High-dose systemic minocycline most effective for treating papules and pustules in rosacea

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High-dose systemic minocycline is the most effective treatment option for rosacea patients with papules and pustules, with a low risk of adverse events (AEs), according to a study. However, more evidence-based data are needed to determine the impact of antibiotics on erythema.

Researchers analyzed all available randomized controlled trials (RCTs) related to rosacea therapy, including both published and unpublished research.

In total, 31 RCTs involving 8226 patients were included in the analysis. The trials demonstrated low heterogeneity and inconsistency, and all were considered to have a low risk of bias. The primary outcome evaluated was the improvement of the Investigator’s Global Assessment (IGA) scores, while secondary outcomes included the improvement of the Patient’s Global Assessment (PaGA) scores, Clinician’s Erythema Assessment (CEA) scores, and AEs.

Based on the findings, oral doxycycline 40 mg, minocycline 100 mg, minocycline 40 mg, as well as topical ivermectin and metronidazole 0.75%, were identified as effective treatments for reducing papules and pustules and improving IGA scores in rosacea patients. Among these, minocycline 100 mg was ranked the most effective. For improving PaGA scores, topical ivermectin, metronidazole 1%, and systemic oxytetracycline demonstrated efficacy, with oxytetracycline yielding the best results. However, neither doxycycline 40 mg nor metronidazole 0.75% showed therapeutic effects on erythema, a common symptom of rosacea.

In terms of safety, it was observed that systemic use of azithromycin and doxycycline 100 mg significantly increased the risk of adverse events.

The authors concluded that it is important to consider the specific phenotype of rosacea and balance the potential benefits and safety considerations when prescribing antibiotics to patients due to the risk of adverse events.

Xiao W, Chen M, Wang B, et al. Efficacy and safety of antibiotic agents in the treatment of rosacea: a systemic network meta-analysis. Front Pharmacol. 2023;14:1169916. doi: 10.3389/fphar.2023.1169916. PMID: 37251342; PMCID: PMC10210163.