Given the recent developments in periostat, oracea and COL-3 an interesting article about the applicability of low dose doxycycline. The term SDD refers to `subantimicrobial dose doxycycline hyclate’.
From US Pharmacist, Vol. No: 29:04 Posted: 4/15/04.
New Applications of Doxycycline Hyclate in Medicine and Dentistry
Golub and his colleagues were able to show that tetracycline exerted a unique property that was independent of its antimicrobial effects. The chemically modified tetracyclines (CMTs) showed no antimicrobial effect but rather inhibited an enzyme called collagenase, which is produced by host neutrophils (white blood cells) and structural cells (eg, fibroblasts and osteoclasts).
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Certain skin diseases appear to have etiologies similar to those seen with periodontitis. Inflammatory, collagenolytic skin diseases that are involved with collagen destruction via the production and release of collagenase include acne vulgaris, rosacea, and other pathological collagen breakdown, such as arthritis.
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In another recent study, 50 rosacea patients (manifesting all stages of disease) received monotherapy with doxycycline hyclate 20 mg tablets twice daily for eight weeks. Most patients had no previous history of treatment for their rosacea symptoms. Patients were evaluated at the initial visit and again between two and eight weeks for erythema, inflammatory lesions, and telangiectasias (spider veins). After an average of four weeks of treatment with doxycycline hyclate 20 mg, patients experienced an 80% to 100% clearing of inflammatory lesions and a 50% reduction in erythema. A decrease in the size and diameter of telangiectasias was also observed, although complete clearing was not achieved. There were no reports of GI side effects, headaches, vaginitis, or photosensitivity (including for patients who had experienced such adverse effects on antimicrobial dosages of doxycycline).
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In an ongoing study, 150 patients with moderate to severe rosacea are randomized to receive doxycycline hyclate 20-mg tablets twice daily or placebo for four months.39 The primary efficacy parameters include change in total papule and pustule lesion counts and change in clinician’s erythema scores from baseline.Although doxycycline hyclate 20 mg tablets are not currently indicated for the treatment of rosacea or acne vulgaris, similarities between these diseases and periodontitis, as well as the encouraging results from studies of its use in acne and rosacea patients, have prompted FDA phase III studies involving orally administered SDD in rosacea patients. Ongoing and planned SDD studies include patients with blepharitis, postmenopausal osteopenia, periodontal implantitis, perioral dermatitis, and additional rosacea studies.
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What was the result of this, did it work on any of your patients?
a late followup – but low doses of doxycycline as in Oracea or 50mg a day of doxycycline have been shown to be good for the papules and pustules of rosacea.