Oral antibiotics are usually the first line of defence prescribed by doctors to relieve papules, pustules, inflammation and some redness. There are two families of antibiotics normally used, traditionally the tetracycline family and now macrolide families have been proven to help treat rosacea. Antibiotics are used for their anti-inflammatory properties rather than their ability to kill micro-organisms. Generally they are prescribed in quantities too small for them to be effective at stopping the growth of micro-organisms.
The Tetracyclines family include: Aureomycin, Demeclocycline, Doxycycline, Minocycline, Oxytetracycline and Tetracycline.
Tetracycline use should be avoided during pregnancy and in the very young (less than 6 years) because it will result in permanent staining of teeth causing an unsightly cosmetic result.
Doxycycline is commonly prescribed by medical doctors for infections and to treat acne. It may also be used to treat urinary tract infections, gum disease, and other bacterial infections such as gonorrhea and chlamydia. Doxycycline is also used commonly as a prophylactic treatment for infection by Bacillus anthracis (anthrax). It is also effective against Yersinia pestis and malaria. At subantimicrobial doses, doxycycline is an inhibitor of matrix metalloproteinases, and has been used in various experimental systems for this purpose.
Oracea is a 40mg modified-release formulation of doxycycline that is taken once daily for the treatment of rosacea and is patented by Collagenex Pharmaceuticals. Oracea works by reducing inflammation.
Minocycline hydrochloride, also known as minocycline, is an antibiotic of the tetracycline class. It is marketed under several trade names, including Minomycin, and Dynacin. It is primarily used to treat acne.
Metronidazole can be taken orally or as a gel or cream. It is sold as MetroLotion®, Metrocream® and Metrogel® by Galderma Laboratories]] and as Noritate® by Dermik.
Metronidazole tastes very bitter, and can cause headaches. Long term or high dosage administration of metronidazole can lead to peripheral neuropathy, which often manifests itself as a tingling or numbness in the fingers or toes. Patients who experience neuropathy should stop taking the drug and immediately contact their physician. Patients taking metronidazole must avoid consuming alcohol in any form (including cough syrup), as it will react badly with the medication, leading to severe nausea and cramping. Another common side effect is the darkening of the urine. Patients should drink plenty of water to avoid constipation. Patients taking metronidazole have also reported loss of appetite and mild nausea. Forcing oneself to eat, despite lack of appetite and fatigue, may reduce the nausea.
Flushing and blushing can be reduced with a centrally-acting alpha-2 agonist Clonidine. Clonidine has side effects of drowsiness and lowered blood pressure. Moxonidine can be used as an alternative to Clonidine as it has less side effects but most people find Clonidine more effective. Beta-Blockers like Propanol are similar to alpha-2 agonists and work better for anxiety and chronic social blushing. More information about Clonidine can be found at the following page (http://www.angelfire.com/journal2/sadhelp/clonidine.htm).
Beta blockers 
Beta blockers or beta-adrenergic blocking agents are a class of drugs used to treat a variety of cardiovascular conditions and some other diseases.
There are two types of beta receptors: β1-receptors located mainly in the heart, and β2-receptors located all over the body, but mainly in the lungs, muscles and arterioles.
Drugs that block beta 2 receptors generally have a relaxing effect and are prescribed for anxiety, migraine, esophageal varices and alcohol withdrawal syndrome, among others. Many beta blockers affect both type 1 and type 2 receptors; these are termed non-selective blockers. Some non-cardio selective beta blockers are Nadolol, Oxprenolol, Propranolol, Pindolol and Sotalol.
- Wikipedia - Full Beta blocker article
- Rosacea Support archives msg:9717 - A patient talks about their experiences with taking atenolol.
Isotretinoin is a powerful medication normally used for the treatment of acne but in low dosage can be used to treat rosacea. It is a retinoid, meaning it is derived from Vitamin A and is found naturally in the body, produced by the liver in small quantities. Isotretinoin is sold under many brand names, including Accutane® and Roaccutane® by Roche. It is also marketed as Accure® (Alphapharm), Oratane® (Douglas Pharmaceuticals), Isohexal® (Hexal Australia), Amnesteem® (Bertek) and Claravis® (Barr).
Isotretinoin is effective at treating rosacea but because of the many side effects it is normally prescribed after other treatments such as antibiotics have been tried. Isotretinoin is typically prescribed at between 0.5 mg/kg/day to 2.0 mg/kg/day for severe acne. For rosacea it is normally prescribed at a dose of 0.5 mg/kg/day to 1.0 mg/kg/day or lower.
17 of a study of 20 patents in a follow up one year after stopping treatment had no relapses showing a long-lasting favourable effect in rosacea.
Dr. Richard B. Odom in a article for Skin & Allergy News suggests using 10 mg of oral isotretinoin two or three times a week or 20 mg twice a week.
There are many acne treatments topicals which are used by mistake for rosacea. A lot of the time the acne products can have a drying effect which can further irritate the redness. A a popular rosacea treatment
- Rosacea Treatment Overview - Dr. Geoffrey Nase - Rosacea Researcher (http://www.drnase.com)
- Yahoo! Health - Antibiotics for rosacea (http://health.yahoo.com/ency/healthwise/tr6025)
- Rosacea Support archives - "Accutane is the only drug that helps reduce all of my rosacea symptoms". (http://health.groups.yahoo.com/group/rosacea-support/message/73790)
- Focus on low-dose accutane - Collection of recent papers and articles on low dose accutane and rosacea. (http://rosacea.ii.net/news/2006/01/focus-on-low-dose-accutane.html)
- Turjanmaa K, Reunala T. Isotretinoin treatment of rosacea. Acta Derm Venereol. 1987;67(1):89-91. Abstract
- Barbara Baker. Low-Dose, Pulsed Oral Isotretinoin May Clear Resistant Rosacea. Skin & Allergy News 30(12):23. Full article
- Erdogan FG, Yurtsever P, Aksoy D, Eskioglu F. Efficacy of low-dose isotretinoin in patients with treatment-resistant rosacea. Arch Dermatol. 1998 Jul;134(7):884-5. Full article
- Hoting E, Paul E, Plewig G. Treatment of rosacea with isotretinoin. Int J Dermatol. 1986 Dec;25(10):660-3. Abstract
- Frucht-Pery J, Sagi E, Hemo I, Ever-Hadani P. Efficacy of doxycycline and tetracycline in ocular rosacea. Am J Ophthalmol. 1993 Jul 15;116(1):88-92. Abstract
- Dahl MV, Katz HI, Krueger GG, Millikan LE, Odom RB, Parker F, Wolf JE Jr, Aly R, Bayles C, Reusser B, Weidner M, Coleman E, Patrignelli R, Tuley MR, Baker MO, Herndon JH Jr, Czernielewski JM. Topical Metronidazole Maintains Remissions of Rosacea. Arch Dermatol. 1998 Jun;134(6):679-83. Abstract