Updates on Acne and Rosacea Treatments, with Christopher Bunick, MD, PhD

At the American Academy of Dermatology (AAD) Annual Meeting in Orlando, Christopher Bunick, MD, PhD, associate professor in dermatology at the Yale School of Medicine, gave a presentation titled ‘Update on Antiobiotics for Acne and Rosacea.’

Bunick sat down with the HCPLive editorial team at the AAD meeting to highlight the takeaways from his talk regarding this update, first highlighting news in the rosacea space.

“My focus was on antibiotics…and the truth is, the antibiotic space moves very slowly in acne and rosacea these days,” Bunick said. “However, I'll start with rosacea. Usually, rosacea takes second fiddle to acne. But today we'll put rosacea first, because we have a new extended release, low-dose minocycline that has just been approved for the treatment of rosacea. Why is this important? This particular minocycline product in the clinical trials was actually compared not just to placebo, but head to head, to an authorized doxycycline low dose 40 milligram, an authorized generic is what we call it.

Bunick noted that the extended-release minocycline was shown to have outperformed the authorized generic of the doxycycline low dose 40 milligrams by 20 - 30 percentage points in terms of achieving Investigator's Global Assessment (IGA) success indicating skin clearance.

“This is really profound, because it has the implications to say that this particular medication may be very effective or potentially more effective in the treatment of popular postulate rosacea,” Bunick explained.

Next, Bunick highlighted a portion of his talk regarding the notable concept of antibiotic stewardship, a topic he states often gets misunderstood by clinicians.

“Some people think antibiotic stewardship means not to use antibiotics at all,” Bunick said. “But it turns out, in medicine, they're great for treating infection but they have, especially the tetracycline class, incredible anti-inflammatory properties. We harness those anti-inflammatory properties every day in dermatology, not just for acne, not just for rosacea, but across the gamut of diseases, including immunobullous diseases like bullous pemphigoid and including other post-sebaceous unit diseases like hidradenitis.”

Bunick added that antibiotics are implemented all the time, adding that this is why he has always been a believer that dermatologists are honorary gastroenterologists.

“So when we give antibiotics, we are affecting the gut microbiome,” Bunick said. “What we don't want to do is cause gut dysbiosis, or certainly don't want to cause harmful gut dysbiosis to high levels. This is where broad-spectrum antibiotics tend to have more gut dysbiosis, whereas narrow-spectrum antibiotics…[by which] I mean antibiotics that focus on gram-positive bacteria way more than gram-negative bacteria, which make up most of the gut bacteria. Broad-spectrum antibiotics are really hitting both gram-positive and gram-negative bacteria at really high levels. So this is why we can protect the gut microbiome, which has health implications for the whole patient by using narrow-spectrum antibiotics.”

Bunick highlighted his presentation of patient photos in which they had used oral narrow-spectrum antibiotics for the treatment of staphylococcus aureus infections.

“In the case of rosacea, using these narrow-spectrum antibiotics can affect and improve the inflammation component of rosacea,” Bunick said. “It also can improve infections, especially staph infections. It's really good to know that.”

To find out more about this topic, view Bunick’s full video posted above the summary. For more from AAD 2025, view our latest conference coverage.

The quotes used in this video summary were edited for clarity. Bunick’s disclosures include the following: Consultant (Fees): AbbVie, Almirall, Apogee Therapeutics, Arcutis Biotherapeutics, Botanix Pharmaceuticals, Eli Lilly, LEO Pharma, LiVDerm, Pfizer, Regeneron, Takeda Pharmaceuticals, Teladoc Health; Advisory Board (Fees/Honoraria): Almirall, Dermatology Times, LEO Pharma, Novartis, Ortho Dermatologics, Pfizer, Sanofi, South Beach Symposium, Takeda Pharmaceuticals, UCB; Investigator (Grants/Research Funding): AbbVie, Almirall, Daiichi Sankyo, Ortho Dermatologics, Palvella Therapeutics, Sun Pharmaceutical Industries, Timber Pharmaceuticals.