Dermatologist with cea

[Guest guest]

Hi,

I found this letter to the editor that was printed in the March 2002

issue of the Journal of the American Academy of Dermatology about his

own experience taking tetracycline for 25 years to help mitigate his

rosacea symptoms. (I believe ny Malak, M.D. is the same person

who had a short letter published in the Journal of the American

Medical Association (JAMA) about the possibility of there being otic

rosacea. I posted his short letter from JAMA some weeks ago.)

Twenty-five years of tetracyclines for rosacea

To the Editor:

In April 1975, at the age of 43 years, I started taking tetracyclines

for rosacea. I had had rosacea for approximately 1 year, and when the

condition become quite flagrant, my colleagues in the then Division

of Dermatology in the School of Medicine of the American University

of Beirut, Drs Amal K. Kurban and Fuad S. Farah, prompted me to

embark on treatment. Although I knew very well that it would be a

long and protracted affair, never did I realize that it was going to

be that long.

There were few telangiectases, but papules and pustules over the face

were plentiful. Tetracycline hydrochloride, 1 g daily, was the

initial dosage. The response was dramatic, and the dosage was

gradually reduced to a maintenance regimen of 250 mg daily.

Over the years, I averaged about 8 months of medication intake per

year, giving myself interrupted respites of 1 to 2 months. Relapses

would usually occur within 2 weeks of cessation of therapy.

In the mid 1980s, tetracycline was replaced by doxycycline. At

irregular intervals, topical metronidazole gel was used either alone

or in conjunction with doxycycline. However, when topical

metronidazole gel was used alone, it did not control the condition to

a satisfactory degree. Oral retinoids and oral metronidazole were not

tried.

In the mid 1990s, ophthalmic rosacea set in. Both eyes were involved

and exhibited blepharitis, meibomitis, and conjunctivitis. Local

antibiotic ointments and topical metronidazole were ineffective,

whereas the response to oral doxycycline was excellent. Nevertheless,

relapses occurred soon after treatment was discontinued, a situation

that required extended periods of drug intake.

In 1999, I experienced, at irregular periods, first an episode

of " otitis externa " in my left ear and still later 2 episodes of

otitis externa in my right ear. Each bout occurred at times when I

was not taking doxycycline and coincided with flares of rosacea. The

conventional treatment of otitis externa prescribed by an

otolaryngologist, consisting of antibiotic eardrops and courses of

oral ciprofloxacin for 3 to 4 weeks, failed to relieve the condition,

whereas on all 3 occasions, the intake of doxycycline cleared the

problem promptly. This otitis externa most probably represented otic

rosacea.1

Yearly routine blood studies including liver and kidney function

tests have revealed, to date, normal results. At present and for the

past 6 months, I have been receiving a maintenance dosage of

doxycycline, 100 mg, every other day and have experienced an almost

complete clearance of lesions, the aim being to effectively control

the condition with the smallest dose possible. Few transient, short-

lived papules do erupt on my chin and cheeks on and off, and a mild

blepharitis does appear from time to time.

In conclusion, in this particular case, the intake of tetracyclines

for an average of approximately 8 months per year over a period of 25

years has not, to date, produced obvious or grossly detectable

adverse effects. This clearly attests to the relative safety of the

prolonged use of these medications.

In view of the fact that dermatologists frequently prescribe

tetracyclines, I believe that it is pertinent to bring this to their

attention.

Published online January 31, 2002.

J Am Acad Dermatol 2002;46:e1

Copyright © 2002 by the American Academy of Dermatology, Inc.

16/90/118546

doi:10.1067/mjd.2002.118546

ny A. Malak, MD

Department of Dermatology, American University of Beirut Medical

Center, PO Box 11-0236, Riad El Solh Beirut, 1107 2020 Lebanon

Reference

1. Malak J, Hadi U. Otic rosacea. Arch Otolaryngol Head Neck Surg

1999;125:479.

