An eight-week course of antibiotic therapy with azithromycin appears to substantially clear outbreaks of acne rosacea and peri-oral dermatitis, Italian researchers reported on February 20th at the 63rd annual meeting of the American Academy of Dermatology.

“We need something new for our patients with these conditions,” said Ruggero Caputo, MD, chairman of the department of dermatology at the University of Milan, Italy, in discussing his poster at a moderated presentation session.

Dr. Caputo and colleagues recruited 20 men and women with acne rosacea and 20 women with peri-oral dermatitis and treated them with a course of oral azithromycin 500 mg a day for three days. They repeated the “pulse therapy” for at least four weeks and up to eight weeks.

“All the patients improved,” said Dr. Caputo, but marked improvement - according to standard scales of improvement - was observed in 13 patients with papulopustular rosacea after four weeks. After 6 weeks, 15 of the patients had achieved a marked improvement, and that increased to 18 patients - 90% of the group - after 8 weeks of treatment.

A similar improvement was seen in the women with peri-oral dermatitis. A marked improvement was demonstrated in 12 patients after 4 weeks, in 14 patients after 6 weeks, and in 17 patients - 85% of the total - after 8 weeks.

“Data at the end of the study are suggestive for a clear therapeutic role of azithromycin in papulopustular rosacea and peri-oral dermatitis like [that already] demonstrated in papulopustular acne,” Dr. Caputo said.

He said the trial also shows:
-Azithromycin has anti-inflammatory properties that could be useful in the treatment of inflammatory dermatoses of the face.
-Pulse therapy regimen improves the compliance of patients.
-Azithromycin is well-tolerated by patients. Two people experienced gastralgia, but neither had to suspend use of the drug.
-Azithromycin is not phototoxic; therefore, it can be prescribed with safety at all times of the year.

“The results of this study were a bit surprising to me,” said session moderator Guy Webster, MD, professor and vice chairman of dermatology at Jefferson Medical College, in Philadelphia, Pennsylvania. He said he did not expect that azithromycin would show as much anti-inflammatory effect as other more commonly used anti-acne antibiotics, such as doxycycline.

But he said the results may have been surprising because the nature of rosacea continues to be puzzling.

Dr. Caputo noted that rosacea is a chronic inflammatory condition primarily affecting the convexities of the face. The papulopustular variant shows transient or persistent central facial erythema, dilated blood vessels, papules, and pustules. He included peri-oral dermatitis patients in the study because that condition - another facial inflammatory dermatosis - usually responds to medications for rosacea.