Rosacea: An Introduction

Rosacea Treatment

The outcome of a successful rosacea treatment and management regimen is usually control rather than eradication of the disease.

Advising the patient to avoid those stimuli that tend to exacerbate the disease — exposure to extremes of heat and cold, excessive sunlight, ingestion of hot liquids, alcohol, and spicy foods — may help.

Although its mechanism of action is not clearly understood, the mainstay of treatment is the use of oral tetracycline, especially for the papular or pustular lesions.

The dosage utilized is generally 250 mg every 6 hours for the first 3 to 4 weeks, followed by tapering based on clinical response.

Doxycycline and minocycline (50-100 mg every 12 hours) are also effective and have the advantage of less frequent dosage and less concern over problems with gastrointestinal absorption.

Patients who are intolerant to the tetracyclines may benefit from the use of erythromycin.

Oral isotretinoin, in doses similar to those used for acne vulgaris, has also been effective for the inflammatory lesions, erythema, and rhinophyma.

There is, however, no beneficial effect on the telangiectasias and isotretinoin may cause blepharitis and conjunctivitis.

Other oral agents that have been used include ampicillin and metronidazole.

Clonidine may also be of some value in reducing facial flushing.

Topical therapy for rosacea is generally less successful than systemic treatment.

Metronidazole may be effective topically.

It is available commercially as a 0.75% gel and, when applied twice daily, substantially reduces inflammatory lesions.

Although topical corticosteroids may effectively improve signs and symptoms, long-term therapy is not advisable since it may cause atrophy, chronic vasodilation, and telangiectasia formation.

The treatment of chronic skin changes may require surgical intervention.

Telangiectasias may be treated by electrocautery or using the tunable dye laser.

Severe rhinophyma is treated by paring with a scalpel, excision with skin grafting, dermabrasion, bipolar electrocautery, or by means of the argon or carbon dioxide laser.

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