What is the diagnosis and treatment for Rosacea?

From the Guidelines

Rosacea treatment should prioritize topical metronidazole 0.75% or 1% gel/cream, applied twice daily, as it has been shown to be effective in reducing inflammatory lesions and perilesional erythema associated with rosacea, as demonstrated in a study published in 2024 1.

Treatment Options

• For mild rosacea, gentle cleansers, daily sunscreen (SPF 30+), and avoiding triggers like spicy foods, alcohol, extreme temperatures, and harsh skincare products are recommended.
• Topical medications such as metronidazole 0.75% or 1% gel/cream (applied twice daily), azelaic acid 15-20% (applied twice daily), or ivermectin 1% cream (applied once daily) can effectively reduce inflammation and redness.
• For moderate to severe cases, oral antibiotics like doxycycline (40-100mg daily for 8-12 weeks) may be prescribed, with a study showing that once-daily doxycycline 40 mg is as effective as once-daily doxycycline 100 mg for moderate-to-severe rosacea 1.

Additional Therapies

• Persistent facial redness can be treated with brimonidine 0.33% gel or oxymetazoline 1% cream applied once daily.
• Laser or intense pulsed light therapy can address visible blood vessels and persistent redness.
• Minocycline 1.5% foam, approved by the FDA in 2020, is also a topical therapeutic option for moderate-to-severe rosacea, with studies showing its efficacy in reducing inflammatory lesion counts 1.

Disease Management

• Rosacea is a chronic relapsing facial skin disease that presents with one or more of the following features: recurrent flushing, erythema, inflammatory lesions (papules and pustules), phymas, and telangiectasias.
• Long-term avoidance of common triggers, use of gentle skin care, and adherence to pharmacologic treatment are fundamental strategies for rosacea control, as highlighted in a review of the current treatment landscape published in 2024 1.

From the Research

Definition and Subtypes of Rosacea

• Rosacea is a chronic inflammatory skin condition associated with four distinct subtypes: erythematotelangiectatic, papulopustular, phymatous, and ocular 2
• Each subtype has its own treatment options, and patients may have multiple subtypes, requiring individualized treatment plans 2, 3, 4

Treatment Options for Rosacea

• Topical treatments:
  • Metronidazole 1% cream and azelaic acid 15% or 20% cream reduce the severity of erythema 2, 3, 4, 5, 6
  • Brimonidine tartrate 0.5% reduces persistent facial erythema 2, 5
  • Ivermectin 1% and permethrin 5% cream may be useful for papulopustular rosacea 3, 4, 6
• Systemic treatments:
  • Oral metronidazole, doxycycline, minocycline, clarithromycin, and isotretinoin may be used to treat papulopustular rosacea 2, 3, 4, 6
  • Nonselective β-blockers and α2-adrenergic agonists decrease erythema and flushing 2
• Procedural interventions:
  • Flashlamp-pumped dye, potassium-titanyl-phosphate and pulsed-dye laser, and intense pulsed light are used for telangiectasias 2, 6
  • Intradermal botulinum toxin injection is almost safe and effective for the erythema and flushing 2
  • Dermatosurgical procedures, decortication, and various types of lasers can be used to correct rhinophyma 2, 6

Management and Prevention of Rosacea

• Patient education and skin care are essential components of rosacea management 2, 5
• Avoiding specific triggers, decreasing transepidermal water loss by moisturizers, and blocking ultraviolet light can help prevent flushing 2
• Treatment for ocular involvement can be treated with oral or topical antibacterial agents 2, 6