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Update in Rosacea Management

Dr Anna Chapman, Dermatologist at The London Skin and Hair Clinic, writes about updates in rosacea management in Dermatology in Practice.

Rosacea is a common skin condition, often untreated, which can have an important psychological impact.

There are four main types of rosacea:

  1. erythemato-telangiectatic (ETR),
  2. papulopustular (PPR),
  3. phymatous (PR) and,
  4. ocular (OR).

In addition, steroidinduced rosacea as an important entity of iatrogenic rosacea.

The following factors are implicated in pathophysiology of rosacea:

  • immune system dysregulation,
  • microorganisms presence,
  • neurogenic dysregulation,
  • abnormal barrier function, and
  • abnormal UV radiation response.

Rosacea should be distinguished from other facial erythema conditions such as acne vulgaris, seborrhoeic eczema, atopic eczema, contact eczema and lupus. Management of rosacea include patient education, appropriate skin care and medical/laser therapy to manage visible manifestations.

First, the most suitable skin care should be advised with adequate moisturising and sun protection properties, to restore and maintain a healthy skin-barrier function. Then, the therapeutic medical treatment should be tailored in accordance with the patient’s symptoms (inflammation, erythema, facial flushing, papulopustular eruption, facial flushing etc) and preference.

Topical rosacea treatments should be introduced first. Reducing the overall use of oral antibiotics should also be part of a general prescribing strategy to reduce antibiotic resistance. A continuous use of topical or oral treatment for 12–16 weeks is recommended. Some individuals remain under remission for a prolonged time, while others relapse quickly or require continued use of medical treatments. Some patients can go into remission with an oral antibiotic and maintained in remission with a topical agent.

A number of topical agents are used in rosacea
treatments including:

  • Metronidazole gel 0.75% or 0.75–1% cream
  • Azelaic acid cream 15% or 20% gel
  • Brimonidine 0.33% gel
  • Ivermectin cream 1%
  • Tretinoin 0.025% cream. Off-label use
  • Protopic 0.03% or 0.1% ointment. Off-label use

The systemic agents used in rosacea treatment include:

  • Oxytetracyclines
  • Macrolides
  • Isotretinoin
  • Laser therapy. Confluent erythema and facial thread veins respond well to vascular laser and intense pulsed light (IPL) devices

You can read the full article by Dermatologist Dr Anna Chapman on Update in Rosacea Management in Dermatology in Practice Winter 2015, Volume 21 Number 4. Dermatology in practice is the UK’s longest-running review-based journal dedicated to dermatology.

You can find out more about treatments for rosacea here and laser treatment for rosacea here.

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