minocycline and Rosacea

In this case report, we highlight minocycline-induced scleral hyperpigmentation, combined with ear and fingernail discoloration that developed after over 15 years of use for rosacea in a 78-year-old male with multiple medical comorbidities. Minocycline, a tetracycline antibiotic, is used to treat rosacea and acne as well as some orthopedic infections. It is typically used for extended periods of time; long-term use of minocycline is associated with hyperpigmentation of the sclera, conjunctiva, retina, teeth, skin, subcutaneous fat, oral mucosa, tympanic membrane, and gingiva. This case highlights that hyperpigmentation is more likely to occur in older patients than in younger patients. Scleral hyperpigmentation is not associated with vision loss; however, cosmetic concerns can prompt discontinuation of minocycline. Nonetheless, after cessation, the lesions persist in some patients. Monitoring for hyperpigmentation in patients using minocycline is important, as the hyperpigmentation is more likely to be permanent with long-term use.

Topics: Acne Vulgaris; Aged; Anti-Bacterial Agents; Humans; Hyperpigmentation; Male; Minocycline; Rosacea; Scleral Diseases; Vision Disorders

Exacerbation of rosacea may occur during pregnancy and there are multiple associated cases of rosacea fulminans (RF). Treatment during pregnancy poses a significant challenge as many rosacea treatments are contraindicated or have limited evidence regarding potential adverse fetal effects.. Review the pregnancy categories of various treatments and develop algorithms for treating pregnant patients with rosacea and RF.. Rosacea treatments showing efficacy in randomized controlled trials were searched through DailyMed to review pregnancy labelling. Searching the PubMed/MEDLINE database for English articles using keywords "rosacea fulminans AND pregnancy" without publishing-time restrictions yielded 8 articles. We summarized treatments used in cases of RF during pregnancy.. Topical ivermectin was more effective than metronidazole, but has a more concerning pregnancy category. Three pregnant women with RF were treated successfully with topical metronidazole in combination with other therapies. Azithromycin is the only oral rosacea therapy that is considered safe for pregnant patients and it has been used to treat RF.. This review highlights the challenging aspects of treating pregnant patients with rosacea, as there is limited pregnancy-related treatment efficacy and safety data. The pregnancy categories of therapeutic options are summarized. Further studies are needed to learn which therapies are effective and safe for use during pregnancy.

Topics: Adult; Algorithms; Animals; Anti-Bacterial Agents; Azithromycin; Brimonidine Tartrate; Dermatologic Agents; Dicarboxylic Acids; Doxycycline; Female; Humans; Isotretinoin; Ivermectin; Metronidazole; Mice; Minocycline; Phototherapy; Pregnancy; Pregnancy Complications; Randomized Controlled Trials as Topic; Rosacea; Tetracyclines; Treatment Outcome

Minocycline-induced pigmentation (MIP) is an uncommon but well-described adverse effect of oral minocycline treatment. MIP is clinically and histopathologically distinct from post-sclerotherapy pigmentation. We report a case of a patient presenting with blackened skin overlying veins recently treated with endovenous laser and foam sclerotherapy. The patient was a 44-year-old male with systemic sclerosis who commenced minocycline for the treatment of rosacea 5 months prior. Histological examination of the discolored tissue and underlying vein revealed hemosiderin deposition in the dermis and pigmented macrophages within the sub-endothelial layer of the vein wall with a staining pattern consistent with MIP. Venous tissue has not previously been reported in the literature as a target of minocycline pigmentation. Our patient preferred to control his rosacea by continuing to take minocycline. Follow-up ultrasound examinations revealed the treated vessels to be fully occluded with no evidence of recanalization, residual flow or ongoing thrombophlebitis. Despite a good sclerotherapy outcome, the pigmentation did not subside over 2 years. This case demonstrates that oral minocycline may induce significant and potentially long-term pigmentation in predisposed patients undergoing sclerotherapy.

Topics: Adult; Anti-Bacterial Agents; Dermatitis; Humans; Laser Therapy; Male; Minocycline; Phlebitis; Pigmentation; Rosacea; Scleroderma, Systemic; Sclerotherapy

Rosacea is one of the most commonly occurring dermatoses treated by dermatologists. There are multiple therapeutic options available for the treatment of papulopustular rosacea. Rosacea is an inflammatory condition, classically presenting with flushing and/or blushing along with erythema, edema, telangiectasia, papules, pustules, and nodules of the face. Minocycline, a member of the tetracycline family, has demonstrated benefit in the treatment of inflammatory lesions in patients with rosacea. This manuscript highlights the use of a new sustained-release low-dose minocycline 45 mg tablet, with or without azelaic acid, for the treatment of papulopustular rosacea.

Topics: Administration, Cutaneous; Administration, Oral; Delayed-Action Preparations; Dermatologic Agents; Dicarboxylic Acids; Double-Blind Method; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Male; Minocycline; Rosacea; Treatment Outcome

Cutaneous side effects of epidermal growth factor receptor inhibitors (EGFRIs) are very frequent and well known. The aim of our study was to investigate the efficacy and safety of pimecrolimus 1% cream in the treatment of papulopustular eruption caused by EGFRIs and to review the relevant literature on therapeutic approaches.. Twenty cancer patients being treated with EGFRIs were included in the study. Nine of the patients showed grade 1 and 11 showed grade 2 papulopustular eruption. All patients were treated with pimecrolimus 1% cream, which was applied twice daily. Patients with grade 2 eruption also received systemic minocycline 100 mg/day.. All patients with grade 1 eruption responded to treatment, with 4/9 experiencing complete resolution of the lesions 2 weeks after the initiation of treatment. Five out of 11 patients with grade 2 eruption had more than 50% improvement in erythema and pustules, and 1 had complete resolution of the skin lesions. Two patients did not respond to treatment but were significantly improved after substitution of pimecrolimus 1% cream with metronidazole 1% cream. No side effects were recorded.. Our case series shows that pimecrolimus cream may be an effective and safe approach in the management of papulopustular eruption related to EGFRIs.

Topics: Aged; Antineoplastic Agents; Dermatologic Agents; Drug Eruptions; ErbB Receptors; Female; Humans; Male; Metronidazole; Middle Aged; Minocycline; Neoplasms; Ointments; Prospective Studies; Protein Kinase Inhibitors; Rosacea; Tacrolimus; Treatment Outcome

Until recently, with the exception of oral isotretinoin for the treatment of severe recalcitrant nodular acne, systemic therapy for acne vulgaris and rosacea has been based on anecdotal support, clinical experience, and small clinical trials. Tetracycline derivatives are the predominant systemic agents that have been used for both disease states, prescribed in dose ranges that produce antibiotic activity. Anti-inflammatory dose doxycycline, a controlled-release (CR) 40-mg capsule formulation of doxycycline that is devoid of antibiotic activity when administered once daily, was US Food and Drug Administration (FDA)-approved for the treatment of inflammatory lesions (papules and pustules) of rosacea, based on large-scale phase 3 pivotal trials and long-term microbiologic and safety data. Also, an extended-release (ER) tablet formulation of minocycline was approved by the FDA for the treatment of inflammatory lesions of moderate to severe acne vulgaris in patients 12 years and older based on large-scale phase 3 clinical trials that evaluated efficacy and safety, dose-response analysis, and long-term data. This article discusses the studies and clinical applications related to the use of these agents.

