In a recently published paper (previously mentioned only via the Abstract – Tetracyclines: their non-antibiotic properties ) we can read some more about how the regular, non-antibiotic (low dose) and chemically modified tetracycline analogues target rosacea.

Tetracyclines: nonantibiotic properties and their clinical implications., Journal American Academy of Dermatology, 2006 Feb;54(2):258-65., Allen N. Sapadin MD, and Raul Fleischmajer MD.

Mechanisms of action of tetracycline and tetracycline derivatives in the treatment of skin disease

Rosacea

• Inhibition of angiogenesis
• Inhibition of neutrophil chemotaxis
• Inhibition of proinflammatory cytokines and MMP-9

….

Acne. Tetracycline, minocycline, and doxycycline are effective in the treatment of acne, particularly during the inflammatory stage. It has previously been suggested that the beneficial effect of tetracycline is due to the inhibition of Propionibacterium acnes accompanied by a reduction in sebum free fatty acids and extracellular lipases. However, it is currently believed that the inflammatory reaction plays an important role in the pathophysiology of acne. The exact cascade of events that is responsible for inflammation in acne is not known. However, there is evidence of chemotaxis of neutrophils, which are known to store MMP-9. Thus the therapeutic effect of tetracyclines in acne may at least in part be due to reduction in neutrophilic chemotaxis as well as their inhibitory effect on proinflammatory cytokines and MMP-9. This contention is supported by a recent study that showed that subantimicrobial-dose doxycycline (20mg taken twice daily) reduced the number of both inflammatory and noninflammatory lesions in patients with moderate facial acne.

No detectable antimicrobial effect on the skin flora was demonstrated.

Rosacea. Tetracyclines and their analogues are effective in the treatment of rosacea and related disorders, such as perioral dermatitis, ocular rosacea, and steroid-related rosacea. A single daily dose of doxycycline may be effective for ocular rosacea. The anti-inflammatory effects of tetracyclines already mentioned may explain, at least in part, their beneficial effects in rosacea. Inhibition of angiogenes is may be a contributory factor in the therapeutic effect of tetracyclines in this group of disorders. Features that favor angiogenesis may contribute to the telangiectasia of rosacea. These include protease-triggered release of angiogenetic factors stored in the extracellular matrix, release of inhibition of endothelial factors, and release of angiogenic factors from activated macrophages.

For those interested in more published information about rosacea and tetracyclines, the paper’s author offers the following references as worth citing ;

• 39. Macdonald A, Feiwel M. Perioral dermatitis: aetiology and
  treatment with tetracycline. Br J Dermatol 1972;87:315-9.
• 40. Jansen T, Plewig G. Rosacea: classification and treatment.
  J R Soc Med 1997;90:144-50.
• 41. Frucht-Pery J, Chayet AS, Feldman ST, Lin S, Brown SJ. The
  effect of doxycycline on ocular rosacea. Am J Ophthalmol
  1989;107:434-5.

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