They can be used alone or in combination. Metronidazole works as an anti-inflammatory drug by altering neutrophil chemotaxis and inactivating reactive oxygen species. Metronidazole 0.
It is usually well tolerated with minor local adverse effects such as skin irritation. Topical azelaic acid is an over-the-counter preparation which has anti-inflammatory, anti-keratinising and antibacterial effects. Adverse effects may include skin irritation, but azelaic acid is usually well tolerated and can be used for long periods of time. Laser therapy, including vascular lasers or intense pulse light, may help to reduce refractory background erythema and clinically significant telangiectases, but will not reduce the frequency of flushing episodes.
Different laser therapies that target the vessels have been used such as nm pulsed dye laser, Nd:YAG and other vascular lasers, or intense pulsed light therapy. These should be administered by an experienced and trained laser therapist and the number of sessions and length of treatment varies for each individual.
Combining topical treatments with oral antibiotics may be needed for papulopustular rosacea. Topical treatments include metronidazole, azelaic acid, ivermectin and dapsone. It has an anti-inflammatory effect as well as having an effect on Demodex mites, which may activate the local immune response to produce the pustules. It is applied once daily for up to four months, and the course may be repeated if needed. Topical dapsone is a sulfone antibacterial with anti-inflammatory actions.
It was recently approved for acne in Australia, but in the USA it is approved for rosacea. Dapsone 7. It should be avoided in those with known glucosephosphate dehydrogenase deficiency. Oral antibiotics used in papulopustular rosacea include minocycline, doxycycline, erythromycin, clarithromycin and clindamycin. Their effectiveness at sub-antimicrobial doses is mostly due to their anti-inflammatory properties rather than a direct antimicrobial mechanism. Although bacteria may contribute to this form of rosacea, evidence for this is scant.
Doxycycline 40 mg per day is commonly given in the USA as a sub-antimicrobial dose. The risk of resistance at this dose is less than with higher doses. In Australia 50 mg daily is used range 25— mg. Photosensitivity is the main adverse effect, and sun avoidance or sunscreens may be required, especially during the summer months. Minocycline is probably a more effective agent but the increased risk of pigmentation, liver disorders and lupus-like syndrome limits its long-term use.
The goal of oral therapy is to improve the rosacea to a point where control is achieved by topical therapies. Treatment duration varies from four weeks to supress flares to many months for long-term disease suppression.
With lower doses, adverse effects like headache, photosensitivity, diarrhoea and mucosal candidiasis are relatively uncommon. The antibiotics should be taken with food. Erythromycin and clarithromycin are generally used in patients who are intolerant or have refractory disease to tetracyclines e. Topical or oral erythromycin is sometimes used in pregnant women with papulopustular rosacea.
Oral isotretinoin is usually reserved for patients who are intolerant to oral or systemic therapies. Its effect is thought to be secondary to the downregulation of the local cutaneous immunity, although an alteration in the lipid environment of the skin cannot be excluded. Low-dose isotretinoin 10 mg daily may be effective and have less adverse effects. The teratogenicity and adverse effects of isotretinoin requires routine clinical and laboratory monitoring for safety.
Referral to a dermatologist is therefore recommended. Oral isotretinoin is also used in phymatous rosacea as with papulopustular rosacea. The hypertrophied tissue in patients with phymatous rosacea can be reshaped and contoured with ablative lasers including carbon dioxide or electrosurgery devices. Treatment is aimed at debulking the excess tissue and then sculpting the disfigured area.
Lasers produce less bleeding when compared to traditional surgery. Patients may be referred to a dermatologist or plastic surgeon for these therapies. Lid care and artificial tears are used for ocular rosacea, as are oral tetracyclines. Ciclosporin drops are reserved for moderate to severe cases and are prescribed by a consultant ophthalmologist. If there is an important clinical improvement in the first six weeks, the patient may need to stay on therapy for at least six months.
Extreme temperatures are a common trigger for rosacea. The hot weather during the summer increases b Can children develop rosacea? Although it is rare, rosacea can develop in children. In fact, it often goes undiagnosed in children Topical therapy results in such minimal levels of medication in the bloodstream, if any, that there is virtually no risk of systemic side effects except allergic reactions.
Possible side effects associated with oral antibiotic therapy include upset stomach, sensitivity to sun exposure, tooth discoloration, diarrhea, allergic reactions and vaginal yeast infections. If I take long-term medication consistently, will it lose its effectiveness?
Topical therapy usually controls rosacea on a long-term basis, without loss of effectiveness. Rosacea is characterized by flare-ups and remissions, and a study found that long-term medical therapy significantly increased the rate of remission in rosacea patients. In a six-month multicenter clinical study, 42 percent of those not using medication had relapsed, compared to 23 percent of those who continued to apply a topical medication.
In general, treatment between flare-ups can prevent them. A rosacea facial care routine recommended by many dermatologists starts with a gentle and refreshing cleansing of the face each morning. Sufferers should use a mild soap or cleanser that is not grainy or abrasive, and spread it with their fingertips. A soft pad or washcloth can also be used, but avoid rough washcloths, loofahs, brushes or sponges. Next, rinse the face with lukewarm water several times and blot it dry with a thick cotton towel.