Topics: Acne Vulgaris; Administration, Oral; Anti-Inflammatory Agents; Delayed-Action Preparations; Dose-Response Relationship, Drug; Doxycycline; Humans; Minocycline; Rosacea

Tetracyclines are broad-spectrum antibiotics that act as such at the ribosomal level where they interfere with protein synthesis. They were first widely prescribed by dermatologists in the early 1950s when it was discovered that they were effective as a treatment for acne. More recently, biologic actions affecting inflammation, proteolysis, angiogenesis, apoptosis, metal chelation, ionophoresis, and bone metabolism have been researched. The therapeutic effects of tetracycline and its analogues in various diseases have also been investigated. These include rosacea, bullous dermatoses, neutrophilic diseases, pyoderma gangrenosum, sarcoidosis, aortic aneurysms, cancer metastasis, periodontitis, and autoimmune disorders such as rheumatoid arthritis and scleroderma. We review the nonantibiotic properties of tetracycline and its analogues and their potential for clinical application.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Anti-Inflammatory Agents; Aortic Aneurysm, Abdominal; Apoptosis; Arthritis, Rheumatoid; Doxycycline; Humans; Matrix Metalloproteinases; Minocycline; Neoplasms; Neovascularization, Physiologic; Periodontitis; Rosacea; Sarcoma, Kaposi; Skin Diseases; Skin Diseases, Vesiculobullous; Tetracyclines

Topics: Anti-Infective Agents; Anti-Inflammatory Agents; Dermatologic Agents; Diagnosis, Differential; Dicarboxylic Acids; Doxycycline; Humans; Laser Therapy; Life Style; Metronidazole; Minocycline; Patient Education as Topic; Referral and Consultation; Risk Factors; Rosacea; Tetracycline

Although potentially significant adverse reactions and drug interactions have been reported in association with erythromycin, oral tetracyclines, and trimethoprim-sulfamethoxazole, overall these agents are associated with excellent safety profiles, especially considering their widespread use over many years. It must be considered that when these antibiotics are used for the treatment of rosacea and also for acne vulgaris, their use is on a long-term basis rather than their typical short-course regimens for most infectious diseases. As a result, dermatologists prescribing these agents may feel assured that most patients will not encounter any significant problems, but they do need to be aware of potential adverse reactions to allow for early recognition and discontinuation of the offending drug when needed. Early recognition also allows for favorable management of adverse reactions. In addition, potentially significant drug interactions may be recognized by obtaining a thorough medical history and avoiding combinations of drugs that may interact unfavorably. Fortunately, there are several choices that allow us to individually select a treatment regimen that is optimal for the individual patient, allowing for effective control of rosacea.

Topics: Administration, Oral; Anti-Bacterial Agents; Doxycycline; Erythromycin; Female; Humans; Male; Minocycline; Prognosis; Rosacea; Secondary Prevention; Severity of Illness Index; Tetracycline; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Anti-Bacterial Agents; Chronic Disease; Female; Humans; Minocycline; Rosacea; Syndrome; Thyroid Diseases; Thyroid Gland

Topics: Dermatologic Agents; Humans; Low-Level Light Therapy; Minocycline; Rosacea; Treatment Outcome

5-Aminolevulinic acid photodynamic therapy (ALA-PDT) showed potential to treat rosacea according to recent studies; however, a lack of clinical evidence and unclear adverse effects limit its use.. To compare the effect of ALA-PDT vs minocycline on rosacea.. In this single-center, randomized, evaluator-blind, controlled study, patients with moderate-to-severe rosacea were allocated to receive 3 to 5 sessions of ALA-PDT or 8 weeks of 100 mg daily minocycline treatment, followed by a 24-week follow-up.. Of all the 44 randomized patients, 41 received complete treatment (ALA-PDT: 20 and minocycline: 21 patients). At the end of treatment, ALA-PDT showed noninferior improvement of papulopustular lesions and Rosacea-specific Quality of Life compared with minocycline (median reduction of lesion count: 19 vs 22, median change of Rosacea-specific Quality of Life score: 0.48 vs 0.53). The Clinician's Erythema Assessment success of ALA-PDT was lower than that of minocycline's (35% vs 67%). Demodex density and relapse rate were comparable in both groups. Erythema, mild pain, and exudation were the most common adverse reactions of ALA-PDT.. Limited sample size restricted us from drawing further conclusions.. As minocycline does, ALA-PDT can improve rosacea mainly in papulopustular lesions and patients' quality of life, indicating a new option for rosacea.

Topics: Aminolevulinic Acid; Humans; Minocycline; Photochemotherapy; Photosensitizing Agents; Quality of Life; Rosacea; Treatment Outcome

In the rosacea an unstable skin microbiota is significant for disease progression. However, data on the influence on the skin microbiota of treatment with systemic antibiotics are limited. This single-arm trial recruited patients with rosacea. Oral minocycline 50 mg was administered twice daily for 6 weeks. The lesions on the cheek and nose were sampled for 16S rRNA amplicon sequencing and metagenomic sequencing at baseline, 3 weeks and 6 weeks of treatment. Physiological parameters were detected using non-invasive instruments. After treatment, distribution of the Investigator Global Assessment scores changed significantly. For the skin microbiota, a notable increase in α-diversity and a shift of structure were observed after treatment. Treatment was accompanied by a reduction in the relative abundance of Cutibacterium and Staphylococcus, indicating negative correlations with increased bacterial metabolic pathways, such as butyrate synthesis and L-tryptophan degradation. The increased butyrate and tryptophan metabolites would be conducive to inhibiting skin inflammation and promoting skin barrier repair. In addition, the abundance of skin bacterial genes related to tetracycline resistance and multidrug resistance increased notably after antibiotic treatment.

Topics: Anti-Bacterial Agents; Humans; Microbiota; Minocycline; RNA, Ribosomal, 16S; Rosacea; Skin

Inflammatory papulopustular rosacea produces sensitive facial skin. Thus, medications designed for rosacea require careful vehicle development to insure optimal drug delivery in an environment suitable for barrier repair.. The objective of this phase 1 study was to elucidate the barrier effects of an investigational topical minocycline anhydrous gel 3% in subjects with inflammatory rosacea.. 31 male or female subjects with all complexion types and moderate facial rosacea, defined as 15+ inflammatory facial lesions, were enrolled in this single-site study to evaluate the effects of an investigational topical 3% minocycline anhydrous gel vehicle on skin barrier function; the new topical minocycline gel is an investigational product under development and has completed a phase 2b study in rosacea patients. Following a 30-minute acclimation period, subjects underwent a one-minute transepidermal water loss (TEWL) measurement on the left cheek and triplicate pin probe corneometry measurements from the right cheek. Subjects used the investigational topical 3% minocycline anhydrous gel every evening and returned to the research center at day 1, week 2, and week 4.. 30/31 subjects completed the research study. The study medication produced a 23% (P=0.003) increase in skin hydration at day 1 and maintained the hydration increase with a 22% (P=0.003) increase at week 2 and a 20% increase (P=0.001) at week 4. Simultaneously, skin barrier function also improved with an 11% reduction in TEWL at day 1 followed by an 18% reduction in TEWL at week 2 (P=0.001) and a 28% decrease in TEWL at week 4 (P<0.001). This improvement in skin barrier was due to a combination of skin healing and the moisturizing properties of the investigational topical 3% minocycline anhydrous gel medication evaluated in this study.. The investigational topical 3% minocycline anhydrous gel decreases TEWL, indicating barrier repair, while increasing corneometry measurements, indicating improved skin hydration. J Drugs Dermatol. 2021;20(6):630-632. doi:10.36849/JDD.6105Visit the rosacea resource center.

