsulfone produces the same effect.

>

> PMID: 1194716 [PubMed - indexed for MEDLINE]

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Guest guest

> Interesting study. Isn't potassium iodide the stuff they're handing

> out to people living near nuclear power plants -- to prevent

> thyroid cancer in case of nuclear meltdown??

Probably, but here it's used as a topical -- it's probably used here

just a reliable and otherwise safe skin irritant.

Marjorie

Marjorie Lazoff, MD

>

> I found an old but

> > interesting study that demonstrates the efficiacy of antibiotics

> in

> > chemically-induced rosacea -- chemically-induced, so we

> know there's

> > no bacterial activity directly causing the resolution of these

> > symptoms:

> >

> >

> > J Invest Dermatol 1975 Dec;65(6):532-6

> >

> >

> > Anti-inflammatory effects of antimicrobial agents: an in vivo

> study.

> >

> > Plewig G, Schopf E.

> >

> > Antimicrobials are used emperically in a variety of inflammatory

> > dermatoses such as rosacea and dermatitis herpetiformis,

> although

> > these diseases are not believed to be of bacterial etiology. We

> have

> > used potassium iodide ointment to induce follicular pustules

> and have

> > found in this in vivo model properties of antimicrobials not

> related

> > to their antibacterial actions. Topical demethylchlortetracycline

> and

> > erythromycin (5%) lead to suppression of KI-induced

> inflammation

> > (erythema, pustules) and systemic use of these drugs as well

> as

> > diaminodiphenylsulfone produces the same effect.

> >

> > PMID: 1194716 [PubMed - indexed for MEDLINE]

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