Congratulations to Dr. Steven Fuchs for highlighting the importance of treating the whole patient rather than simply a mouth ("Identifying Rosacea: What All Dentists Should Know," May JADA). Many of our patients may not see a physician for several years, yet routinely visit their dentist. This puts our profession in a unique position to recognize rosacea, as well as other dermatologic problems such as skin cancer.
As Dr. Fuchs pointed out, various mediators of inflammation are thought to contribute to the pathophysiology of rosacea. Similarly, in periodontal disease, the inflammatory reaction of the body in association with a bacterial challenge is responsible for the periodontal tissue destruction. Recent reports in Dermatology Times1 and the Archives of Dermatology2 have announced the finding that sub-antimicrobial doses of doxycycline (Periostat' CollaGenex Pharmaceuticals, Newtown, Pa.) commonly used to treat periodontal disease appear to be effective against some forms of rosacea and acne vulgaris.
Investigation of a subantimicrobial dose of doxycycline hyclate (20 milligrams twice daily) has found that it may be as effective in the treatment of rosacea and acne as antibiotic doses of the same drug, with fewer dose-related side effects and no evidence of antibiotic or bacterial resistance. According to Dr. Joseph Fowler Jr., M.D., at the University of Kentucky in Louisville, 60 to 65 percent of patients with rosacea taking subantimicrobial-dose doxycycline see improvement in four to eight weeks.1
In the progression of adult periodontitis as well as in rosacea and acne, much of the damage is related to the inflammatory response. By decreasing inflammation via suppression of enzymes, we can expect to see improvement in both periodontal disease and rosacea.
A multicenter, double-blind, placebo-controlled study is currently under way to confirm the efficacy of subantimicrobial dose doxycycline in the treatment of rosacea. The more we learn about systemic pathways of disease and how they relate to periodontitis, the better we can care for our patients.
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