Topics: Dermatologic Agents; Female; Humans; Male; Minocycline; Rosacea; Skin; Treatment Outcome; Water Loss, Insensible

Papulopustular rosacea is characterized by chronic facial erythema and inflammatory facial lesions. Minocycline has anti-inflammatory properties which may be effective in the treatment of rosacea inflammatory lesions.. To assess the safety and efficacy of once-daily topical minocycline gel 1% and 3% in patients with papulopustular rosacea.. This was a prospective, 12-week, double-blinded study conducted at 26 sites in the United States; 270 patients with papulopustular rosacea and 12-40 inflammatory lesions were randomized to minocycline 1%, minocycline 3% or vehicle. The primary endpoint was the mean change in inflammatory lesions at week 12. Key secondary endpoints included success on an Investigator's Global Assessment (IGA).. Baseline mean lesion counts were 24·6, 25·1 and 24·3 in the minocycline 1%, minocycline 3% and vehicle groups, respectively; at week 12, the counts had decreased by 12·6, 13·1 and 7·9, respectively. Minocycline significantly decreased lesions, compared with the vehicle [P = 0·01, 95% confidence interval (CI) 7·9 to 0·9, for minocycline 1%; P = 0·007, 95% CI 8·3 to 1·3, for minocycline 3%]. The proportion of patients achieving IGA success was 39% in the minocycline 1% arm [P = 0·34, odds ratio (OR) 1·396 and OR 95% CI 0·71 to 2·75 vs. vehicle], 46% in the minocycline 3% arm (P = 0·04, OR 2·03 and OR 95% CI 1·04 to 3·95 vs. vehicle) and 31% in the vehicle arm.. Minocycline topical gel appears to be safe and tolerable at concentrations of 1% and 3%, and both concentrations significantly decreased inflammatory lesion counts, with a significantly larger proportion of patients achieving IGA success at week 12 in the minocycline 3% arm. These findings support further evaluation of minocycline gel for treating inflammatory lesions associated with papulopustular rosacea. Linked Comment: Hampton. Br J Dermatol 2020; 183:412-413.

Topics: Administration, Cutaneous; Dermatologic Agents; Double-Blind Method; Humans; Minocycline; Prospective Studies; Rosacea; Treatment Outcome; United States

Efficacious topical medications for rosacea are needed. FMX103 1.5% is a novel topical minocycline foam that may have therapeutic benefits in treating rosacea while minimizing systemic adverse effects due to its topical route of delivery.. To determine the efficacy, safety, and tolerability of 12 weeks of treatment with FMX103 1.5% topical minocycline foam for papulopustular rosacea.. Two 12-week, phase 3, randomized, multicenter, double-blind, vehicle-controlled, 2-arm studies were performed in patients with moderate to severe papulopustular rosacea.. Participants who received FMX103 1.5%, versus control individuals treated with vehicle, exhibited a significantly greater reduction in the number of inflammatory lesions (FX2016-11: -17.57 vs -15.65; P = .0031; FX2016-12: -18.54 vs -14.88; P < .0001) and higher rates of Investigator Global Assessment treatment success (FX2016-11: 52.1% vs 43.0%; P = .0273; FX2016-12: 49.1% vs 39.0%; P = .0077). No serious treatment-related treatment-emergent adverse events occurred.. The generalizability of these data from a controlled clinical trial should be examined in a real-world setting.. FMX103 1.5% was efficacious for moderate to severe papulopustular rosacea and maintained a favorable safety profile.

Topics: Administration, Topical; Adult; Dermatologic Agents; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Female; Humans; Male; Middle Aged; Minocycline; Prognosis; Rosacea; Severity of Illness Index; Treatment Outcome; United States; Young Adult

Our objective was to demonstrate the safety, tolerability, and efficacy of a minocycline foam, FMX103, in the treatment of moderate-to-severe facial papulopustular rosacea.. This was a phase II, randomized, double-blind, multicenter study. Healthy subjects aged ≥ 18 years with moderate-to-severe rosacea that had been diagnosed ≥ 6 months previously and with ≥ 12 inflammatory facial lesions were randomized (1:1:1) to receive once-daily 1.5% FMX103, 3% FMX103, or vehicle for 12 weeks. The primary endpoint was the absolute change in inflammatory lesion count at week 12. Other assessments included grade 2 or higher Investigator's Global Assessment (IGA) improvement, IGA "clear" or "almost clear" (IGA 0/1), clinical erythema, and safety/tolerability. Safety and efficacy were evaluated at weeks 2, 4, 8, and 12, with a safety follow-up at week 16.. A total of 232 subjects were randomized; 213 completed the study. At week 12, inflammatory lesion count reduction was significantly greater for the 1.5 and 3% FMX103 doses than for vehicle (21.1 and 19.1 vs. 7.8, respectively; both p < 0.001). Both doses were significantly better than vehicle for achieving grade 2 or higher IGA improvement and assessment of "clear" or "almost clear." Both doses appeared generally safe and well tolerated. In total, 11 (4.7%) subjects reported treatment-related treatment-emergent adverse events (TEAEs); all but one (eye discharge) were dermal related, and all resolved by study end. No treatment-related systemic TEAEs were reported. Four subjects discontinued the study because of TEAEs (3% FMX103, n = 3; vehicle, n = 1).. Topical minocycline foam, FMX103, appeared to be an effective, safe, and well tolerated treatment for moderate-to-severe papulopustular rosacea. These results support further investigation in larger clinical trials. CLINICALTRIALS.. NCT02601963.

Topics: Administration, Cutaneous; Adult; Aged; Aged, 80 and over; Dermatologic Agents; Double-Blind Method; Female; Humans; Male; Middle Aged; Minocycline; Rosacea; Severity of Illness Index; Skin; Treatment Outcome; Young Adult

There is a lack of evidence for minocycline in the treatment of rosacea.. To compare the efficacy and safety of doxycycline 40 mg vs. minocycline 100 mg in papulopustular rosacea.. In this randomized, single-centre, 1 : 1 allocation, assessor-blinded, noninferiority trial, patients with mild-to-severe papulopustular rosacea were randomly allocated to either oral doxycycline 40 mg or minocycline 100 mg for a 16-week period with 12 weeks of follow-up. Our primary outcomes were the change in lesion count and change in patient's health-related quality of life (using RosaQoL). Intention-to-treat and per protocol analyses were performed.. Of the 80 patients randomized (40 minocycline, 40 doxycycline), 71 were treated for 16 weeks. Sixty-eight patients completed the study. At week 16, the median change in lesion count was comparable in both groups: doxycycline vs. minocycline, respectively 13 vs. 14 fewer lesions. The RosaQoL scores were decreased for both doxycycline and minocycline, respectively by 0·62 and 0·86. Secondary outcomes were comparable except for Investigator's Global Assessment success, which was seen significantly more often in the minocycline group than in the doxycycline group (60% vs. 18%, P < 0·001). At week 28, outcomes were comparable, except for RosaQoL scores and PaGA, which were significantly different in favour of minocycline (P = 0·005 and P = 0·043, respectively), and fewer relapses were recorded in the minocycline group than in the doxycycline group (7% and 48%, respectively; P < 0·001). No serious adverse reactions were reported.. Minocycline 100 mg is noninferior to doxycycline 40 mg in efficacy over a 16- week treatment period. At follow-up, RosaQoL and PaGA were statistically significantly more improved in the minocycline group than in the doxycycline group, and minocycline 100 mg gives longer remission. In this study there was no significant difference in safety between these treatments; however, based on previous literature minocycline has a lower risk-to-benefit ratio than doxycycline. Minocycline 100 mg may be a good alternative treatment for those patients who, for any reason, are unable or unwilling to take doxycycline 40 mg.

