What are the potential side effects of systemic treatments for acne rosacea that I should discuss with my patients?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

When discussing systemic treatments for acne rosacea with patients, it is important to cover potential side effects. Oral antibiotics, which are commonly used, may cause systemic side effects and antimicrobial resistance .

Doxycycline, Oxytetracycline, and Tetracycline:

  • These oral tetracyclines can cause photosensitivity, meaning increased sensitivity to the sun .
  • They are contraindicated during pregnancy and when planning a pregnancy . Patients of childbearing potential will need to use effective contraception or choose an alternative treatment .
  • Low-dose modified-release doxycycline has been noted to have fewer adverse effects compared to the higher-dose 100 mg preparation .

Erythromycin:

  • Erythromycin is an alternative oral preparation that can be considered for pregnant or breastfeeding women .

Minocycline:

  • Oral minocycline carries an increased risk of adverse effects, such as autoimmune hepatitis, lupus erythematosus, and hyperpigmentation of the skin, compared to low-dose modified-release doxycycline .

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