[Guest guest]

Hi,

I found this letter to the editor that was printed in the March 2002

issue of the Journal of the American Academy of Dermatology about his

own experience taking tetracycline for 25 years to help mitigate his

rosacea symptoms. (I believe ny Malak, M.D. is the same person

who had a short letter published in the Journal of the American

Medical Association (JAMA) about the possibility of there being otic

rosacea. I posted his short letter from JAMA some weeks ago.)

Twenty-five years of tetracyclines for rosacea

To the Editor:

In April 1975, at the age of 43 years, I started taking tetracyclines

for rosacea. I had had rosacea for approximately 1 year, and when the

condition become quite flagrant, my colleagues in the then Division

of Dermatology in the School of Medicine of the American University

of Beirut, Drs Amal K. Kurban and Fuad S. Farah, prompted me to

embark on treatment. Although I knew very well that it would be a

long and protracted affair, never did I realize that it was going to

be that long.

There were few telangiectases, but papules and pustules over the face

were plentiful. Tetracycline hydrochloride, 1 g daily, was the

initial dosage. The response was dramatic, and the dosage was

gradually reduced to a maintenance regimen of 250 mg daily.

Over the years, I averaged about 8 months of medication intake per

year, giving myself interrupted respites of 1 to 2 months. Relapses

would usually occur within 2 weeks of cessation of therapy.

In the mid 1980s, tetracycline was replaced by doxycycline. At

irregular intervals, topical metronidazole gel was used either alone

or in conjunction with doxycycline. However, when topical

metronidazole gel was used alone, it did not control the condition to

a satisfactory degree. Oral retinoids and oral metronidazole were not

tried.

In the mid 1990s, ophthalmic rosacea set in. Both eyes were involved

and exhibited blepharitis, meibomitis, and conjunctivitis. Local

antibiotic ointments and topical metronidazole were ineffective,

whereas the response to oral doxycycline was excellent. Nevertheless,

relapses occurred soon after treatment was discontinued, a situation

that required extended periods of drug intake.

In 1999, I experienced, at irregular periods, first an episode

of " otitis externa " in my left ear and still later 2 episodes of

otitis externa in my right ear. Each bout occurred at times when I

was not taking doxycycline and coincided with flares of rosacea. The

conventional treatment of otitis externa prescribed by an

otolaryngologist, consisting of antibiotic eardrops and courses of

oral ciprofloxacin for 3 to 4 weeks, failed to relieve the condition,

whereas on all 3 occasions, the intake of doxycycline cleared the

problem promptly. This otitis externa most probably represented otic

rosacea.1

Yearly routine blood studies including liver and kidney function

tests have revealed, to date, normal results. At present and for the

past 6 months, I have been receiving a maintenance dosage of

doxycycline, 100 mg, every other day and have experienced an almost

complete clearance of lesions, the aim being to effectively control

the condition with the smallest dose possible. Few transient, short-

lived papules do erupt on my chin and cheeks on and off, and a mild

blepharitis does appear from time to time.

In conclusion, in this particular case, the intake of tetracyclines

for an average of approximately 8 months per year over a period of 25

years has not, to date, produced obvious or grossly detectable

adverse effects. This clearly attests to the relative safety of the

prolonged use of these medications.

In view of the fact that dermatologists frequently prescribe

tetracyclines, I believe that it is pertinent to bring this to their

attention.

Published online January 31, 2002.

J Am Acad Dermatol 2002;46:e1

Copyright © 2002 by the American Academy of Dermatology, Inc.

16/90/118546

doi:10.1067/mjd.2002.118546

ny A. Malak, MD

Department of Dermatology, American University of Beirut Medical

Center, PO Box 11-0236, Riad El Solh Beirut, 1107 2020 Lebanon

Reference

1. Malak J, Hadi U. Otic rosacea. Arch Otolaryngol Head Neck Surg

1999;125:479.