Never pull, tug, scratch or treat the face harshly. Sufferers should let their face air dry for several minutes before applying a topical medication. Let the medication soak in for an additional five or 10 minutes before using any makeup or other skin care products. The skin of many rosacea sufferers may be sensitive and easily irritated. Patients should avoid using any products that burn, sting or irritate their skin. In a National Rosacea Society survey, many individuals with rosacea identified alcohol, witch hazel, fragrance, menthol, peppermint, eucalyptus oil, clove oil and salicylic acid as ingredients that irritated their individual cases, and many also avoided astringents and exfoliating agents.
A useful rule of thumb may be to select products that contain no irritating or unnecessary ingredients. Sunscreens or sunblocks effective against the full spectrum of ultraviolet A and B radiation can be especially important for rosacea patients, whose facial skin may be particularly susceptible to sun damage and consequent rosacea flare-ups.
An SPF of 15 or higher is recommended, and physical blocks utilizing zinc or titanium dioxide may be effective if chemical sunscreens cause irritation. To remove visible blood vessels or reduce extensive redness, vascular lasers emit wavelengths of light that target tiny blood vessels just under the skin.
Heat from the laser's energy builds in the vessels, causing them to disintegrate. Generally, at least three treatments are required, depending on the severity of redness or visible blood vessels. Vascular lasers may also be used to help retard the buildup of excess tissue, and in severe cases a CO 2 laser may be used to remove unwanted tissue and reshape the nose.
New laser technology has been developed to minimize bruising, and recently developed devices called intense pulsed light sources mimic lasers but generate multiple wavelengths to treat a broader spectrum of tissue. As with any surgical technique, the safety and effectiveness of laser therapy may depend on the skill of the physician.
The National Rosacea Society has instituted a research grants program to encourage and support scientific investigation into the potential causes and other key aspects of rosacea that may lead to improvement in its treatment, as well as its potential prevention or cure. Information on this program can be found under Research Grants. As always, the best offense is a good defense. Individuals with rosacea should identify and avoid environmental and lifestyle factors that cause flushing.
A list of the most common rosacea triggers can be found here. In severe cases, certain medications may be prescribed by a physician to lessen the intensity and frequency of flushing, and a topical therapy is now available to treat persistent facial redness. While effective in treating certain skin conditions, long-term use of topical steroids may prompt rosacea-like symptoms informally called " steroid-induced rosacea.
Acknowledgments: This section has been reviewed and edited by Dr. Phone: Email: info rosacea. The National Rosacea Society is a c 3 non-profit organization whose mission is to improve the lives of people with rosacea by raising awareness, providing public health information and supporting medical research on this widespread but poorly understood disorder. The information the Society provides should not be considered medical advice, nor is it intended to replace consultation with a qualified physician.
The Society does not evaluate, endorse or recommend any particular medications, products, equipment or treatments. Rosacea may vary substantially from one patient to another, and treatment must be tailored by a physician for each individual case. For more information, visit About Us. Frequently Asked Questions. Click on the questions below to read an answer. General What causes rosacea? Is rosacea contagious? Is rosacea hereditary? Can rosacea be diagnosed before a flare-up?
Is there any sort of test for rosacea? Will my rosacea get worse with age? How long does rosacea last? How can I find a rosacea specialist? Are there any studies or research that I can participate in?
Can rosacea occur in children? Are there support groups for rosacea sufferers? Signs and Symptoms Does rosacea cause facial swelling, burning or itching? Are symptoms generally symmetrical or asymmetrical? I suffer from acne and rosacea — is this common? Is dry, flaky skin typical with rosacea? Is oily skin common for rosacea sufferers? Is there a connection between rosacea and seborrheic dermatitis?
Is there a connection between rosacea and eczema? Is there a connection between rosacea and lupus? No specific test is used to diagnosis rosacea. Instead, your doctor relies on the history of your symptoms and an examination of your skin. You may have tests to rule out other conditions, such as psoriasis or lupus. Studies show that in people of color, rosacea can be missed or misdiagnosed as an allergic reaction or seborrheic dermatitis.
If your symptoms involve your eyes, your doctor may refer you to an eye specialist ophthalmologist for evaluation. Treatment for rosacea focuses on controlling signs and symptoms. Most often this requires a combination of good skin care and prescription drugs. The duration of your treatment depends on the type and severity of your signs and symptoms. Recurrence is common. New rosacea medications have been developed in recent years. The type of medication your doctor prescribes depends on which signs and symptoms you're experiencing.
You may need to try different options or a combination of drugs to find a treatment that works for you. Topical drugs that reduce flushing. For mild to moderate rosacea, your doctor may prescribe a cream or gel that you apply to the affected skin. Brimonidine Mirvaso and oxymetazoline Rhofade reduce flushing by constricting blood vessels. You may see results within 12 hours after use. The effect on the blood vessels is temporary, so the medication needs to be applied regularly to maintain improvements.
Other topical products help control the pimples of mild rosacea. These drugs include azelaic acid Azelex, Finacea , metronidazole Metrogel, Noritate, others and ivermectin Soolantra. With azelaic acid and metronidazole, noticeable improvements generally don't appear for two to six weeks.
Ivermectin may take even longer to improve skin, but it results in a longer remission than does metronidazole. Laser therapy can make enlarged blood vessels less visible. Because the laser targets visible veining, it's most effective on skin that isn't tanned, brown or black.
Talk with your doctor about the risks and benefits of laser therapy. Side effects of laser therapy for rosacea include swelling and bruising that might last for several days. Icing and gentle skin care will be needed during the recovery period. On brown or black skin, laser treatment might cause long-term or permanent discoloration of the treated skin.
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