dermatologic disorders
Rosacea
Treatment of Rosacea
Avoidance of triggers Consideration of topical or oral antibiotics or topicalazelaic acidorivermectin For flushing or persistent erythema, consideration of topicalbrimonidineoroxymetazoline For recalcitrant cases, consideration of oralisotretinoin For rhinophyma, consideration of dermabrasion, laser ablation, and tissue excision For telangiectasia, consideration of laser or electrocautery treatment Primary initial treatment of rosacea involves avoidance of triggers (including use of sunscreen). Antibiotics and/orazelaic acidmay be used for inflammatory disease. The objective of treatment is control of symptoms, not cure. See the Canadian2016 clinical practice guidelines for rosacea. Metronidazolecream (1%), lotion (0.75%), or gel (0.75%) andazelaic acid20% cream, applied 2 times a day, are equally effective; 2.5%benzoyl peroxidein any form (eg, gel, lotion, cream), applied once a day or 2 times a day, can be added for improved control. Less effective alternatives include sodiumsulfacetamide10%/sulfur 5% lotion;clindamycin1% solution, gel, or lotion; anderythromycin2% solution, all applied 2 times a day.Minocycline1.5% foam can also be applied once a day. Many patients require indefinite treatment for long-term control. Topicalivermectin1% cream also has efficacy in the treatment of inflammatory lesions of rosacea. Oral antibiotics are indicated for patients with multiple papules or pustules and for those with ocular rosacea; options includedoxycycline50 to 100 mg 2 times a day,tetracycline250 to 500 mg 2 times a day,minocycline50 to 100 mg 2 times a day,erythromycin250 to 500 mg 2 times a day, andazithromycin250 mg once a day or various alternate-day or pulse dose regimens. Dose should be reduced to the lowest one that controls symptoms once a beneficial response is achieved. Subantimicrobial doses ofdoxycycline(40 mg once a day in a preparation containing 30 mg of immediate-release and 10 mg of sustained-releasedoxycycline) are effective for acne and rosacea. hydrochloride 1% cream applied once a day ( Treatment reference ). Recalcitrant cases may respond to oralisotretinoin. Techniques for treatment of rhinophyma include dermabrasion, laser ablation, and tissue excision; cosmetic results are good. Techniques for treatment of telangiectasia include laser and electrocautery. 1.Baumann L, Goldberg DJ, Stein Gold L, et al: Pivotal trial of the efficacy and safety ofoxymetazolinecream 1.0% for the treatment of persistent facial erythema associated with rosacea: Findings from the second REVEAL trial.J Drugs Dermatol17(3):290–298, 2018. PMID: 29537447 