A First-line Treatment
Oral medications, particularly antibiotics, are usually a first-line treatment for rosacea once acne-like papules and pustules appear. These drugs are typically prescribed in conjunction with topical medications, lifestyle changes, and laser and/or light therapy.
Antibiotics Fight Inflammation
Antibiotics have anti-inflammatory effects that seem to suppress the inflammation associated with rosacea. It’s thought that these drugs may also reduce the excess vascularity (formation of blood vessels) that plays such a central role in the development of the condition’s symptoms. The most common oral antibiotics prescribed for rosacea include tetracycline, doxycycline, and minocycline.
Because oral antibiotics can produce unwanted side effects, including an upset stomach and diarrhea, and because of the dangers of bacterial resistance, their long-term use is not recommended. You’ll most likely be prescribed these drugs until your symptoms have been brought under control, at which point topical medications, lifestyle changes, and laser and/or light treatments will be used to keep further flare-ups at bay.
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Isotretinoin for Severe Cases
For severe cases of rosacea—those, in particular, that involve cystic acne—doctors sometimes prescribe low doses of isotretinoin (Accutane or Roaccutane). This powerful drug, which is derived from vitamin A, appears to shrink the skin’s sebaceous glands, thus keeping papules and pustules from forming. Isotretinoin cannot be taken by women who are pregnant or who may become pregnant while on the drug, for it has been linked to birth defects.
Short-term Oral Steroids
Short-term (a week or less) doses of oral steroids may be prescribed in severe cases of rosacea to reduce swelling and inflammation to the point where topical antibiotics can then be comfortably applied.
Anti-Hypertensives for Severe Flushing
Some people have found that taking anti-hypertensive medications—drugs used to lower blood pressure—help reduce their symptoms of severe flushing. Obviously, these drugs are not for everybody, and you’ll need to discuss their pros and cons carefully with your physician.