Oracea should be tested against Generic Doxycycline

This just published abstract is looking at recent advances in the use of the tetracycline family in treating rosacea. Of course a lot of the interest in subantimicrobial dose doxycyline has been motivated by the introduction of the Oracea to the market.

A previous published study instigated by Collagenex (now owned by Galderma) showed that 100mg doxycycline was no better than oracea in treating the papules and pustules of rosacea.

What would be really interesting, though, would be to see a double blind study comparing 50mg a day of generic doxycyline with Oracea. I doubt that Galderma would be at interested in the this sort of comparison, but perhaps one of the manufacturers of generic doxycycline should undertake such a trial.

Galderma holds up to 6 patents related to Oracea, so we can expect that it will be may years before  generic oracea becomes available. Pharmaceutical companies that want to make generic oracea will have to wait until all of the patents lapse.

This paper additionally calls for further trials of metronidazole vs. oral tetracyclines. Now that is something for which I think we already have enough published, light weight papers.

The role of tetracyclines in rosacea, Am J Clin Dermatol. 2010;11(2):79-87

There is a great deal of evidence to support the use of tetracycline and doxycycline in the treatment of papulopustular rosacea. Nevertheless, these agents have shared and unique adverse effects and relative contraindications.

Recently, subantimicrobial-dose doxycycline was demonstrated to be an effective treatment for rosacea, due to its inherent anti-inflammatory properties.

Furthermore, subantimicrobial-dose doxycycline has a more preferable tolerability profile and a lower occurrence of bacterial resistance than traditional-dose doxycycline.

To further elucidate the role of tetracycline agents in rosacea, clinical trials that compare these agents with each other as well as with other effective rosacea treatments are called for. Adherence studies comparing oral tetracycline treatment with topical metronidazole treatment may also enhance clinical decision making.

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

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3 Reader Comments

  1. evam says:

    Anyone else getting photosensitivity when using oracea?


  2. David Pascoe says:

    Hello Evam,

    Sun sensitivity to doxycycline is one of the known side effects. One of the selling points of Oracea is the possibility of less side effects due to the reduced dosage – but sun sensitivity is still possible.

    Be sure to check with your doctor if you continue to be concerned.


  3. Pete H says:

    I have been fighting rosacea since 1976, and I have a good handle on it. My rosacea has always involved only my nose and the skin to the right and the left of my nostrils. When it flares up it creates large painful pustules on a red blood-engorged nose.

    When I first got it in 1972 my doctor put me on a heavy daily dose of tetracycline. This resolved it completely. Periodically I would take myself off the tetracycline and the rosacea would return in about three weeks. I was on and off the tetracycline for perhaps 20 years. I tolerated the tetracycline very well with no side effects. I have always been a moderate alcohol consumer (one or two drinks before dinner).

    About six years ago I decided to see if I could quit the tetracycline permanently. The rosacea returned after about six months. I tried various putups of metrodinazole, but it did not work very well. My son in law is a derm. He put me on doxycycline which quickly and effectively resolved the rosacea, but he was not anxious to let me stay on it too long. So he then had me try a topical foam called Clarifoam EF, a sodium sulfacetamide and sulfur product of Onset Therapeutics. I only need to spread a very small amount the size of a raisin on my nose and adjacent skin each night at bedtime. It has worked perfectly for about six months now.

    I have come to believe over time that each rosacea patient responds differently to the available remedies.

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