Treating Rosacea with Azithromycin

Written by on November 22, 2005 in macrolides with 9 Comments

The author of this paper has been kind enough to provide a scan of the 2 page article. As well as being published in Archives of Dermatology, this paper was also presented as a poster at the 59th Annual Meeting of the American Academy of Dermatology, March 2-7, 2001. The author has submitted a followup article that is currently being reviewed.

Oral use of azithromycin for the treatment of acne rosacea,

Archives of Dermatology 2004, Apr;140(4):489-90, Adolfo Fernandez-Obregon MD, Hudson Dermatology & Skin Cancer Center.

Oral antibiotics, requiring frequent administration, introduce the possibility of poor compliance, and their long-term use carries the risk of uncomfortable side-effects or other adverse reactions.

Topical agents have been known to cause dryness and irritation in individuals with sensitive skin.

Azithromycin given 3 times a week has been used successfully to treat acne vulgaris. Its use for the treatment of rosacea has not been previously evaluated.

Methods: 10 adults ranging in age from 32 to 76 were given azithromycin monotherapy for the treatment of acne rosacea. These patients had responded poorly to previous orgal regimes, did not favor repeating previous therapy, or had sufficiently irritated skin to warrent with holiding topical therapy at the time. The patients were not receiving treatment for rosacea for at least 30 days, nor were they taking any medication that could either exacerbate or improve signs and symptoms of rosacea.

Patients washed involved skin with a commercially available soap substitute (Cetaphil Cleanser), the sole topical agent used.

These patients were advised to take a single dose of 250 mg of azithromycin 3 times a week (Mondays, Wednesdays, and Fridays).

Results: All patients treated with azithromycin showed moderate to marked improvement of their rosacea.

Five patients had moderate clinical staging and 5 had severe clinical staging prior to treatment. Seven of the 10 patients showed marked improvement following therapy, while 3 showed moderate improvement. With the exception of 2 patients with moderate clinical staging, eye involvement was seen in the more severe cases. Though not shown in the data, severe cases reported a tendency to have eye symptoms. No significant side effects were reported from the use of the cleanser or azithromycin.

All patients feel the regimen improved their rosacea. All patients felt the showed a universal preference to the regimen using azithromycin 3 times a week when asked to compare it with other oral regimes used previously.

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

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9 Reader Comments

  1. Linda Hamata says:

    What was the duration of treatment for the study subjects? What duration of treatment using azithromycin for the treatment of rosacea is recommended for rosacea patients now, post study? Would the topical use of metrogel 0.75% be used concurrently now, post study, in rosacea patients?

  2. Hi Linda,

    According to the short paper within 4 weeks all patients showed significant improvement. They took 250mg a day 3 times a week – Mon, Wed, Fri.

    Metrogel in combination with oral antibiotics is generally considered safe and effective.

    The paper ends with the statement that further studies are needed to confirm long term efficacy and tolerabilty – so this paper doesn’t directly answer you post study question.

    hope this helps,

  3. Tired of Rosacea says:

    I googled CAN azithromycin, treat Rosacea?? Because I recently had viral Pneumonia and was give azithromycin, I noticed after a couple of days my Rosacea dimenished to nothing, I had no bumps, no flare ups, no white heads, and BARELY any redness. I was so stunned and excited to see my old face again in the mirror I felt like I was in my 20’s again.
    I am desperate to know if I can use this for long term treatment?
    I have suffered with Rosacea for 11 years and would really love to look normal again if that is at all possible.

    Desperate to know??

  4. David Pascoe says:

    You would need to speak to your doctor about the long term usage of Azithromycin. I would think that this antibiotic is best used only short term for infections or rapid rosacea relief.

    There are other options available for verified-safe long term usage such as Oracea or generic doxycycline 50mg a day. Maybe suggest this as an option as well.


  5. Mary Watson says:

    I too am being treated for pneumonia with Azithromycin and my Rosacea symptoms have cleared. No red nose!!
    This is extremely exciting. Have tried Oracea and doxy and Metrogel and Finacea without much success. I will be looking for this as a treatment in the near future!!

  6. Yuchan says:

    Dr. Pascoe- I am diagnosed with perioral dermatitis which I was told is a form of rosacia. I am allergic to two of the cycline drugs. Also sulfur and cephedroxil. My Dr. recommended arithomycin or ketflex. Have you had any success with patients taking other of these and having Sucess? Just find it so frustrating I’m allergic to everything? Do you think eating an anti inflammatory diet can Help? Thanks so much for your shared thought.

    • Hi Yuchan, I am not a doctor so cannot offer you medical advice. Sorry to hear that you react to some of the rosacea treatments. The trick will be to use your doctor to find some inflammatory relief – if there are no systemic possibilities then you still have many topicals that you can try as well. all the best.

      • Yuchan says:

        My apologies and thank you for your thoughts. Given my reactions to certain antibiotics do you think id be a good candidate for Azithromycin?

  7. Jamie MacDonald says:

    hi, i have been on this medication for over a week. I am really breaking out. when will it start to take effect? Does it get worse before it gets better?

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