Topics: Administration, Oral; Anti-Bacterial Agents; Dermatologic Agents; Doxycycline; Drug Administration Schedule; Facial Dermatoses; Female; Humans; Male; Minocycline; Quality of Life; Recurrence; Rosacea; Single-Blind Method; Treatment Outcome

Rosacea is one of the most commonly occurring dermatoses treated by dermatologists. There are multiple therapeutic options available for the treatment of papulopustular rosacea. Rosacea is an inflammatory condition, classically presenting with flushing and/or blushing along with erythema, edema, telangiectasia, papules, pustules, and nodules of the face. Minocycline, a member of the tetracycline family, has demonstrated benefit in the treatment of inflammatory lesions in patients with rosacea. This manuscript highlights the use of a new sustained-release low-dose minocycline 45 mg tablet, with or without azelaic acid, for the treatment of papulopustular rosacea.

Topics: Administration, Cutaneous; Administration, Oral; Delayed-Action Preparations; Dermatologic Agents; Dicarboxylic Acids; Double-Blind Method; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Male; Minocycline; Rosacea; Treatment Outcome

Cutaneous side effects of epidermal growth factor receptor inhibitors (EGFRIs) are very frequent and well known. The aim of our study was to investigate the efficacy and safety of pimecrolimus 1% cream in the treatment of papulopustular eruption caused by EGFRIs and to review the relevant literature on therapeutic approaches.. Twenty cancer patients being treated with EGFRIs were included in the study. Nine of the patients showed grade 1 and 11 showed grade 2 papulopustular eruption. All patients were treated with pimecrolimus 1% cream, which was applied twice daily. Patients with grade 2 eruption also received systemic minocycline 100 mg/day.. All patients with grade 1 eruption responded to treatment, with 4/9 experiencing complete resolution of the lesions 2 weeks after the initiation of treatment. Five out of 11 patients with grade 2 eruption had more than 50% improvement in erythema and pustules, and 1 had complete resolution of the skin lesions. Two patients did not respond to treatment but were significantly improved after substitution of pimecrolimus 1% cream with metronidazole 1% cream. No side effects were recorded.. Our case series shows that pimecrolimus cream may be an effective and safe approach in the management of papulopustular eruption related to EGFRIs.

Topics: Aged; Antineoplastic Agents; Dermatologic Agents; Drug Eruptions; ErbB Receptors; Female; Humans; Male; Metronidazole; Middle Aged; Minocycline; Neoplasms; Ointments; Prospective Studies; Protein Kinase Inhibitors; Rosacea; Tacrolimus; Treatment Outcome

To observe the clinical efficacy of Chibixiao Recipe (CBX) in combination with minocycline and spironolactone in treating rosacea in females.. Sixty-eight women with rosacea were randomly assigned to the treated group (48 cases) and the control group (20 cases), both of which were treated with minocycline and spironolactone taken orally, but to the treated group, the Chinese herbal recipe, CBX was given additionally. Besides, cryotherapy with liquid nitrogen was applied to those with apparent capillary dilatation. The therapeutic course for both groups was 8 weeks. The levels of serum testosterone before and after treatment were determined by radioimmunoassay (RIA), and a 4-month follow-up was conducted.. In the treated group the cure-markedly effective rate was 87.5% and the recurrent rate was 6.5%, while in the control group, they were 45.0% and 41.2% respectively. Comparisons in the indexes between the two groups all showed significant difference (both P<0.01), with the cure-markedly effective rate higher, and the recurrent rate lower in the treated group. The serum level of testosterone got lowered in both groups ( P<0.05 and P<0.01), but the lowering in the treated group was more significant, showing significance when compared with that in the control group ( P<0.01).. CBX in combination with Western medicine has effect in treating rosacea superior to that of Western medicine alone, and could effectively reduce recurrent rate and the serum level of testosterone. female rosacea, testosterone, Chibixiao Recipe, minocycline, spironolactone

Topics: Adult; Drug Therapy, Combination; Female; Humans; Medicine, Chinese Traditional; Middle Aged; Minocycline; Recurrence; Rosacea; Spironolactone; Testosterone

Symptomatic dermographism (SD) is the most common form of chronic inducible urticarias. The etiology of this disease has rarely been reported in the literature. Minocycline is widely used in the treatment of acne, rosacea, and other inflammatory skin diseases. Herein we report four cases of SD onset during minocycline administration. These were young women in their 20s to 30s who were taking minocycline orally for acne vulgaris or rosacea. They all experienced the onset of SD 2-3 weeks after taking the drug, and then the complete disappearance of SD 1 month after stopping the drug. Minocycline was thought to be the culprit drug in these cases as other drugs were ruled out on clinical grounds. Our small series suggests that oral minocycline may induce SD, thus raising the awareness of this association in clinical practice. More research is needed to further confirm this association and reveal the underlying mechanism(s).

Topics: Acne Vulgaris; Anti-Bacterial Agents; Chronic Inducible Urticaria; Female; Humans; Minocycline; Rosacea; Urticaria

Topics: Facial Dermatoses; Humans; Hyperpigmentation; Lupus Vulgaris; Minocycline; Rosacea

Rosacea is a common inflammatory facial skin condition affecting the adult population. Its papulopustular subtype is mainly treated pharmacologically by topical and oral antibiotics. For severe or antibiotics-recalcitrant disease, daily low-dose isotretinoin has also been reported to be effective. However, no previous study has assessed the efficacy of once-weekly administered isotretinoin for papulopustular rosacea. For this purpose, a retrospective comparative study was conducted. For severe rosacea, 40 mg/week isotretinoin (24 patients) was administered. For mild to moderate rosacea, once-weekly 20 mg/week isotretinoin (28 patients) was compared with 100 mg/day minocycline (24 patients). Treatment courses lasted 4 to 7 months. Forty milligrams per week isotretinoin was highly effective for severe rosacea, achieving complete response (over 90% improvement) in 62.5% of patients and partial response (50%-90% improvement) in additional 29.2% of patients. Twenty milligrams per week isotretinoin and hundred milligrams per day minocycline showed comparable efficacy for mild to moderate rosacea (complete response of 10.7% vs 8.3% and partial response of 28.6% vs 33.3%, respectively). This study demonstrates that that the use of a weekly low-dose isotretinoin is an effective treatment for papulopustular rosacea, including among patients with severe disease.

