Minocycline for MGD

[redandunhappy]

Has anyone out there tried minocycline for MGD? The doctor in this article seems to think it's marvellous:

http://www.aao.org/publications/eyen...404/cornea.cfm

But I don't think it's often prescribed and maybe there is a reason for that.

Doxy is not working for me anymore and I really don't know why. My eyes are so puffy it's aged me by about 10 years....and gone are my big clear blue eyes. Now have red and piggy eyes. It's very depressing.

[Andrey]

Yep, for me it worked insanly good. All pain disappeared, my eyes was white all the time etc... But the problems came back some weeks after I stopped taking it.

I will visit a doctor soon and try to get it again (azithromycin), and hopefully this time I will take it a bit longer or maybe even permanent !

[redandunhappy]

Hi Andrey,

Just to clarify, you took oral azithromycin, not minocycline? What dose did you take, and how long did you take it for before you noticed it working - if you don't mind me asking

[Andrey]

Fast answer

Yea, I thought it was the same, I think I read that somewhere but maybe I'm wrong.

Uhm dose.. I think 500mg first day (2 tablets), then 250mg for five days in a road, then 250 mg one day, nothing the other day, 250mg the next day etc. I was on it for 24 days. Effects maybe came after 2 weeks or so?

[irish eyes]

Has anyone out there tried minocycline for MGD? The doctor in this article seems to think it's marvellous:

http://www.aao.org/publications/eyen...404/cornea.cfm

But I don't think it's often prescribed and maybe there is a reason for that.

Doxy is not working for me anymore and I really don't know why. My eyes are so puffy it's aged me by about 10 years....and gone are my big clear blue eyes. Now have red and piggy eyes. It's very depressing.

I take Minocycline. I take it instead of Doxy because it is 'slow release' and less harsh on the stomach. (I have inflamed stomach lining but Doxy didn't cause it -I already had it).

[redandunhappy]

Hi Irish eyes,

And you've noticed that minocycline really helps?

Do you mind me asking what dose, and how long before you saw any difference?

thanks

[spmcc]

I have a book called Rosacea: Diagnosis and Management (FC Powell, 2009). In the chapter on Papulopustular Rosacea, Powell writes (pg. 87):

Minocycline is usually well tolerated by patients and appears to act more rapidly than other antibiotics (possibly related to its lipophilic properties and penetration of the pilosebaceous follicle), but it is expensive and can rarely lead to unsightly hyper pigmentation of the skin (which can persist after discontinuing treatment) or headaches (benign intracranial hypertension) and should not be used for prolonged periods without appropriate monitoring.

I've used minocycline (50mg once or twice a day) and found it worked well on my facial rosacea and ocular rosacea.

But I always have to remind myself that, esp with summer approaching in the northern hemisphere, these antibiotics make skin photosensitive (i.e., skin burns easily!!!).

[redandunhappy]

That's interesting. I wonder why doxycycline is favoured over minocycline then.

The consultant at Moorfields told me that they generally only prescribe doxycyline, oxtytetracyline and erithromycin. When the registrar asked whether he could use lymecycline, the consultant said "we don't tend to use that one....we stick to what we usually prescribe"

[spmcc]

That's interesting. I wonder why doxycycline is favoured over minocycline then.

It could be due to cost or availability (e.g., tetracycline was *very* cheap in the mid-1980s when I was first diagnosed with rosacea. Now it is almost impossible to get in North America. Probably it became too cheap for the manufacturers to make a profit off).

So, then came doxycycline (100mg). But it can upset stomachs (among other things).

Then there's minocycline (50mg). More expensive, but possibly fewer stomach problems.

Erythromycin is a macrolide antibiotic (a different type of antibiotic than the tetracycline family which include oxytetracycline, doxy, and mino).

[Joseph]

My doctor just put me on a minocycline called Solodyn and feels it works great. I have ocular rosacea which is way I was perscibed minocycline and he feels I should have improvement in about two to three months. I have only been taking it for two weeks but I will be glad to keep you posted on my progress.

[redandunhappy]

Thanks for all your responses and information. It's good to hear that spmcc found minocycline worked well, but I wonder how effective it is generally for posterior blepharitis/MGD (ocular rosacea in my case) in comparison to doxycycline...

Also, I wonder how long it stays effective for - as in my case I found the effective of doxycycline wore off after a while.

