From the Guidelines
Rosacea is a chronic inflammatory skin condition that can be effectively controlled with proper treatment and trigger avoidance, and the most recent and highest quality study recommends a phenotype-based treatment approach.
Characteristics of Rosacea
Rosacea is characterized by facial redness, visible blood vessels, acne-like bumps, and sometimes eye irritation or thickening of the skin, particularly on the nose, and it typically affects the central face including cheeks, nose, forehead, and chin 1. There are four subtypes: erythematotelangiectatic (redness and visible vessels), papulopustular (acne-like bumps), phymatous (skin thickening), and ocular (eye involvement) 1.
Treatment Options
Treatment options vary based on subtype and severity, and topical medications like metronidazole (0.75% or 1% applied twice daily), azelaic acid (15-20% applied twice daily), or ivermectin 1% cream (once daily) can reduce inflammation and redness 1. For moderate to severe cases, oral antibiotics such as doxycycline (40-100mg daily for 8-12 weeks) may be prescribed, and severe cases might require oral isotretinoin 1. Persistent facial redness can be treated with brimonidine gel 0.33% (applied once daily) or oxymetazoline cream 1% for temporary relief. Laser or intense pulsed light therapy can help reduce visible blood vessels and redness.
Lifestyle Modifications
Lifestyle modifications are crucial and include:
- avoiding triggers like spicy foods, alcohol, extreme temperatures, sun exposure, and stress
- daily use of gentle cleansers, fragrance-free moisturizers, and broad-spectrum sunscreen (SPF 30+) to manage symptoms and prevent flares 1. The newest topical agent for rosacea, microencapsulated benzoyl peroxide 5% (E-BPO 5%), has been approved by the US Food and Drug Administration (FDA) in 2022 and can be used as an alternative treatment option 1.
From the FDA Drug Label
PRECAUTIONS General: If sensitivity or severe irritation develop with the use of AZELEX® Cream, treatment should be discontinued and appropriate therapy instituted. Information for patients: Patients should be told: To use AZELEX® Cream for the full prescribed treatment period. DOSAGE AND ADMINISTRATION After the skin is thoroughly washed and patted dry, a thin film of AZELEX® Cream should be gently but thoroughly massaged into the affected areas twice daily, in the morning and evening.
The characteristics of rosacea are not explicitly described in the provided drug labels. However, treatment options for rosacea may include the use of azelaic acid cream, which is applied twice daily to the affected areas.
- The duration of use can vary from person to person and depends on the severity of the condition.
- Improvement of the condition occurs in the majority of patients with inflammatory lesions within four weeks 2 2.
From the Research
Characteristics of Rosacea
- Rosacea is a common chronic dermatosis affecting an estimated 14 million Americans 3
- It is characterized by flushing, redness, pimples, pustules, and dilated blood vessels on the face 4
- The eyes are often involved, and thickening of the skin with enlargement (phymas) can occur, especially on the nose 4
- Rosacea can be classified into different subtypes, including papulopustular rosacea, erythematotelangiectatic rosacea, and phymatous rosacea 5
Treatment Options for Rosacea
- Topical metronidazole is a commonly used treatment for rosacea, and it has been shown to be effective in reducing inflammatory lesions and erythema 3, 4
- Other topical treatments, such as azelaic acid, ivermectin, and brimonidine, have also been shown to be effective in treating rosacea 5, 4
- Oral antibiotics, such as doxycycline and tetracycline, can be used to treat papulopustular rosacea, and they have been shown to be effective in reducing inflammatory lesions and improving quality of life 4, 6
- Laser and light-based treatments can be used to treat telangiectases and erythema associated with rosacea 4
- Maintenance therapy with topical metronidazole or azelaic acid can help to prevent relapses and maintain remission 3, 7
Combination Therapies for Rosacea
- Combination therapy with topical metronidazole and oral doxycycline has been shown to be effective in treating papulopustular rosacea 3
- Combination therapy with topical azelaic acid and oral doxycycline has also been shown to be effective in treating papulopustular rosacea 7
- Combination therapy with topical brimonidine and topical ivermectin may be effective in treating erythematotelangiectatic rosacea and papulopustular rosacea, respectively 5