Rosacea
General Overview
General Overview
- Subtypes:
- Erythemotelangiectatic (flushing/redness, telangiectasias)
- Papulopustular
- Phymatous (fibrotic skin thickening)
- Ocular (blepharitis, conjunctivitis)
Treatment
Treatment
- Behavioural changes
- Avoid triggers
- Extreme temperature
- Sunlight
- Spicy food
- Alcohol
- Exercise
- Acute psychological stressor
- Medication
- Menopausal hot flashes
- Sun protection
- Avoid triggers
- May take 2-3 months on regular treatment before clinical effect seen
DDx
DDx
- Unlike acne, no comedones in papulopustular rosacea
- Unlike systemic lupus, no cheilitis in erythematotelangiectic rosacea
- Perioral dermatitis
- Seborrheic dermatitis and rosacea may co-exist
Treatment for Papulopustular Rosacea
Treatment for Papulopustular Rosacea
- First-line
- Metronidazole 0.75-1% gel or cream daily
- Note: There is no clinical difference between 0.75% and 1% metronidazole, but 0.75% may cost more
- Azelaic Acid (Finacea) 15% gel BID
- Ivermectin (Rosiver) 1% cream daily
- Metronidazole 0.75-1% gel or cream daily
- If Moderate-Severe
- Add oral antibiotics to topical above
- Doxycycline 50-100mg PO BID or 40mg modified-release daily or tetracycline or isoretinoin
- Taper after 2-3 months and maintain on topical
- Add oral antibiotics to topical above
Treatment for Erythema
Treatment for Erythema
- First-line
- Brimonidine (Onreltea) 0.33% gel
- Metronidazole 0.75-1% gel or cream daily
- Azelaic Acid (Finacea) 15% gel BID
- Second-line
- Alternative first-line or combination of first-line
- Intense pulsed light device or vascular laser
References:
- Br J Dermatol 2019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6850438/
- https://www.cfp.ca/content/65/11/803
- Asai Y, Tan J, Baibergenova A, Barankin B, Cochrane CL, Humphrey S, Lynde CW, Marcoux D, Poulin Y, Rivers JK, Sapijaszko M, Sibbald RG, Toole J, Ulmer M, Zip C. Canadian Clinical Practice Guidelines for Rosacea. J Cutan Med Surg. 2016 Sep;20(5):432-45. doi: 10.1177/1203475416650427. Epub 2016 May 17. http://journals.sagepub.com.proxy3.library.mcgill.ca/doi/pdf/10.1177/1203475416650427