Topics: Adult; Anti-Bacterial Agents; Dermatologic Agents; Humans; Isotretinoin; Minocycline; Retrospective Studies; Rosacea

Topics: Double-Blind Method; Humans; Minocycline; Rosacea

Topics: Aged; Anti-Bacterial Agents; Face; Female; Gingival Diseases; Humans; Hyperpigmentation; Minocycline; Pigmentation Disorders; Rosacea

Topics: Administration, Topical; Adult; Anti-Bacterial Agents; Dermatologic Agents; Female; Humans; Minocycline; Pregnancy; Rosacea

Intense pulsed light (IPL) is a good option for erythema and telangiectasia of rosacea. Demodex, which is light and heat sensitive, is an important risk of Rosacea. Sometimes, IPL can induce rosacea aggravation. Here, we show two cases of erythema rosacea aggravated as pustule in several hours after IPL. Both cases show high density of Demodex after IPL. Neither of them had photosensitivity, systemic disease, or any other contraindication for IPL. One of the patients received IPL again after Demodex infection relieved and this time there was no inflammation induction. We need to attract more attention to IPL-induced rosacea aggravation and latent Demodex infection may act as a cofactor.

Topics: Adult; Animals; Anti-Bacterial Agents; Biopsy; Erythema; Female; Follow-Up Studies; Humans; Immunosuppressive Agents; Intense Pulsed Light Therapy; Middle Aged; Minocycline; Mite Infestations; Retrospective Studies; Rosacea; Skin; Skin Cream; Tacrolimus; Telangiectasis; Treatment Outcome

Topics: Acne Vulgaris; Anti-Bacterial Agents; Female; Humans; Hyperpigmentation; Middle Aged; Minocycline; Rosacea

Topics: Anti-Bacterial Agents; Doxycycline; Humans; Minocycline; Rosacea

In paediatric rosacea, ocular symptoms are often predominant. Literature about systemic therapy of paediatric ocular rosacea is sparse, though.. Analysis of children with ocular rosacea treated systemically, particularly addressing remission and recurrence rates.. Retrospective study reviewing the medical records of children with ocular rosacea treated with systemic antibiotic therapy. Nine of 19 patients were chosen for detailed analysis. To our knowledge, this is the first study in paediatric ocular rosacea requiring systemic therapy with a larger patient group and a longer follow-up (mean follow-up = 30.2 months).. 17 patients (89.5%) suffered from blepharitis, 15 patients (78.9%) from conjunctivitis, twelve patients (63.2%) from chalazia/styes and nine female patients (47.4%) from corneal involvement. We used erythromycin (n = 9) or roxithromycin (n = 1) in patients younger than 8 years and doxycycline (n = 8) or minocycline (n = 1) in patients older than 8 years. Seven of nine patients treated with erythromycin, one of eight patients treated with doxycycline and the patient treated with minocycline achieved a complete remission of ocular and cutaneous symptoms. Two of nine patients treated with erythromycin, seven of eight patients treated with doxycycline and the patient treated with roxithromycin achieved a partial remission. Relapses occurred in the patient treated with minocycline (cutaneous), two of eight patients treated with doxycycline (ocular and cutaneous) and one of nine patients treated with erythromycin (cutaneous).. To achieve a complete remission of cutaneous and ocular rosacea, a long-term anti-inflammatory treatment of at least 6 months is necessary. The relapse rates seem to be lower than in adults especially in the patients treated with erythromycin.

Topics: Adolescent; Child; Child, Preschool; Doxycycline; Erythromycin; Eye Diseases; Female; Humans; Infant; Male; Minocycline; Recurrence; Remission Induction; Retrospective Studies; Rosacea; Roxithromycin; Skin Diseases

Topics: Adult; Anti-Bacterial Agents; Female; Humans; Livedo Reticularis; Middle Aged; Minocycline; Polyarteritis Nodosa; Rosacea

Topics: Adult; Anti-Bacterial Agents; Dermatologic Agents; Drug Therapy, Combination; Female; Humans; Minocycline; Propranolol; Rosacea; Tranexamic Acid; Treatment Outcome

This is a report of an 80-year-old man with a history of rosacea and rhinophyma treated for 15 years with oral minocycline who developed significant minocycline-induced hyperpigmentation. He also had a history of Fuchs' endothelial dystrophy and had undergone penetrating keratoplasty in the right eye. Best-corrected visual acuity was 20/60 in both eyes. Examination revealed slate-grey hyperpigmentation of his body, face, and sclera and black, confluent pigmentation in the central maculae of both eyes. Green wavelength fundus autofluorescence demonstrated speckled hyperautofluorescence in the right eye, and swept-source OCT and OCTA demonstrated pigmented epithelial detachments and significant signal blocking without choroidal neovascularization.

Topics: Administration, Oral; Aged, 80 and over; Anti-Bacterial Agents; Fluorescein Angiography; Humans; Hyperpigmentation; Male; Minocycline; Multimodal Imaging; Optical Imaging; Prospective Studies; Retinal Detachment; Retinal Pigment Epithelium; Rhinophyma; Rosacea; Tomography, Optical Coherence

Demodex mites seem to serve as a pathogenic trigger in many Demodex-associated diseases such as rosacea. In facial skin of patients with rosacea significantly higher numbers of Demodex mites have been shown compared with healthy controls. Reflectance confocal microscopy (RCM) allows the detection and quantification of Demodex mites in vivo noninvasively. It is hypothesized that a reduction of Demodex mites under rosacea therapy can be monitored by RCM.. To use RCM to monitor the density of Demodex mites in patients with rosacea before and after treatment.. In 25 patients with facial rosacea RCM was performed before and after therapy. Mosaics of 5 × 5 mm(2) and 8 × 8 mm(2) were scanned, and the total numbers of mites per follicle and per area were counted, along with the number of follicles per area.. In all patients Demodex folliculorum could be detected and quantified using RCM. RCM showed significant differences pre- and post-treatment (P = 0.0053 for 5 × 5 mm(2) and P < 0.001 for 8 × 8 mm(2)). The mean numbers of mites per follicle were 0.63 (range 0.16-2.28) per 8 × 8 mm(2) area and 0.70 (range 0.11-2.20) per 5 × 5 mm(2) area before treatment, and 0.41 (range 0.074-1.75) and 0.51 (range 0.094-1.70), respectively, after treatment. The corresponding mean numbers of mites were 155 (range 45-446) and 86.2 (range 12-286), respectively, before treatment and 96.2 (range 18-363) and 58.5 (range 12-230), respectively, after treatment.. By RCM, a reduction in the density of Demodex mites in facial skin of patients with rosacea under therapy, correlating to clinical improvement, can be quantified and monitored noninvasively. Possible reasons for this therapeutic effect are discussed.

