Oral antibiotics are a cornerstone of treatment for rosacea. They are particularly valuable when a patient presents with an acute flare-up or when topical creams like Ivermectin or Azelaic acid have failed to adequately control inflammation.
I find tetracycline antibiotics to be the most effective and most commonly prescreibe lymecycline. They likely work through a combination of reducing the quantity of bacteria in the hair follicles - which is a stimulus for inflammation - in combination with potent intrinsic anti-inflammatory properties. They reduce inflammatory cytokines decreasing the redness, tissue swelling, and inflammatory lesions seen with a rosacea flare.
Newer tetracyclines, such as lymecycline, are very well tolerated but can occasionally cause mild gastrointestinal upset. Unlike older tetracyclines such as doxycycline, lymecycline is less likely to increase sensitivity to sunlight.
