Acne rosacea is a chronic skin disorder that requires long-term
therapy. Oral
azithromycin has been used successfully to treat
acne vulgaris. an observation that suggested an infectious agent may play an active role in the etiology of this disorder. Ten adults (not previously reported) with
acne rosacea were selected to be treated with oral
azithromycin. Nine of the 10 subjects received 250 mg 3 times weekly for periods ranging from 5 to 19 weeks, at which time follow-up examinations were performed on 8 of the 9 treated subjects: 1 subject was lost to follow-up. Prior to
therapy. C pneumoniae
antigen was detected in malar biopsy specimens in 4 of 10 subjects by immunoperoxidase technique (using
monoclonal antibody to C pneumoniae). Serum
antibodies against C pneumoniae were detected in 8 of 10 intent-to-treat subjects. Using polymerase chain reaction, C pneumoniae was not detected in peripheral blood mononuclear cells. The inflammatory response in tissues was characterized by a widespread infiltration of polymorphonuclear neutrophil cells, lymphocytes, and plasma cells, which support the clinical diagnosis of
acne rosacea. Nine of 10 subjects treated with
azithromycin showed moderate to marked improvement of their
acne rosacea. No adverse reactions to
azithromycin occurred. and the
drug appeared to be safe and effective. These preliminary data suggest the need for further investigation with clinical trials to study long-term tolerability and efficacy and also strongly implicate C pneumoniae in the pathogenesis of
acne rosacea.