Subantimicrobial Dose Doxycycline for Acne and Rosacea

Written by on September 19, 2005 in doxycycline, Oracea (40mg doxycycline), tetracyclines with 14 Comments

Some more background about subantimicrobial (sometimes referred to as SD – Subantimicrobial Dosage) doxycycline and rosacea. A dosage of around 50mg per day is enough to see a benefit in rosacea symptoms but also low enough to not affect gut flora or cause other antibiotic related side effects. SD doxycycline can also be take safely for longer periods of time compared to higher doses of doxycycline.

Subantimicrobial Dose Doxycycline for Acne and Rosacea, From SKINmed, 2(4):234-245, 2003

Conclusions: The tetracyclines have been used effectively for decades for the treatment of acne and rosacea at doses of 50-200 mg daily for doxycycline and minocycline and 250 mg twice or four times daily for tetracycline HCl. Reports of serious adverse events and the increasing rates of bacterial resistance to tetracyclines at standard doses in patients undergoing long-term therapy have prompted interest in new therapeutic approaches for their use in acne and rosacea therapy.

Lesions of periodontitis and acne are mediated by a somewhat similar inflammatory response. The efficacy of clinical trials and subsequent approval of SD doxycycline in adult periodontitis was the impetus for the study of its effect in acne. Results from the study of SD doxycycline in acne are promising and should encourage further research into this new strategy for treating acne. A 50-patient, open-label experience trial with SD doxycycline in the treatment of rosacea also provided evidence of the utility of the drug. The use of SD doxycycline can potentially avoid the adverse events of standard-dose, long-term therapy with tetracyclines for acne and thereby enhance patient compliance. In addition, widespread adoption of this dosage as part of a maintenance therapy for acne and rosacea will limit exposure of patients and their microflora to doxycycline and may slow the steadily increasing rate of resistance of P. acnes and other organisms to the tetracyclines.

Full Article Online

SKINmed is a peer reviewed outreach journal specifically written to be of interest to Dermatologists and serve as a teaching, didactic resource of clinical content for non-Dermatologists.

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

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14 Reader Comments

  1. Rhonda says:

    I have used Oracea for 2 months for Rosacea, I am clear.

    I wake up thankful every day.

  2. Great to hear Rhonda. I wish you all the best, that it continues to work well for you !

  3. Jim D says:

    I have tried absolutely everything to control my papo pustular rosacea. Nothing has worked for any length of time. All topicals including Metrogel and Aczone worked at first then like everything else seemed to contribute to the problem. Most soaps and lotions cause immediate breakouts and deep pimples.

    My PCP and dermatologist seem to be reticent to prescribe Doxy on a permanent basis so I scraped together all of the doxy I could get my hands on and I have been taking 100mg Doxy once per day for the past 45 days and am almost completely clear of lesions and breakouts. I am going to discuss a permanent ongoing regime with my doctor. And if they won’t listen I’ll go to one that does.

    Since the generic Doxy works very well I see no reason to pay the extra costs of a name-brand pharmaceutical.

  4. Good for you Jim.

    All the best for getting a solution with your doctor. One more benefit of generic doxycycline is, as you say, the price !


  5. MW says:

    Are there data about subantimicrobial doses and pregnancy? Are these very small doses safe or are they afraid to allow pregnant women to take even a small amount?

  6. Hi MW,

    I don’t know how easily such data could be collected as I can’t seriously imagine anyone being willing to test the safety of Oracea during pregnancy. The animal studies are pretty conclusive it seems.

    The prescribing information clearly says “ORACEA should not be used during pregnancy”, and also mentions breastfeeding. Also “Results from animal studies indicate that doxycycline crosses the placenta and is found in fetal tissues”.

    So it seems that official literature for Oracea is the same as for higher doses of antibiotics as far as warnings are concerned.

    all the best,

  7. JP says:

    I’ve been on 100 mg of doxycycline for almost two years with no ill effects at all. I am male, 40 years old, and weigh 215.

    I had recurrent corneal erosions and was later diagnosed with rosacea. Since I began the doxcycline, I’ve had no more problems. The recurrent corneal erosions stopped, my ocular rosacea ceased, and I’ve had no more pustules on my face. I have my dermatologist to thank. My opthamologist is happy too.

    Here is a good link with the pros and cons:

    I especially like doxy because of the inhibition of metalloproteinases. My grandfather had wet macular degeneration. Something I would like to avoid.

  8. TW says:

    36 year old female – Diagnosed with recurrent corneal erosions 1 1/2 years ago. Diagnosed a couple months ago with rosacea. Taking oral antibiotics, using topical antibiotic cream, topical gel to “dry up” the rosacea, and using cetaphil gentle cleanser. My opthamologist is also excited and saying the antibiotics should help my eyes too. I have many allergies to anitbiotics and am not comfortable taking it for entended periods of time. Should I consider laser treatmetns or be patient a bit longer? Going on week three . . . minimal change in skin or eyes.

  9. MommyMomster says:

    I use the Doxy 100mg daily for maintenance…it is affecting my eyes now too, which is all the more reason to stay on top of it. However, I saw that somebody asked about pregnancy…I was advised to discontinue taking it when I began trying to conceive, and to not take it again until I was done nursing my baby. So, I had almost two years off of it. Of course when pregnant and nursing I did not drink coffee, alcohol, take hot baths, or eat really spicy foods…all which seem to make mine flare up…so to be honest, I didn’t notice a big difference. I am back to using the Doxy again now though at the request of my eye doctor, but my “baby” is 5 now (-: . Hope this helps.

  10. Hi MommyMonster,

    Congratulations on the addition to your family, and thanks for such a helpful and useful post.


  11. Zack says:

    Hi I’m Zack, I’m a 19 year old male about 140lbs . I believe I have a moderate case of plaque psoriasis. I have no insurance yet and wondered if it was wise to start my own low once a day or everyother day treatment using 1 100mg doxycycline. Please anybody who has used this treatment or any other inexpensive creams or Med. Response ASAP to me. Ypi can email me as well at

  12. JP says:

    One side effect I have noticed is tinnitus. The ringing sound in my ears got so bad, I had to stop. It is a noted side effect and I’m waiting for the effects to diminish.

    • Mike says:

      does the ringing go away, I had the minocycline 100 mg twice a day for a month and had ringing in ears. It has been 5th weeks. It diminish so much but it fluctuates.

  13. Brenda says:

    I have just started Oracea 10 days ago. What I see is that it has gotten worse. My nose has broke out so bad I look like Rudolf. t My nose has so many whiteheads and swollen I get one cleared and another one breaks out next to it. I use a deffen gel to dry it up but nothing helps.

    Also I was on Doxy for 2yrs daily but it never cleared it up totally. It helped at first but not completely, it stopped helping all together.

    Does anyone have any advise?

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