drnase
3rd July 2005, 07:41 PM
Physicians and their knowledge of rosacea. As with any human in life, we should always try our best to treat physicians and fellow sufferers with respect. We need to do this, even when the physician is not correct, is not up on the latest literature, or is just stating opinion and not fact (this point is especially germane because of our upcoming Physician Q and A).
With that said, rosacea sufferers have to be their own advocates many times. In fact, sometimes they need to be fully educated to know what physician really knows rosacea and what physician does not. These are keys to successful treatment. I have met many laser specialists who know nothing about rosacea, I have also met many dermatologists that do not have a good grasp on rosacea. Such is life.
When I recommend things from the medical literature or in collaboration with cutting edge rosacea experts, I try to always state facts and back them up with references. We have had several discussions on almost every board lately about the macrolide antibiotics. Like any substance one puts in their mouth, there certainly can be side effects.
But, pure opinions (not facts) have lead some rosacea sufferers to automatically discount macrolide antibiotics. The opinions even go so far as to implicate them in heart attacks and strokes (which they do not cause and in fact, help) and somehow got mislabeled as dangerous……. all from opinion. For example, one doctor purely discounts these drugs based on opinion and does not even realize there are now many studies on these medications for rosacea treatment as well as anti-angiogenesis. Quote: "I do not view this as the use of a powerful group of drugs rather than an ABUSE of these drugs--There has never been a study to prove the benefits outweigh the risks". Please remember to base your information and decisions on facts because rosacea has too much confusion surrounding its treatment and too many misconceptions by physicians. Arm yourself with facts which can lead you to an educated decision. Below is just a small cropping on the facts about the macrolide antibiotics ability to treat resistant rosacea cases and also clearly shows that not only are they not dangerous, but they, in fact, have less overall side effects than tetracyclines.
ORAL ANTIBIOTICS: CLARITHROMYCIN & AZITHROMYCIN
Medical experts are now realizing that the most effective oral antibiotics are those with the greatest anti-inflammatory actions. In this respect, the newer macrolide antibiotics may offer significant advantages over standard tetracycline antibiotics. Experimental and clinical studies demonstrate that macrolide antibiotics possess strong anti-inflammatory actions that are generally greater than tetracycline antibiotics. (1, 9, 13, 14) Two of the most popular macrolide antibiotics are clarithromycin and azithromycin.
Clarithromycin
Clarithromycin is a recently synthesized macrolide antibiotic that possesses strong anti-inflammatory actions. (9) Clarithromycin is also highly bioavailable, extremely long acting, can be taken with or without food, and has very few side effects. Medical experts indicate that all of these attributes make clarithromycin a great choice for rosacea treatment. (1, 9, 15)
In a recent medical article, “Clarithromycin Versus Doxycycline in the Treatment of Rosacea”, Drs. Torresani, Pavesi and Manara compared the effects of oral doxycycline to clarithromycin in 40 rosacea patients. (9) After 4 weeks of treatment, these physicians found that facial papules and redness were significantly better in the clarithromycin-treated group. These physicians also documented that clarithromycin treatment was associated with fewer side effects. These medical researchers conclude that clarithromycin is an extremely safe medication that is virtually free of side effects. (1, 9)
In a more recent article, “Clarithromycin: A New Perspective in Rosacea Treatment”, Dr. Torressani document that oral clarithromycin is very effective in the treatment of other inflammatory skin disorders such as acne vulgaris, perioral dermatitis, and steroid-induced rosacea. (1) He states, “The effectiveness of clarithromycin in treating steroid-induced rosacea is truly impressive.” (1) Dr. Torressani attributes clarithromycin’s positive effect on skin inflammation to its powerful anti-inflammatory action.
In his medical practice, Dr. Torressani has found clarithromycin to be superior to standard antibiotics in the treatment of rosacea. (1) In fact, he has documented a case in which a rosacea patient, who was previously unresponsive to tetracycline antibiotics, cleared dramatically with clarithromycin.
