Rosacea

General Overview

• Subtypes:
  • Erythemotelangiectatic (flushing/redness, telangiectasias)
  • Papulopustular
  • Phymatous (fibrotic skin thickening)
  • Ocular (blepharitis, conjunctivitis)

Treatment

• Behavioural changes
  • Avoid triggers
    • Extreme temperature
    • Sunlight
    • Spicy food
    • Alcohol
    • Exercise
    • Acute psychological stressor
    • Medication
    • Menopausal hot flashes
  • Sun protection
• May take 2-3 months on regular treatment before clinical effect seen

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

• 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
• 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

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