IN THE 1994 issue of the ARCHIVES in an editorial on rosacea, I described the combination regimen of systemic tetracycline (beginning at 1 g/d in divided doses) and topical metronidazole.1 Typically, after 1 to 3 months of systemic tetracycline plus topical metronidazole, I can wean patients from the systemic agent completely to the topical metronidazole alone. Knight and Vickers2 studied 68 patients who achieved remission with systemic tetracycline. Within 1 month of tetracycline withdrawal, 25% of these patients relapsed. Within 6 months, two thirds of the patients relapsed. In my practice, topical agents, such as metronidazole, appear to maintain the remission at significantly higher levels than those in the untreated patients of Knight and Vickers.
Wilkin JK. Use of Topical Products for Maintaining Remission in Rosacea. Arch Dermatol. 1999;135(1):79-80. doi:10.1001/archderm.135.1.79