it has been surprisingly discovered that azithromycin , administered systemically for a period of several weeks or more , is effective in treating the signs and symptoms of granulomatous rosacea . the invention is a method for treating the signs and symptoms of granulomatous rosacea in an individual suffering from such signs and symptoms by systemically administering azithromycin to the individual at a dosage and for a period of time sufficient to ameliorate the signs and symptoms of granulomatous rosacea in the individual . the azithromycin used for the method of the invention may be any form of azithromycin . such forms include non - crystalline and crystalline azithromycin . crystalline forms of azithromycin include dihydrate and monohydrate forms . administration of azithromycin for the treatment of granulomatous rosacea is systemic . such systemic administration includes both enteral and parenteral routes of administration . examples of systemic administration suitable for the method of the invention include injection , such as intravenous , intramuscular , and subcutaneous , and oral administration , such as by swallowing tablets or capsules , including immediate release and delayed release tablets and capsules . the dosage of azithromycin that is used in accordance with the method of the invention is a dose that is effective to ameliorate the signs and symptoms of granulomatous rosacea in a person suffering from this disorder . typically , a daily dose of 100 to 1000 mg of azithromycin is administered . preferably , the daily dose is between 150 mg and 750 mg . most preferred is a daily dose of up to about 500 mg , such as between 175 to 350 mg . an alternative dosing regimen is an every other day regimen in which a patient receives between 250 mg and 1000 mg on alternate days , preferably between 250 mg and 750 mg on alternate days , and most preferably about 500 mg on an alternating day basis . the every other day dose regimen may be utilized following an initial period of daily dosing of azithromycin , if desired . other dosing regimens are also possible under this invention including once weekly dosage in which a total weekly dose is provided that equals the total weekly amounts that would be administered under the above described daily dosing above . for example , a typical weekly dose of azithromycin could be between 700 mg and 7000 mg administered as a single weekly dose . additional variations in dosing schedule are also possible , for example to provide the same weekly amount of azithromycin by administering 2 or 3 doses per week . an alternative dosing schedule is as a cycle therapy . cycle therapy means dosing for a period of time , such as for one week , followed by a rest period ( no administration of azithromycin ) for a period of time typically the same as that for the dosing period , for example one week . the cycle of dosing and rest is then repeated . thus , for the week on / week off cycle , the total treatment duration could be as little as 2 cycles or as many as 13 cycles or even more if desired . an alternative preferred treatment cycle is a one - month treatment , with any of the described dosing schedules within each week such as described above , and a one - month rest period . the duration of therapy with azithromycin to ameliorate the signs and symptoms of granulomatous rosacea will vary according to the severity of the condition in an individual and the individual &# 39 ; s response to azithromycin therapy . preferably , azithromycin is administered for at least two weeks , preferably for four weeks or more , and more preferably for at least two months . generally therapy should be continued until clinically significant clearance is observed . treatment with azithromycin in accordance with the invention may last for as long as 6 months or even longer . moreover , in the event that an individual &# 39 ; s granulomatous rosacea worsens after the initial treatment with azithromycin as described above , additional courses of therapy may be utilized in accordance with the invention to bring the disease back into control . if desired , the azithromycin may be administered to an individual suffering from signs and symptoms of granulomatous rosacea in combination with other auxiliary medications and therapies . examples of such auxiliary medications include hormones such as sex hormones like estrogens , retinoids such as isotretinoin , and other topical medications such as azaleic acid ( finacea ®, intendis , montville , n . j . ), sodium sulfacetamide 10 % with sulfur 5 % ( rosac ® cream with sunscreens , stiefel laboratories , coral gables , fla . ), and / or metronidazole ( metrogel ®, galderma laboratories , fort worth , tex .). topical and or systemic medications known to be effective in the treatment of forms of rosacea other than granulomatous rosacea may be administered in combination with the azithromycin . the method of the invention is especially well suited for treating cases