Is Long-Term Antibiotic Use for Rosacea Safe?

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Rosacea is an inflammatory condition of the skin that presents as redness, flushing, visible blood vessels, and reddish bumps. Rosacea is very common. It is a condition that dermatologists encounter every day in patients. In fact, according to the National Rosacea Society, more than 16 million Americans have rosacea.

Rosacea often occurs after the age of 30 in individuals that are fair-skinned. We do not know the exact cause of rosacea, though it is believed that microscopic demodex mites play a role in its development. Additionally, genetics may contribute to rosacea. Frequent blushing may actually be a symptom of rosacea. Rosacea can be triggered by extreme temperatures, exercise, menopause, and emotional stress. Certain foods and beverages, such as spicy food and alcohol, can also exacerbate symptoms.

Rosacea is a chronic condition, and treatments vary. A comprehensive review of rosacea management suggests that there is no clear winner when it comes to treatment. We often combine oral and topical medications with laser treatments for the most effective treatment of rosacea. In-office laser treatments can be used to decrease the reddish appearance of rosacea. However, treatment for rosacea is individualized.

Since many patients are treated with oral antibiotics, many ask whether long-term antibiotic use is safe. First, when antibiotics are used for the treatment of rosacea, they are often used at very low doses. We prescribe them at such low levels so that they do not actually exhibit antibiotic activity. Many people do not know this, but antibiotics also have an anti-inflammatory effect. We use antibiotics for their anti-inflammatory properties when treating rosacea. 

High antibacterial doses are not necessary, as anti-inflammatory effects occur even when the dose is too low to have any antibacterial effect. For example, Oracea, a commonly used antibiotic for rosacea, contains a very low dose of doxycycline. The dose of doxycycline usually prescribed is actually not high enough to even have any antibiotic activity. Since the antibiotics are prescribed at such low doses there are minimal long-term side effects. When using low doses of antibiotics at anti-inflammatory doses, studies have shown long-term use to be safe.

If you suffer from rosacea, see a dermatologist, because there is help. Rosacea can cause redness in the face, which can be embarrassing for some people. Oftentimes it is a matter of trying a variety of treatments including dietary and lifestyle changes, topical creams, oral antibiotics, and laser treatments. Most importantly, don’t give up. I can tell you from experience, many of my rosacea patients have enjoyed remarkable improvement once they finally sought help.

Dr. Schweiger is a Board Certified dermatologist in private practice in Manhattan. He practices cosmetic and general dermatology, with a particular focus on laser and light-based treatments at http://www.nyccosmeticdermatology.com/.

He is a HealthGrades Recognized Doctor.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 May 18

  1. van Zuuren EJ et al. British Journal of Dermatology. Effective and evidence-based management strategies for rosacea: summary of a Cochrane systematic review. 2011 Oct;165(4):760-81.

  2. What Is Rosacea? National Rosacea Society. http://www.rosacea.org/index.php

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