From the Guidelines
When evaluating a patient with suspected rosacea, the most effective approach is to determine their specific symptoms, triggers, and how long they've been experiencing the rash, and then tailor treatment based on the phenotype-led approach, as recommended by the global Rosacea Consensus (ROSCO) panel 1.
Key Considerations
- Determine the patient's specific symptoms, including flushing episodes, persistent redness, papules or pustules, eye symptoms (ocular rosacea), and any burning or stinging sensations.
- Identify common triggers, such as sun exposure, hot or cold temperatures, spicy foods, alcohol, stress, and certain skincare products.
- Treatment typically begins with gentle skincare using mild, non-irritating cleansers and moisturizers, along with daily broad-spectrum sunscreen.
Treatment Options
- For mild cases, topical medications like metronidazole (0.75% or 1% cream/gel), azelaic acid (15-20% cream/gel), or ivermectin 1% cream may be prescribed, applied once or twice daily for several weeks 2.
- For moderate to severe cases, oral antibiotics such as doxycycline (40-100mg daily for 4-12 weeks) may be needed 1.
- Persistent redness can be treated with brimonidine 0.33% gel or oxymetazoline 1% cream.
- Laser or intense pulsed light therapy may help with visible blood vessels.
Recent Developments
- Encapsulated benzoyl peroxide 5% (E-BPO 5%) is a newly FDA-approved topical treatment for rosacea that shows promise in enhancing therapeutic response and minimizing skin irritation 3.
- E-BPO 5% offers a promising addition to the treatment options due to its microencapsulation technology, which prolongs drug delivery time and aims to improve therapeutic response while minimizing skin irritation.
Ongoing Management
- Patients should understand that rosacea is chronic and requires ongoing management, with treatment plans adjusted based on symptom severity and response to therapy.
- Long-term avoidance of common triggers, use of gentle skin care, and adherence to pharmacologic treatment are fundamental strategies for rosacea control 4.
From the Research
Key Considerations for Rosacea Treatment
The treatment of rosacea (acne rosacea) rash involves a combination of topical and systemic therapies, as well as lifestyle modifications. The key considerations for a patient presenting with rosacea rash include:
- Classification and diagnosis: Rosacea is a chronic, sometimes progressive, dermatosis characterized by central facial erythema, symmetric flushing, stinging sensation, inflammatory lesions, telangiectasias, and phymatous changes 5.
- Treatment options: Topical metronidazole, sulfacetamide/sulfur, and azelaic acid are generally effective for patients with mild rosacea, while combination therapy with oral tetracyclines and topical agents is the first-line choice for moderate papulopustular rosacea 5, 6, 7.
- Systemic therapy: Oral antibiotics such as tetracyclines, metronidazole, and macrolides may be used in some cases, especially for patients with sensitive skin or ocular involvement 6, 7, 8.
- Lifestyle modifications: Avoidance of trigger factors and proper skin care are essential for managing rosacea symptoms 9.
- Combination therapy: A combined therapy of anti-inflammatory dose doxycycline and topical metronidazole may have synergy effects, and other therapy options such as low-dose minocycline and isotretinoin may be considered for short- and long-term therapy 7.
- New treatment options: Topical brimonidine, oxymetazoline, ivermectin, tacrolimus, pimecrolimus, low-dose modified-release tetracyclines, and botulinum toxin are new additions to the therapeutic armamentarium for rosacea management 8, 9.
Treatment Approaches
The treatment approach for rosacea depends on the severity and subtype of the disease. The following approaches may be considered:
- Topical therapy: Topical metronidazole, azelaic acid, and sulfacetamide/sulfur are commonly used for mild to moderate rosacea 5, 6, 7, 9.
- Systemic therapy: Oral antibiotics such as tetracyclines and metronidazole may be used for moderate to severe rosacea or for patients with ocular involvement 5, 6, 7, 8.
- Light-based therapies: Intense pulsed light and pulsed dye laser may be used for the erythemato-telangiectatic type of rosacea 8.