I'm definitely going to put minocycline on my list of antibiotics to try.

[spmcc]

Also, I wonder how long it stays effective for - as in my case I found the effective of doxycycline wore off after a while.

This is the big downside to using antibiotics for ocular rosacea... once you stop taking them, the benefits disappear (that's also what Frank Powell writes in his book on rosacea).

[redandunhappy]

I'm talking about the benefits disappearing whilst you are still taking them! (which is what i found with doxycycline) I wouldn't expect them to work if they weren't in my system

How long did you take minocycline for spmcc? Did you notice any deterioration in its effectiveness over this time?

[irish eyes]

Redandunhappy

Let me answer your question this way; I noticed Doxy making a difference when I first started taking it, which was years ago and my eyes were really bad. I still had a lot of pain and discomfort but the consultants though the inflammation had decreased and things were looking generally `healthier'.

I had breaks from Doxy - just to give my stomach a rest. The consultant knows about my stomach problems so it was he who suggested I transfer to Minocycline because he felt it was the `lesser of two evils' ie doing the job but not aggravating a pre-existing condition.

The eye inflammation seems to wax and wane and it's hard to know why. When it's not too bad, I don't really know how much is down to the Minocycline and how much it's down to `me'. I have to take care with what I eat anyway, so that covers the eye health bit as well. Environment, stress levels are factors also - so I see Minocycline as just another thing I might include to make things a bit better - as the consultants have advised. I would certainly give it a go; I have to get another 2 months supply from my GP today so I'm glad you raised the topic!

[littlemermaid]

We used oral Lymecycline 6wk and nothing much happened to the eyes although the nose inflammation reduced. We used oral Erythromycin 6wk with tapering and nothing much happened to the MGs or skin. This is not to say it isn't a good fix for other people with MGD but in this case I think there were other factors like contact sensitivity + changed surface from blitzing with random eyedrops previously.

We use topical Erythromycin (Zineryt) on acne rosacea skin every day or 2 + daily Dermol antibac face wash + daily honey moisturiser + avoiding contact sensitivity triggers - it's been great for control of p&p rosacea inflammation. But 3 days off and the skin does a terrible flareup. Now we are thinking about needing eg Azelaic Acid (Finacea) or Metronidazole. When the skin is well controlled, the eye inflammation is good, and we can taper steroid eyedrops to maybe 2/wk, and maintain comfortably on normal saline 0.9% + warm compress (Blephasteam and gentle wash + rub) + diet.

The eye inflammation seems to wax and wane and it's hard to know why

Skin sensitivity/allergy is a big factor for us and may be part of the immunological 'why'. Stress and cold viruses are causing flareups of rosacea + intracranial hypertension (another useful marker of what might be causing the systemic inflammation). Also diet + chemicals in detergent triggers. Freezing cold Raynaud's type hands is another indicator for us. Just if this helps anyone with rosacea-type systemic sensitivities to think about this.

We had amazing clearance of the MGs on topical Azithromycin (Azyter) 6 days although there was cherry-red soreness under the eyelids from contact sensitivity, I think. Not a long-term solution but may be good for a kick-start.

Unfortunately, as the maestro Frank Powell says, we set up chronic intracranial hypertension (2.5y ongoing) and shifted the cerebellum slightly down into the foramen magnum. This happens but rarely. Any side-effect symptoms from oral antibiotics (see US FDA website - headache, vision disturbance), stop and present at A&E with a drug reaction. You need a neuro-ophthalmologist + a neurologist (for a diuretic) - problems mostly resolve straight away, but ongoing vision monitoring, esp visual field, is important in case intervention (shunt, decompression, optic nerve fenestration) is to be considered because raised pressure on optic nerves may persist without eg headache signs. They must get advice from a neuro-ophth before attempting a lumbar puncture in A&E, it's normally not necessary, and could either shift a cerebellar hernia or release pressure on the back of the eye too fast. (If anyone's into ICH, the Raynaud's-type symptoms appeared post-viral 2m into start of eye symptoms rather than peripheral neuro.) If a doc calls this 'benign' or 'pseudo-tumour cerebri', I get really annoyed and consider a doc-dump.

Again, this drug reaction rarely happens but, as Prof Super-derm (TC) told us, there are increased-risk groups for the indicidence and one of them is just pre- or early-puberty in treatment for acne. Joy.