Clarithromycin dosage: The standard rosacea treatment protocol is 250 milligrams, twice daily for the first month, followed by 250 milligrams once daily. (1, 9) Experts point out that due to its strong anti-inflammatory actions, long-lasting effectiveness, and quick onset of action, clarithromycin may also be used intermittently each month (pulse-dosing) to maintain rosacea clearance. (1)
My personal experience with Clarithromycin: Throughout the years, I have tried many oral antibiotics including tetracycline-HCl, doxcycline, minocycline, and clarithromycin. In my particular case, clarithromycin was the fastest- and best-acting antibiotic. While the standard tetracycline antibiotics had no sustainable effect on my rosacea, clarithromycin was moderately effective on my facial papules, pustules, and generalized inflammation.
Azithromycin
Azithromycin is similar to clarithromycin, in that it is a macrolide antibiotic that possesses strong anti-inflammatory actions. Two recent studies have shown azithromycin to be a powerful tool in the fight against rosacea.
At a recent American Academy of Dermatology Meeting (1998) in Orlando, Florida, Dr. Thomas Fitzpatrick of Harvard Medical School detailed an effective rosacea treatment regimen that consisted of pulse dosing with azithromycin. (14) Pulse-dosing therapy is possible with azithromycin due to its fast onset of action, powerful anti-inflammatory actions, and long half-life (it remains in the body for extended periods of time, maintaining therapeutic serum levels for 6 days following discontinuation of the drug). In this study, Dr. Fitzpatrick treated his patients for only 10 days out of the month -- azithromycin was given on the first of the month for 5 straight days, and on the fifteenth of the month for 5 straight days. All rosacea patients reported significant reductions in symptoms while on this treatment regimen.
In a recent clinical study, Dr. Adolfo Fernandez-Obregon, of the Hudson Dermatology and Skincare Center, demonstrated that azithromycin is one of the more effective antibiotics for rosacea treatment. (13) In this study, he treated 10 rosacea patients with azithromycin (each of whom did not respond to previous treatment with standard tetracycline antibiotics). His treatment protocol consisted of only a single dose of azithromycin (250 milligrams), three times a week. Within three to four weeks, all patients reported moderate to marked improvement in their rosacea symptoms. So, not only did these patients respond markedly to low doses of azithromycin; but, they did so very quickly.
Azithromycin dosage: Although there are no general guidelines yet for rosacea treatment, the mild to moderate sufferers may only need pulse-dose therapy (i.e., 250 milligrams three times a week). (13, 14) In the more severe cases, daily treatment may be needed for one to three months to control the symptoms. If the patient responds adequately after this time, pulse dosing may be employed to maintain clearance.
With that said, rosacea sufferers have to be their own advocates many times. In fact, sometimes they need to be fully educated to know what physician really knows rosacea and what physician does not. These are keys to successful treatment. I have met many laser specialists who know nothing about rosacea, I have also met many dermatologists that do not have a good grasp on rosacea. Such is life.
When I recommend things from the medical literature or in collaboration with cutting edge rosacea experts, I try to always state facts and back them up with references. We have had several discussions on almost every board lately about the macrolide antibiotics. Like any substance one puts in their mouth, there certainly can be side effects.
But, pure opinions (not facts) have lead some rosacea sufferers to automatically discount macrolide antibiotics. The opinions even go so far as to implicate them in heart attacks and strokes (which they do not cause and in fact, help) and somehow got mislabeled as dangerous……. all from opinion. For example, one doctor purely discounts these drugs based on opinion and does not even realize there are now many studies on these medications for rosacea treatment as well as anti-angiogenesis. Quote: "I do not view this as the use of a powerful group of drugs rather than an ABUSE of these drugs--There has never been a study to prove the benefits outweigh the risks". Please remember to base your information and decisions on facts because rosacea has too much confusion surrounding its treatment and too many misconceptions by physicians. Arm yourself with facts which can lead you to an educated decision. Below is just a small cropping on the facts about the macrolide antibiotics ability to treat resistant rosacea cases and also clearly shows that not only are they not dangerous, but they, in fact, have less overall side effects than tetracyclines.
ORAL ANTIBIOTICS: CLARITHROMYCIN & AZITHROMYCIN
Medical experts are now realizing that the most effective oral antibiotics are those with the greatest anti-inflammatory actions. In this respect, the newer macrolide antibiotics may offer significant advantages over standard tetracycline antibiotics. Experimental and clinical studies demonstrate that macrolide antibiotics possess strong anti-inflammatory actions that are generally greater than tetracycline antibiotics. (1, 9, 13, 14) Two of the most popular macrolide antibiotics are clarithromycin and azithromycin.
