Approximately 13 million individuals in the United Sates suffer from rosacea, a 
recurrent disease that may require long-term therapy. Topical and oral 
antibiotics have been used to treat rosacea; however, high-dose antibiotics or 
long-term, low-dose antibiotics commonly used for the treatment of rosacea 
flares or for rosacea maintenance therapy, respectively, can lead to the 
development of antibiotic-resistant organisms. The first oral medication 
approved by the U.S. Food and Drug Administration for the treatment of rosacea 
in the United States is Oracea (CollaGenex Pharmaceuticals Inc., Newtown, PA, 
USA). Oracea is a 40 mg capsule of doxycycline monohydrate, containing 30 mg 
immediate-release and 10 mg delayed-release doxycycline beads 
("anti-inflammatory-dose doxycycline"). Anti-inflammatory-dose doxycycline is 
not an antibiotic and does not lead to the development of antibiotic-resistant 
organisms. Each capsule of anti-inflammatory-dose doxycycline contains a total 
of 40 mg of anhydrous doxycycline as 30 mg of immediate-release and 10 mg of 
delayed-release beads. In contrast to other oral therapies, 
anti-inflammatory-dose doxycycline is taken once daily, which may increase 
treatment compliance. The results of two phase III trials have been encouraging, 
leading to the recent release (summer 2006) of Oracea for the treatment of 
rosacea in the United States. Anti-inflammatory-dose doxycycline should not be 
used by individuals with known hypersensitivity to tetracyclines or increased 
photosensitivity, or by pregnant or nursing women (anti-inflammatory-dose 
doxycycline is a pregnancy category-D medication). The risk of permanent teeth 
discoloration and decreased bone growth rate make anti-inflammatory-dose 
doxycycline contraindicated in infants and children. However, when used 
appropriately in patients with rosacea, anti-inflammatory-dose doxycycline may 
help prolong the effectiveness and life span of our most precious antibiotics.