Systemic Treatments

Select Treatments:
  • What is it and how does it work?
  • Who is it for?
  • Who is it not for?
  • How well does it work?
  • What are the possible side effects?
  • Will it inconvenience me?
  • How much does it cost?

Systemic Treatments

What is it and how does it work?

Oral Tetracyclines

Tetracyclines reduce inflammation in rosacea.

Azithromycin

It is unclear how azithromycin works in rosacea.

Isotretinoin

Isotretinoin reduces the size of oil-producing glands and reducing oil production.

Who is it for?

Oral Tetracyclines

Moderate to severe pimples.

Azithromycin

Moderate to severe pimples.

Isotretinoin

Moderate to severe rosacea pimples that didn't respond to previous treatment, inflamed skin thickening that didn't respond to previous treatment.

Who is it not for?

Oral Tetracyclines

Patients sensitive to tetracyclines or other ingredients.

Minocycline: Patients with severe liver disease, kidney failure, certain immune system diseases (myasthenia gravis), or are pregnant/breastfeeding should avoid these drugs.

Azithromycin

Patients sensitive to azithromycin, erythromycin, other macrolide (eg, azalide or ketolide) antibiotics, or other ingredients. Patients with gallbladder/liver disease caused by prior azithromycin use.

Isotretinoin

Patients sensitive to isotretinoin, vitamin A, or other ingredients. Patients who are pregnant, breastfeeding, or have liver/kidney disease, high vitamin A, high blood fats, and who are also taking tetracyclines should not use this drug.

How well does it work?

Oral Tetracyclines

Doxycycline is 2 times more effective at reducing pimples of rosacea compared to no active treatment (high certainty).

Minocycline is non-inferior to doxycycline (low certainty).

Azithromycin

Azithromycin has the same chance of reducing pimples as doxycycline (very low certainty).

Isotretinoin

This treatment has about a 6 times greater chance of reducing pimples by 90% compared to no active treatment (high certainty).

What are the possible side effects?

Oral Tetracyclines

Skin darkening, reduced enamel, dental staining

Serious specific to minocycline: certain immune system conditions (e.g. drug induced lupus, autoimmune hepatitis.)

Other: Burning sensation, redness, skin peeling, darkening, itchiness, stinging, blood vessel lines, sun sensitivity, flushing, diarrhea, headache, increased blood glucose, belly enlargement, belly pain, diarrhea, upper belly pain, dry mouth, female genital fungal infections.

Pregnancy: Tetracyclines taken by the mother can reach the baby and cause harm. These drugs should be avoided during pregnancy. Category D.

Azithromycin

Serious: heart problems, gut infections/diarrhea, liver inflammation, allergic reactions.

Other: Diarrhea/constipation, nausea/vomiting. chest pain, facial swelling, heart racing, sweating, eczema, itchiness, light sensitivity, rash/hives, belly discomfort, fungal infection, vaginal inflammation, agitation, dizziness, drowsiness, fatigue, headache, insomnia, muscle spasms,, throat spasm, cough, water in the lungs, fever.

Pregnancy: Azithromycin taken by the mother can reach the baby. Category B.

Isotretinoin

Serious: Risk of birth defects if a child is conceived while taking medication.

Other: Back pain, joint stiffness, muscle/bone disease, decreased bone density.

Pregnancy: Category X; Not to be used in women who are or may become pregnant.

Will it inconvenience me?

Oral Tetracyclines

Involve taking pill(s) on a regular basis. Reminders for taking the pill(s) are required.

Azithromycin

Involve taking pill(s) on a regular basis. Reminders for taking the pill(s) are required.

Isotretinoin

Involve taking pill(s) on a regular basis. Reminders for taking the pill(s) are required.

How much does it cost?

Oral Tetracyclines

$+. Cost is based on price without insurance and may vary.

Azithromycin

$. Cost is based on price without insurance and may vary.

Isotretinoin

$$$. Cost is based on price without insurance and may vary.