What are the potential side effects of systemic treatments for rosacea, and how can I monitor patients for these effects?

Potential side effects of systemic treatments for rosacea include:

• Low-dose modified-release doxycycline is generally well tolerated with fewer adverse effects compared to higher doses ¹.
• Oral minocycline may cause more adverse effects such as autoimmune hepatitis, lupus erythematosus, and hyperpigmentation of the skin ¹.
• Oral tetracyclines (including doxycycline) can cause photosensitivity ¹,².
• Alternative oral antibiotics such as oxytetracycline, tetracycline, or erythromycin may be used, with erythromycin preferred in pregnancy or breastfeeding ¹.

Monitoring patients for these side effects involves:

• Reviewing clinical response and side effects after 8–12 weeks of treatment to assess efficacy and tolerability ¹.
• Monitoring for signs of photosensitivity and advising patients to avoid excessive sun exposure and use sun protection ¹,².
• For oral doxycycline and other tetracyclines, monitoring for gastrointestinal upset and hypersensitivity reactions is advised ¹.
• Considering referral to dermatology if there is little or no improvement or if adverse effects occur ¹.

Overall, systemic treatments require individualized management and regular review to balance efficacy and side effects ¹.