Rosacea is a chronic inflammatory skin condition that primarily affects the face. Common treatment options include topical and oral antibiotics such as metronidazole, doxycycline, and minocycline.
Though experts still don’t fully understand what causes rosacea, they think the condition’s underlying inflammation may be triggered by bacterial growth. As a result, antibiotics, in combination with lifestyle changes, are sometimes prescribed to treat it.
Topical antibiotics may be used as part of a first-line treatment, while oral antibiotics are typically reserved for when topical medications fail or flare-ups are particularly severe. Here’s what you need to know about treating rosacea with antibiotics.
Though experts still don’t exactly know what causes rosacea, they believe it may stem in part from reactions to:
- demodex folliculorum (mites)
- staphylococcus (bacteria)
- helicobacter pylori (bacteria)
Though it’s relatively common to have some degree of mites (Demodex) or staph bacteria on the skin, those with rosacea are thought to be particularly sensitive to them, causing flare-ups. H. pylori, meanwhile, is a very common stomach bacteria that may impact those with rosacea and trigger inflammation.
Antibiotics treat bacterial infections and are often prescribed to treat Demodex mites. As a result, doctors may sometimes prescribe topical or oral antibiotics to kill any bacteria that may be either causing or worsening rosacea symptoms.
Like all medications, antibiotics can have side effects, especially when taken long-term. Due to this, dermatologists will typically prescribe them for the shortest length of time possible while still being effective.
Ideally, antibiotics will kill any bacteria, mites, or other organisms irritating the skin and triggering rosacea symptoms.
If symptoms reemerge later, another dose may be required. It’s important to keep in mind that since antibiotic resistance can occur, this therapy alone may not be a sustainable long-term treatment.
Instead, antibiotic use is recommended alongside other clinical treatments, specialized skin care, and lifestyle measures — more on that below.
There are a few commonly prescribed antibiotics that are approved by the
Metronidazole (topical)
Topical metronidazole kills bacteria and parasites on the skin. It’s often prescribed to treat mild to moderate rosacea and may come in the form of a cream, gel, or lotion. It’s generally applied twice daily to impacted areas, but you should always follow a doctor’s instructions to be sure.
Side effects are generally mild but may include:
- irritation
- burning
- itching
- dryness
In rare cases, it may cause:
- cold symptoms
- yeast infections
- upper respiratory infections
After initially applying metronidazole, rosacea symptoms may seem to temporarily worsen. However, side effects should generally go away within several days.
Doxycycline (oral)
Oral doxycycline is a tetracycline antibiotic, which means it functions by stopping bacteria from making the proteins they need to grow. It’s commonly prescribed to treat severe rosacea symptoms like intense papules and pustules. It can also stop skin thickening from worsening and causing permanent damage.
It’s typically taken once or twice a day.
Potential side effects include:
- dizziness
- headache
- drowsiness
- nausea
- vomiting
- sun sensitivity
- upset stomach
- teeth discoloration
- rapid heart rate
Low dose doxycycline may also sometimes be prescribed, which allows the medication to be taken relatively safely over a longer period of time.
Minocycline (oral or topical)
Oral or topical minocycline is another type of tetracycline antibiotic that may also be prescribed to treat moderate to severe rosacea. This antibiotic is often prescribed to treat inflammatory acne.
The topical version typically comes in the form of foam but is also available as a cream. It’s intended to be applied 1 to 2 times a day.
In a 2023 review of over 1,700 rosacea cases, researchers concluded that minocycline
Possible side effects of minocycline include:
- nausea
- vomiting
- diarrhea
- headaches
- dizziness
- skin discoloration
- changes in urine color
- numbness or tingling
- tongue swelling
- tinnitus
The following side effects generally should be mild and not last more than a few days.
In rare cases, more serious side effects may include:
- blurry vision
- joint pain
- rashes
- hives
- chest pain
- seizures
- facial swelling
- issues breathing
- increased bleeding
- blood in stool
If you experience any of the above side effects, you should talk with a doctor right away. If you experience chest pain, seizures, or issues breathing, seek emergency care immediately.
In addition to antibiotics, a doctor may also recommend:
- azelaic acid foam or gel to reduce pustules, papules, and inflammation
- topical gels like brimonidine to constrict blood vessels and reduce redness
- laser treatments or intense pulsed light (IPL) therapy to remove visible blood vessels
- in severe cases, low dose isotretinoin (Accutane) oral medication
Like many inflammatory conditions, rosacea symptoms can significantly improve through healthy lifestyle measures, including:
- using a journal to track and avoid common triggers, like extreme weather and spicy food
- reducing stress with relaxation techniques like breathwork, yoga, or meditation
- going to cognitive behavioral therapy (CBT) to deal with anxiety and flushing, etc.
- eating a healthy, rosacea-approved diet full of anti-inflammatory foods
- wearing a minimum of SPF 30 regularly and limiting UV exposure
- avoiding medication interactions (i.e., beta-blockers, vasodilators)
- trying natural remedies like aloe vera to soothe symptoms
If your rosacea symptoms don’t respond to first-line treatments, your dermatologist may prescribe antibiotics. If topical antibiotics fail to work, oral ones may be necessary.
In general, it’s a good idea to visit the doctor if you have any condition that negatively impacts your daily quality of life. So if rosacea symptoms like flushing, inflammation, or papules don’t resolve with at-home treatments or lifestyle changes, visit a doctor as soon as possible.
Since more severe rosacea symptoms like skin thickening may be permanent, seeking treatment sooner rather than later is recommended.
Antibiotics are often effective at treating rosacea symptoms in combination with lifestyle changes like avoiding triggers, eating healthy, and reducing stress. A skin care routine with azelaic acid and plenty of SPF is also recommended.
Since antibiotics come with side effects, their use is only recommended in the short term.