of granulomatous rosacea that have not responded favorably , or have responded less favorably than is desired , to other therapy . such unsuccessful therapies include treatments with antibiotics other than azithromycin , including with antifungal medications such as naftifine hydrochloride ( naftin ®, merz , pharmaceuticals , greensboro , n . c . ), and treatment with azithromycin for a time shorter than 2 weeks . the method of the invention is further illustrated in the following non - limiting examples . a 34 year old hispanic female patient presented with severe inflammatory diffuse facial granulomatous rosacea . the condition had been present for 6 years . prior treatment with the antibiotic doxycycline had produced no improvement . she was started on oral azithromycin 500 mg daily dose together with an estrogenic hormone , norgestimate / ethinyl estradiol ( ortho tri - cyclen ®, ortho - mcneil pharmaceutical , raritan , n . j .). the patient was greatly improved with only minimal residual facial erythema and no residual inflammatory lesions on representation 9 weeks after initiation of azithromycin therapy . at that time , the dose of azithromycin was reduced to 500 mg every other day and topical azaleic acid was applied daily . the patient remained clear on a follow - up examination two months later . treatment was continued with a follow - up examination expected in another 6 to 8 weeks . a 70 year old caucasian male patient presented with complaints of a “ facial rash ”. on physical exam the patient had malar erythema with large papules on the nose , cheeks , forehead , and on the trunk . blepharitis was also reported . he was started on oral cephalexin . one month later , the patient returned with worsening pustules and tender nodules worse on both sides of the face . a biopsy was obtained from the right jaw and the pathology revealed “ suppurative and granulomatous folliculitis ”. treatment with dicloxicillin was initiated . six weeks later , the patient was seen in follow - up with persistent severe to worsening involvement and naftifine cream was added . the patient saw a different dermatologist the next day who diagnosed the problem as granulomatous rosacea . oral azithromycin at a dosage of 500 mg daily was started , together with daily topical application of a sodium sulfacetamide 10 % with sulfur 5 % cream and a metronidazole cream . the patient was again evaluated six weeks after initiation of the azithromycin therapy and had , at that time , minimally perceptible residual erythema and papulation . the treatment was continued except that azithromycin was decreased to 500 mg every other day . the patient was again evaluated two months later and had no evidence of residual rosacea . the azithromycin was discontinued . a 59 year old woman presented with a facial rash . examination revealed erythematous patches and some pustules and papules involving her forehead , hairline , infraorbital area , and nose . a clinical diagnosis of granulomatous rosacea was made . treatment was initiated with a variety of topical medications , including metronidazole gel , elidel ® ( pimecrolimus , novartis pharmaceuticals corp ., new york , n . y . ), 2 . 4 % hydrocortisone , and desonide cream . these topical treatments took place over the course of several months and were ineffectual . oral tetracycline 500 mg twice daily was then tried , but the patient &# 39 ; s condition was not responsive to this therapy . following these unsuccessful therapies , the patient was biopsied and the biopsy confirmed the diagnosis of granulomatous rosacea . the next therapy tried was oral doxycycline 100 mg twice daily . this therapy was also unsuccessful . klaron ® lotion ( 10 % sodium sulfacetamide , dermik laboratories , berwyn , pa .) also failed to ameliorate the patient &# 39 ; s condition . the patient was then started on accutane ® ( hoffman - laroche inc ., nutley , n . j .) at an initial dosage of 20 mg per day , which was subsequently raised to 40 mg per day and then to 60 mg per day . even at the higher dosages of accutane ®, the patient &# 39 ; s condition did not improve . treatment was subsequently initiated with azithromycin as the sole therapy , administered orally at a dosage of 250 mg daily for three weeks . the patient &# 39 ; s condition underwent a remarkable improvement as her face cleared and she has not had a recurrence of her granulomatous rosacea following cessation of azithromycin therapy . further modifications , uses , and applications of the invention described herein will be apparent to those skilled in the art . it is intended that such modifications be encompassed in the following claims .
systemic administration of azithromycin for a period of at least two weeks is effective in ameliorating the signs and symptoms of granulomatous rosacea , a variant form of rosacea that often fails to respond favorably to treatment regimens that are effective against forms of rosacea other than granulomatous rosacea .