Topics: Adult; Aged; Animals; Anti-Infective Agents; Doxycycline; Drug Therapy, Combination; Facial Dermatoses; Female; Hair Follicle; Humans; Male; Metronidazole; Microscopy, Confocal; Middle Aged; Minocycline; Mite Infestations; Mites; Prospective Studies; Rosacea; Treatment Outcome

Topics: Anti-Bacterial Agents; Face; Female; Humans; Lymphedema; Middle Aged; Minocycline; Rosacea

Topics: Animals; Facial Dermatoses; Female; Humans; Male; Minocycline; Mite Infestations; Rosacea

Topics: Aged; Anti-Bacterial Agents; Fluorescein Angiography; Humans; Male; Minocycline; Retinal Diseases; Retinal Pigment Epithelium; Rosacea; Scleral Diseases; Tomography, Optical Coherence; Visual Acuity

Topics: Acne Vulgaris; Aged; Anti-Bacterial Agents; Humans; Incidence; Male; Minocycline; Nails; Pigmentation Disorders; Rosacea; Skin; Treatment Outcome

Millions of rosacea sufferers are not being treated, and the reasons they do not get treatment are not well characterized.. The aim of this study is to determine the main reasons for visit, providers seen and treatments used for rosacea.. We used data from the National Ambulatory Medical Care Survey for 1993-2010, tabulating the leading reasons for visit, providers seen and treatments used in rosacea visits.. There were 1 750 000 visits per year for rosacea. The leading reasons for visit were other diseases of the skin (25.3%), skin rash (19.6%), and discoloration or abnormal pigmentation (14.7%). Dermatologists managed 72.4% of visits. The most common treatments used were topical metronidazole (29.3%), tetracycline (11.0%), minocycline (8.5%), doxycycline (7.9%), and oral metronidazole (6.9%).. Some reasons for visit were too nonspecific to provide good insight on why the patient made a visit.. Dermatologists manage rosacea most commonly, but primary care physicians need the proper training to diagnose it correctly. Improved strategies to reach untreated people with rosacea are needed.

Topics: Administration, Oral; Administration, Topical; Ambulatory Care; Anti-Infective Agents; Dermatology; Doxycycline; Female; Health Care Surveys; Humans; Metronidazole; Minocycline; Rosacea; Tetracycline; United States

Patients with rosacea frequently report increased skin sensitivity, with features suggestive of an abnormal stratum corneum (SC) permeability barrier. Sebum, pH and hydration levels influence epidermal homeostasis. The correlation of changes in these parameters with clinically effective treatment has not been previously analysed.. To analyse sebum, pH and epidermal hydration levels of patients with papulopustular rosacea (PPR) before and after treatment with systemic minocycline.. We analysed sebum casual levels, pH and hydration along with erythema levels (as a marker of disease activity and response to treatment) on seven designated facial sites of 35 patients with active PPR and compared the results with values on the same sites of 34 control subjects with normal facial skin. To determine the effect of minocycline on these parameters, we re-examined the patients with PPR at the same sites after a 6-week course of treatment.. Patients with untreated PPR had significantly increased erythema indices, normal sebum casual levels, a more alkaline centrofacial region and reduced epidermal hydration levels compared with controls. Treatment with minocycline resulted in reduced erythema and increased hydration levels, with the most marked changes evident in the cheeks (13·3% reduction in erythema indices, P < 0·001; 12·4% increase in hydration levels, P = 0·012). There was no change in skin pH or sebum casual levels following treatment.. Patients with PPR have increased erythema indices, normal sebum casual levels, a more alkaline centrofacial region and reduced epidermal hydration levels compared with control subjects. Treatment with systemic minocycline reduces erythema and increases hydration, in the absence of any change in skin pH or sebum casual levels.

Topics: Adult; Aged; Body Water; Case-Control Studies; Dermatologic Agents; Electric Capacitance; Erythema; Facial Dermatoses; Female; Humans; Hydrogen-Ion Concentration; Male; Middle Aged; Minocycline; Rosacea; Sebum; Treatment Outcome

Topics: Aged; Anti-Bacterial Agents; Humans; Male; Minocycline; Pigmentation Disorders; Rosacea; Scleral Diseases; Skin Pigmentation

Patients with papulopustular rosacea (PPR) frequently complain of dry, sensitive skin. We have previously demonstrated that patients with PPR have reduced skin surface hydration levels in the presence of normal sebum casual levels, suggesting that it may be the quality and not the quantity of sebum that plays a role in PPR.. To compare the sebaceous fatty acid composition of patients with PPR to that of controls with normal facial skin.. The sebaceous fatty acid composition of 25 patients with PPR and 24 age- and sex-matched controls was analysed by gas chromatography - mass spectrometry. Results  Myristic acid (C14:0) was present in greater concentrations in PPR sebum, while the long chain saturated fatty acids arachidic acid (C20:0), behenic acid (C22:0), tricosanoic acid (C23:0) and lignoceric acid (C24:0) as well as the monounsaturated fatty acid cis-11-eicosanoic acid (C20:1) were present in the sebum of patients with PPR in lesser concentrations as compared with controls.. There is increasing evidence that sebaceous fatty acids play a role in the maintenance of skin barrier integrity. We have shown for the first time that patients with PPR have an abnormal sebaceous fatty acid composition, with reduced levels of long chain saturated fatty acids. These new findings may have therapeutic implications for the development of sebum-modifying nonantibiotic treatments for patients with PPR.

Topics: Adult; Aged; Case-Control Studies; Dermatologic Agents; Fatty Acids; Female; Gas Chromatography-Mass Spectrometry; Humans; Male; Middle Aged; Minocycline; Rosacea; Sebaceous Glands; Sebum

Topics: Anti-Bacterial Agents; Humans; Male; Middle Aged; Minocycline; Nail Diseases; Pigmentation Disorders; Rosacea; Skin Pigmentation

Topics: Administration, Topical; Aged, 80 and over; Anti-Bacterial Agents; Anti-Infective Agents; Antineoplastic Agents; Female; Humans; Immunohistochemistry; Interferon-gamma; Lymphoma, B-Cell, Marginal Zone; Metronidazole; Minocycline; Nose; Recombinant Proteins; Rosacea; Skin Neoplasms

Was this a case of Addison's disease, hemochromatosis, or melanoma? Or did one of the patient's medications have something to do with it?

Topics: Addison Disease; Aged; Anti-Bacterial Agents; Comorbidity; Diagnosis, Differential; Face; Female; Humans; Hyperpigmentation; Minocycline; Rosacea; Scleral Diseases

Topics: Aged; Esthetics; Facial Dermatoses; Female; Humans; Hyperpigmentation; Laser Therapy; Minocycline; Patient Satisfaction; Risk Assessment; Rosacea; Severity of Illness Index; Treatment Outcome

Topics: Aged; Anti-Bacterial Agents; Azithromycin; Doxycycline; Humans; Male; Minocycline; Rosacea

Phymas (swellings, masses, or bulbs) are considered the end-stage of rosacea and mostly affect the nose (rhinophyma), and rarely involve the chin (gnatophyma), the cheek (metophyma), eyelids (blepharophyma), or ears (otophyma). Herein, we report the case of a 57-year-old man who developed unilateral enlargement of his left ear over 2 years. Biopsy revealed changes of rosaceous lymphedema associated with Demodex infestation. Corticosteroid and minocycline therapies resulted in partial reduction of the ear enlargement. Literature review examining for cases of lymphedema (elephantiasis) of the ear revealed that chronic inflammatory disorders (rosacea (most frequent), psoriasis, eczema), bacterial cellulitis (erysipelas), pediculosis, trauma, and primary (congenital) lymphedema can all lead to localized, lymphedematous enlargement of the ear. Depending on the severity, medical treatment directed at the inflammatory condition for mild, diffuse enlargement to surgical debulking for extensive diffuse enlargement or tumor formation can improve the signs and symptoms of otophyma. Decreased immune surveillance secondary to rosaceous lymphedema may explain why Demodex infestation is common in rosacea and support the suspicion that phymatous skin is predisposed to skin cancer development.

