Combination therapy of tetracycline and tacrolimus resulting in rapid resolution of steroid-induced periocular rosacea

Journal of Drugs in Dermatology, Dec, 2003

Pabby A, An KP, Laws RA. Cutis 2003 Aug; 72(2):141-2.

The authors present a case report of a 55 year-old man with history of fluticasone use BID for seborrheic dermatitis for 12 months. On physical exam the patient presented with erythematous papules and telangiectasias on the facial area. The patient was diagnosed with steroid-induced periocular rosacea. Patient was started on tacrolimus .1% and tetracycline 500 mg BID. The authors state that a temporary decrease to a lower-potency steroid prior to discontinuation remains optional. The limitations of standard therapy include a prolonged course of treatment with exacerbations prior to permanent improvement. The authors suggest the concomitant use of tacrolimus with tetracycline for the treatment of steroid-induced rosacea.

JDD AUTHOR EVALUATION

The authors present a case report of combination therapy tetracycline and tacrolimus for steroid induced rosacca. They described complete resolution of the rosacea at three weeks: while the tacrolimus acts as an anti-inflammatory; the exact mechanism of tetracycline is unknown. The anti-inflammatory effect explains the resolution of the rosacea, hut would tacrolimus work alone without the antibiotic? A case series was performed in 2001 with a rebound effect on tacrolimus similar to that of temporary decrease of steroids. In those case series topical antibiotics were added prior to complete resolution. Perhaps another double-blind randomized study of tacrotimus or pimecrolimus versus oral antibiotics versus a decrease to lower steroids versus tacrolimus/pimecrolimus oral antibiotics versus topical antibiotics is preferable to assess a better therapy for steroid rosacea. All in all, tacrolimus is good, but tacrolimus and tetracycline is better as per the authors' experience. Further studies are needed. On a personal experience, I have had one patient with rosacea who was on etanercept for one month. Topical etanercept? An interesting concept.

References: Goldman D. Tacrolimus ointment for the treatment of steroid-induced rosacea: a prelimirtary report J Am Acad Dermatol 2001 Jun; 44(6).995-8.