Rosacea

Management

• Use a gentle soap-free cleanser

• Avoid factors that cause facial flushings (e.g. excessive sun exposure, wind, heat, alcohol, spicy foods, hot drinks—tea and coffee)

• Sun protection

Topical agents

• For mild erythema and inflammatory lesions: metronidazole gel or cream, apply thin film bd, or azelaic acid gel d

• New topical agent—brimonidine 0.5% (a vasoconstrictor) for flushed skin

Note: Topical steroids should not be used because of severe rebound vascular changes.

Laser therapy is suitable for telangiectasia, erythema and rhinophyma.

Systemic antibiotics

• Doxycycline:

  • – 50–100 mg (o)/d for a total of 8–10 wks

  • – if inadequate response at 4 wks, consider minocycline 50–100 mg (o)/d for up to 8 wks

  • – repeat for recurrences; avoid maintenance

• Erythromycin 250–500 mg (o) bd is an alternative for pregnant women or if the above is not tolerated

• Doxycycline or minocycline 50 mg (o)/d are appropriate for longer use if symptoms recur within a month