Topics: Adrenal Cortex Hormones; Alcoholism; Anti-Infective Agents; Anti-Inflammatory Agents; Antidepressive Agents, Second-Generation; Antihypertensive Agents; Dapsone; Doxycycline; Ear Deformities, Acquired; Elephantiasis; Fenofibrate; Fluoxetine; Humans; Hydrochlorothiazide; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hypercholesterolemia; Hypertension; Hypolipidemic Agents; Insecticides; Male; Middle Aged; Minocycline; Mite Infestations; Mood Disorders; Permethrin; Prednisone; Rosacea; Triamcinolone

There are few treatments that address both papulopustular and telangiectatic components of rosacea. We present a case of rosacea that was unresponsive to treatment with antibiotics. We report the novel use of a new laser technology, the multiplexed laser, for treatment of both papular and telangiectatic rosacea.

Topics: Administration, Cutaneous; Anti-Bacterial Agents; Chronic Disease; Combined Modality Therapy; Female; Humans; Low-Level Light Therapy; Middle Aged; Minocycline; Rosacea; Time Factors

Minocycline-induced nail pigmentation is an uncommon side-effect. It usually develops after years of the therapy, and coincides with other pigmented sites. We report a 73-year-old male and a 33-year-old female developing nail discoloration after 8 weeks of therapy of 100 mg minocycline twice daily. No other pigmentation was found elsewhere on the skin, mucous membranes, teeth or sclerae of them. Our cases demonstrate that nail pigmentation can occur after short-term minocycline therapy, and propose the possibility that nail discoloration may precede other pigmentary changes.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Female; Humans; Male; Middle Aged; Minocycline; Nail Diseases; Pigmentation Disorders; Pseudolymphoma; Rosacea; Time Factors

Topics: Administration, Oral; Administration, Topical; Humans; Male; Metronidazole; Middle Aged; Minocycline; Rosacea; Tetracycline

A 9-year-old female developed facial papules and pustules since four years. Clinically, perioral dermatitis was suspected. Different topical therapy regimens and systemic anibiotics had been unsuccessful and a skin biopsy showed granulomatous (lupoid) rosacea. Only systemic antibiotic treatment with minocyclin led to healing of the skin lesions. While granulomatous rosacea-like dermatitis is more frequently diagnosed in adults, it is only rarely encountered in children where, in most of the cases, it represents a therapeutic challenge.

Topics: Anti-Bacterial Agents; Biopsy; Child; Drug Resistance; Drug Therapy, Combination; Female; Humans; Minocycline; Permethrin; Retreatment; Rosacea; Roxithromycin; Skin; Tretinoin

Granulomatous rosacea is a variant of rosacea that may present similar to other granulomatous diseases. We present the case of a 45-year-old woman with a 2-year history of facial erythema with multiple papules and pustules on the cheeks, chin, and glabella. The patient responded to minocycline, resulting in healing 6 months without residual scarring. This patient's clinical and histological presentation and treatment outcome are to our assessment consistent with granulomatous rosacea. However, other clinically and histologically related entities will be discussed. These entities include, but are not limited to, perioral dermatitis, granulomatous periorificial dermatitis, lupus miliaris disseminatus faciei, facial afro-caribbean eruption syndrome, and sarcoidosis.

Topics: Dermatitis, Perioral; Diagnosis, Differential; Facial Dermatoses; Female; Granuloma; Humans; Middle Aged; Minocycline; Remission Induction; Rosacea; Skin Diseases, Papulosquamous; Tuberculoma

Minocycline-induced dark pigmentation has been described affecting the oral cavity (teeth, mucosa, alveolar bone), skin, nails, eyes and thyroid. To date, there is no report of other bones being affected. We report a case of black pigmentation of the acromian in a patient who had used minocycline on a long-term basis for acne rosecea. Biopsy of the iliac crest revealed that the pelvis was also affected.

Topics: Anti-Bacterial Agents; Bone Diseases; Diagnosis, Differential; Humans; Humerus; Male; Middle Aged; Minocycline; Pigmentation Disorders; Rosacea

To present a patient with rosacea lymphoedema of one upper eyelid resulting in unilateral complete ptosis.. A 51-year-old white man presented with a 12-month history of progressive painless swelling of the left upper eyelid. An incisional biopsy of the upper eyelid was performed.. The biopsy showed dermal oedema with lymphangiectasia and telangiectasia, accompanied by a mild to moderate mixed chronic inflammatory infiltrate of lymphocytes, histiocytes, plasma cells and rare eosinophils. Stains for fungi and mycobacteria were negative. The lack of lichenoid reaction, dermal mucin or lip swelling indicated a lymphoedematous manifestation of rosacea. The patient was treated with minocycline and prednisolone with no effect.. Rosacea lymphoedema involving the eyelid, as in our case, is a rare complication and can present diagnostic and therapeutic challenges to the ophthalmologist.

Topics: Anti-Bacterial Agents; Blepharoptosis; Drug Therapy, Combination; Eyelid Diseases; Glucocorticoids; Humans; Lymphedema; Male; Middle Aged; Minocycline; Prednisolone; Rosacea

The objective of this research was to determine the effect of oral minocycline on the meibomian gland nonpolar and free fatty acid lipids of chronic blepharitis patients. Patients--seborrheic blepharitis (SBBL), acne rosacea (AR) without ocular involvement, and acne rosacea with meibomianitis (AR-MKC). Minocycline treatment--50mg orally for 2 weeks followed by 100mg to the end of 3 months; this was followed by 3 more months with no treatment. Meibomian gland secretions (meibum) were collected before treatment, at the end of the 3 months on treatment, and 3 months after stopping treatment. Lipids were separated and analyzed for wax and sterol esters, triglycerides, diglycerides, free cholesterol and free fatty acids. Data were analyzed statistically by ANOVA. Minocycline treatment resulted in decreased diglycerides and free fatty acids in the group AR-MKC, which continued into the second 3 months (off treatment) and was significant. Cholesterol decreased, but triglycerides initially decreased with treatment and then increased when treatment in the group was discontinued (second 3 months); these results, however, were not significant. Thus, minocycline has its greatest effect on lipid types, which result from degradation (lipase) reactions, suggesting a lipase inhibition effect and/or direct effect on ocular flora. This minocycline effect continues even after treatment is discontinued, suggesting a more lasting effect on ocular microflora. Minocycline may be most effective when the treatment period is longer than 3 months. These results give insight into disease mechanisms associated with chronic blepharitis.