Clarithromycin
Clarithromycin is a recently synthesized macrolide antibiotic that possesses strong anti-inflammatory actions. (9) Clarithromycin is also highly bioavailable, extremely long acting, can be taken with or without food, and has very few side effects. Medical experts indicate that all of these attributes make clarithromycin a great choice for rosacea treatment. (1, 9, 15)
In a recent medical article, “Clarithromycin Versus Doxycycline in the Treatment of Rosacea”, Drs. Torresani, Pavesi and Manara compared the effects of oral doxycycline to clarithromycin in 40 rosacea patients. (9) After 4 weeks of treatment, these physicians found that facial papules and redness were significantly better in the clarithromycin-treated group. These physicians also documented that clarithromycin treatment was associated with fewer side effects. These medical researchers conclude that clarithromycin is an extremely safe medication that is virtually free of side effects. (1, 9)
In a more recent article, “Clarithromycin: A New Perspective in Rosacea Treatment”, Dr. Torressani document that oral clarithromycin is very effective in the treatment of other inflammatory skin disorders such as acne vulgaris, perioral dermatitis, and steroid-induced rosacea. (1) He states, “The effectiveness of clarithromycin in treating steroid-induced rosacea is truly impressive.” (1) Dr. Torressani attributes clarithromycin’s positive effect on skin inflammation to its powerful anti-inflammatory action.
In his medical practice, Dr. Torressani has found clarithromycin to be superior to standard antibiotics in the treatment of rosacea. (1) In fact, he has documented a case in which a rosacea patient, who was previously unresponsive to tetracycline antibiotics, cleared dramatically with clarithromycin.
Clarithromycin dosage: The standard rosacea treatment protocol is 250 milligrams, twice daily for the first month, followed by 250 milligrams once daily. (1, 9) Experts point out that due to its strong anti-inflammatory actions, long-lasting effectiveness, and quick onset of action, clarithromycin may also be used intermittently each month (pulse-dosing) to maintain rosacea clearance. (1)
My personal experience with Clarithromycin: Throughout the years, I have tried many oral antibiotics including tetracycline-HCl, doxcycline, minocycline, and clarithromycin. In my particular case, clarithromycin was the fastest- and best-acting antibiotic. While the standard tetracycline antibiotics had no sustainable effect on my rosacea, clarithromycin was moderately effective on my facial papules, pustules, and generalized inflammation.
Azithromycin
Azithromycin is similar to clarithromycin, in that it is a macrolide antibiotic that possesses strong anti-inflammatory actions. Two recent studies have shown azithromycin to be a powerful tool in the fight against rosacea.
At a recent American Academy of Dermatology Meeting (1998) in Orlando, Florida, Dr. Thomas Fitzpatrick of Harvard Medical School detailed an effective rosacea treatment regimen that consisted of pulse dosing with azithromycin. (14) Pulse-dosing therapy is possible with azithromycin due to its fast onset of action, powerful anti-inflammatory actions, and long half-life (it remains in the body for extended periods of time, maintaining therapeutic serum levels for 6 days following discontinuation of the drug). In this study, Dr. Fitzpatrick treated his patients for only 10 days out of the month -- azithromycin was given on the first of the month for 5 straight days, and on the fifteenth of the month for 5 straight days. All rosacea patients reported significant reductions in symptoms while on this treatment regimen.
In a recent clinical study, Dr. Adolfo Fernandez-Obregon, of the Hudson Dermatology and Skincare Center, demonstrated that azithromycin is one of the more effective antibiotics for rosacea treatment. (13) In this study, he treated 10 rosacea patients with azithromycin (each of whom did not respond to previous treatment with standard tetracycline antibiotics). His treatment protocol consisted of only a single dose of azithromycin (250 milligrams), three times a week. Within three to four weeks, all patients reported moderate to marked improvement in their rosacea symptoms. So, not only did these patients respond markedly to low doses of azithromycin; but, they did so very quickly.
Azithromycin dosage: Although there are no general guidelines yet for rosacea treatment, the mild to moderate sufferers may only need pulse-dose therapy (i.e., 250 milligrams three times a week). (13, 14) In the more severe cases, daily treatment may be needed for one to three months to control the symptoms. If the patient responds adequately after this time, pulse dosing may be employed to maintain clearance.