Minocycline 100mg is better than Oracea

A study just published in the British Journal of Dermatology has shown that Minocycline 100mg a day is as good, and by some measures is a better treatment for the papules and pustules of rosacea compared to the 40mg a day  doxyxcycline treatment Oracea.

Minocycline as a treatment for rosacea is relatively unknown, with a lack of available evidence confirming its success, when compared to tetracyclines such as doxycycline. So this study will enhance our understanding of the usefulness of Minocycline as first-line treatment for rosacea.

But isn’t Oracea the bees knees?

This result is interesting for rosacea sufferers who are used to the continual barrage of positive research study results and publicity surrounding the 40mg doxycycline treatment Oracea. Given the high and ever increasing cost of Oracea, an alternative treatment option such as 100mg of minocycline a day may be an option worth considering.

Minocycline is relatively unknown for rosacea

Although minocycline is commonly used for treatment of rosacea, there is lack of evidence for its efficacy, and there are no reported studies comparing minocycline with another antibiotic treatment for rosacea.

This is the first study comparing doxycycline and minocycline for the treatment of papulopustular rosacea, including quality of life assessments as primary outcome.

The ways Minocycline is better than Oracea

The study lists the following areas where Minocycline 100mg a day is superior to Oracea.

  • minocycline 100mg a day gives longer remission periods than doxycycline 40mg – or stated another way, less relapses were recorded in the minocycline group once treatment had ceased.
  • those unable to take Oracea because of allergic or other concerns may find minocycline offers them a viable alternative.
  • based on 2 qualitative measures, the Rosacea Quality of Life (RosaQoL) and the Patient Global Assessment (PaGA), the minocycline group was significantly better as a treatment than Oracea.

Minocycline is also available as a slow release formulation called Solodyn and is available via a variety of brands such as Minocin, Akamin and Dynacin.

Like all sytemic treatments, and specifically antibioitics, there are known unwanted side effects from minocycline treatment. Also be aware that the cost of some forms of minocycline such as Solodyn can be expensive where a bottle of 30 of Solodyn tablets can cost up to $1,040.41.

 Tetracyclines and rosacea

Tetracyclines, including tetracycline, doxycycline and minocycline have been used for
decades for patients with rosacea, because of their anti-inflammatory effects.

Minocycline and rosacea

For minocycline, evidence is missing although it is frequently prescribed in clinical practice

Official Summary of results

  1. In terms of efficacy, minocycline 100mg during 16 weeks, is non-inferior to doxycycline 40mg for rosacea treatment.
  2. In comparison with doxycycline 40mg, treatment with minocycline 100mg may result in less relapse (three months follow up).
  3. In comparison with doxycycline 40mg, Patient Reported Outcomes (PROs), including
    Health Related Quality of Life (HRQoL) and Patient’s Global Assessment (PaGA) favour minocycline 100mg.
  4. In this study safety profiles of doxycycline 40mg and minocycline 100mg are comparable


DOMINO, doxycycline 40mg vs minocycline 100mg in the treatment of rosacea: a
randomised, single blinded, non-inferiority trial, comparing efficacy and safety.

Short Title: Doxycycline 40mg versus minocycline 100mg, for rosacea

M.M.D. van der Linden, A.R. van Ratingen, D.C. van Rappard, S.A. Nieuwenburg, Ph.I. Spuls Department of Dermatology, Academic Medical Centre, University of Amsterdam

Br J Dermatol 2016 Oct 31.

BACKGROUND: There is lack of evidence for minocycline in the treatment of rosacea.

OBJECTIVES: To compare the efficacy and safety of doxycycline 40mg versus minocycline 100mg in papulopustular rosacea.

METHODS: In this randomised single centre, 1:1 allocation, assessor blinded, non-inferiority trial, patients with a mild to severe papulopustular rosacea, were randomly allocated to either oral doxycycline 40mg or minocycline 100mg for a 16-week period with 12 weeks of follow up. Our primary outcomes were the change in lesion count and change in patient’s Health Related Quality of Life (HRQoL): RosaQoL scores.

Our secondary outcomes were: Patient’s Global Assessment (PaGA) success (“excellent” or “good” improvement), Investigator Global Assessment (IGA) success (“clear” or “near clear”), Clinicians Erythema Assessment (CEA) success (at least one point decrease), the relapse rate at follow up and safety profile of the treatment drugs. Intention to treat (ITT) and per protocol analyses (PPA) were performed.

RESULTS: Of the 80 patients randomised, (40 for minocycline and 40 for doxycycline) 71 patients were treated for 16 weeks. 68 patients completed the study.

At week 16, the median change in lesion count was comparable in both groups: doxycycline versus minocycline respectively 13 versus 14 lesions less. (Non-inferiority difference 3, 90% Confidence interval (CI) -2 to 8).

The RosaQoL scores were decreased for both doxycycline and minocycline, respectively 0.62 and 0.86. (Non-inferiority difference 0.15, 90% CI -0.09 to 0.42).

Secondary outcomes were comparable except for IGA success, which was assessed significantly more often in the minocycline group than in the doxycycline group (respectively 60% and 17.5%; p<0.001).

At week 28, outcomes were comparable, except for RosaQoL scores and PaGA, which were significantly different in favour of minocycline (P=0.005 and P=0.043 respectively), and less relapses were recorded in the minocycline group than in the doxycycline group (respectively 6.7% and 48%; p<0.001).

In this study no serious adverse reactions (SAEs) were reported.

CONCLUSIONS: Minocycline 100mg is non-inferior to doxycycline 40mg in efficacy over a 16- week treatment period.

Furthermore, at follow up, RosaQoL scores and PaGA were statistically significantly more improved in the minocycline group than in the doxycycline group, and minocycline 100mg gives longer remission than doxycycline 40mg.

In this study there was no significant difference in safety between these treatments, however, based on previous literature minocycline has a lower risk/benefit ratio than doxycycline.

Minocycline 100mg may be a good alternative treatment for those patients who, for any reason, are unable or unwilling to take doxycycline 40mg. This article is protected by copyright. All rights reserved.

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About the Author

About the Author: David Pascoe started the Rosacea Support Group in October 1998. .

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3 Reader Comments

  1. Response via email.

    “I got terribly sick with Minocycline. Bad side effects. The doctor said it resembled “drug-induced lupus”. One of the sickest I’ve ever been. Missed work for a week.


  2. Mike says:

    This doesn’t make sense. Isn’t the point of Oracea low dose, therefore antibiotic resistance is not an issue? Of course high (100mg) of one tetracycline is going to be better than 40mg of another in most cases.

  3. Missy says:

    I agree with Mike. Oracea IMO is superior if it works for the individual vs.100 mg of Minocycline simply because Oracea is sub microbial. We need the anti-inflammatory mechanism only vs the antibacterial action. Less side effects and more to the heart of the issue.

    It’s upsetting that health insurance companies and pharmaceutical companies make life more and more difficult by not covering necessary meds and by the exorbitant prices that are charged for said drugs.

    Thanks as always David for your thorough and helpful website.


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