Topics: Analysis of Variance; Blepharitis; Chronic Disease; Diglycerides; Drug Administration Schedule; Fatty Acids, Nonesterified; Follow-Up Studies; Humans; Lipid Metabolism; Meibomian Glands; Minocycline; Rosacea

To assess the effect of minocycline on the ocular flora in patients with acne rosacea or blepharitis.. A total of ten patients were enrolled in this prospective study, with six patients diagnosed with acne rosacea with concomitant meibomianitis, two patients with acne rosacea without concomitant ocular involvement, and two patients with seborrheic blepharitis. The eyelids and conjunctiva of both eyes were cultured before the initiation of systemic minocycline therapy, after 3 months of active therapy, and 3 months after the discontinuation of therapy. Isolated bacteria were identified and quantified, and antibiotic susceptibility was determined.. The colony-forming units (CFU) isolated from the eyelids significantly decreased after a 3-month treatment with minocycline (P = 0.0013). The CFU significantly increased to approach that of the baseline with the discontinuation of minocycline (P = 0.0275). The most common isolated bacteria, including coagulase-negative Staphylococcus (CNS), Staphylococcus aureus (S. aureus), and Propionibacterium acne (P. acne), except for corynebacterium, had a significant decrease in bacterial count with minocycline therapy compared with baseline (P < 0.05). There was a trend in the decrease of bacterial CFU isolated from the conjunctiva with minocycline therapy, although this was not statistically significant (P = 0.1955). Four of the ten patients carried tetracycline-resistant CNS strains, but none of the S. aureus or P. acne isolated at baseline was resistant to tetracycline. All six patients with acne rosacea and concomitant meibomianitis had marked clinical improvement.. Minocycline effectively decreased eyelid bacterial flora in patients with acne rosacea or blepharitis. One of the mechanisms of newer generation tetracycline analogues may be a decrease or elimination of bacterial flora from the eyelids.

Topics: Anti-Bacterial Agents; Bacteria; Blepharitis; Colony-Forming Units Assay; Dermatitis, Seborrheic; Drug Administration Schedule; Eye; Humans; Minocycline; Prospective Studies; Rosacea; Stem Cells

Topics: Adult; Anemia, Iron-Deficiency; Biopsy; Criminology; Drug Eruptions; Female; Ferric Compounds; Humans; Hyperpigmentation; Injections, Intramuscular; Male; Middle Aged; Minocycline; Rosacea; Silver Nitrate; Skin; Theft

Topics: Aged; Anti-Bacterial Agents; Female; Humans; Leg; Minocycline; Pigmentation Disorders; Rosacea; Skin Pigmentation

Topics: Adult; Anti-Bacterial Agents; Antibodies, Antinuclear; Female; Humans; Lupus Erythematosus, Systemic; Minocycline; Rosacea; Syndrome

Topics: Aged; Anti-Bacterial Agents; Diagnosis, Differential; Facial Dermatoses; Female; Humans; Minocycline; Pigmentation Disorders; Rosacea; Scleral Diseases

Minocycline can cause hyperpigmentation of the conjunctiva, oral mucosa, and skin. Pigmentation of the oral mucosa may also be associated with a variety of endogenous or exogenous factors. Lingual pigmentation may be seen in Addison's disease, amalgam tatoo, malignant melanoma, Peutz-Jegher's syndrome, and other diseases. Two women who had isolated pigmentation of the tongue while taking minocycline are described; no other drug-induced pigmentation of their oral mucosa or skin occurred. Minocycline-induced pigmentation should be added to the differential diagnosis of isolated lingual hyperpigmentation.

Topics: Acne Vulgaris; Adult; Female; Humans; Hyperpigmentation; Middle Aged; Minocycline; Mouth Mucosa; Rosacea; Tongue Diseases

Fifty-four patients taking minocycline for acne or rosacea were assessed for adverse effects. Their mean duration of treatment was 17 months, and their average cumulative dose was 47 g. No symptoms attributable to the therapy were reported. Biochemistry and haematology profiles were normal. There was no evidence of an adverse effect on thyroid function. Skin pigmentation was detected in eight patients (14.8%). Five patients had diffuse facial pigmentation, and three patients had localized pigmentation at the site of a scar or injury. Diffuse pigmentation occurred only in patients who had been on treatment for 3 years or more; 50% of such patients were affected. Age and solar damage may also have been factors in this type of pigmentation. Localized pigmentation occurred at sites of previous tissue damage, and was not directly related to the duration of therapy. Patients who receive long-term minocycline therapy should be regularly monitored for the development of pigmentation.

Topics: Acne Vulgaris; Adolescent; Adult; Age Factors; Aged; Cicatrix; Facial Dermatoses; Female; Humans; Male; Middle Aged; Minocycline; Pigmentation Disorders; Rosacea; Skin Aging; Skin Pigmentation; Thyroid Gland; Thyrotropin; Thyroxine; Time Factors

A rare side effect of minocycline is acute eosinophilic pneumonia. In the literature only ten cases have been reported. We report two cases of minocycline which induced (eosinophilic) alveolitis. A high fever, dry cough, dyspnoea and fatigue are the main features of the clinical picture. Peripheral blood eosinophilia and elevated total IgE content were seen in one patient. Bronchoalveolar lavage in this patient revealed eosinophilia. Transbronchial lung biopsies showed infiltration with eosinophilic granulocytes in both patients. Airway macrophages contained brown-black pigment granules. In the acute stage an important decrease in diffusion capacity was observed. The pulmonary and systemic symptoms promptly cleared up after discontinuation of minocycline. Provocation with minocycline was positive, because both patients noticed the same symptoms within one day.

Topics: Adult; Bronchoalveolar Lavage Fluid; Drug Hypersensitivity; Humans; Male; Middle Aged; Minocycline; Pulmonary Eosinophilia; Rosacea

Topics: Anti-Bacterial Agents; Clinical Trials as Topic; Erythema; Humans; Josamycin; Minocycline; Rosacea

Topics: Administration, Cutaneous; Diagnosis, Differential; Facial Dermatoses; Humans; Male; Middle Aged; Minocycline; Rosacea; Steroids

Topics: Adult; Facial Dermatoses; Female; Granuloma; Humans; Minocycline; Rosacea

Acne rosacea has been considered to be a rare disease among black patients. Three cases of rosacea in blacks are described and illustrated. Acne rosacea may be more common in black patients than heretofore believed.

Topics: Black People; Humans; Isotretinoin; Male; Middle Aged; Minocycline; Rosacea; Tretinoin

Topics: Aged; Diagnosis, Differential; Humans; Male; Minocycline; Rosacea; Silicones; Simethicone; Syndrome; Tetracyclines; Virus Diseases

We studied a patient with a grossly black thyroid gland considered to be related to minocycline therapy. Microscopically, a brown granular pigment was localized in follicular cells and colloid, which histochemically was melanin or a melaninlike substance. Ultrastructurally, the pigment is confined to lysosomes. The pigment seems to be either an oxidative degradation product of the drug itself, or the results of an as yet unknown alteration of tyrosine metabolism by the drug. Although minocycline is known to interfere with thyroid function in animals, no evidence has been presented for such an effect in humans. The occurrence of a black thyroid gland in humans seems to be virtually pathognomonic for long-term minocycline therapy.

Topics: Humans; Lysosomes; Male; Melanins; Middle Aged; Minocycline; Pigmentation Disorders; Rosacea; Tetracyclines; Thyroid Diseases; Thyroid Gland; Tyrosine