From the Guidelines
Rosacea management should prioritize a combination of lifestyle modifications and medical treatments tailored to the specific subtype and severity, with a focus on minimizing morbidity, mortality, and improving quality of life, as supported by the most recent and highest quality study 1.
Key Considerations
- Patients should avoid triggers such as sun exposure, spicy foods, alcohol, extreme temperatures, and stress.
- Daily use of a gentle cleanser, fragrance-free moisturizer, and broad-spectrum SPF 30+ sunscreen is essential.
- For mild to moderate papulopustular rosacea, topical treatments include metronidazole 0.75-1% (applied once or twice daily), azelaic acid 15-20% (twice daily), or ivermectin 1% cream (once daily).
- For more severe cases, oral antibiotics like doxycycline (40-100mg daily for 8-12 weeks) are effective, with the lower anti-inflammatory dose (40mg) preferred to reduce antibiotic resistance, as shown in a study 1.
- Persistent facial redness can be treated with brimonidine 0.33% gel or oxymetazoline 1% cream applied once daily for temporary reduction of erythema.
- For ocular rosacea, artificial tears, lid hygiene, and sometimes oral doxycycline are recommended.
- Phymatous changes may require procedural interventions like laser therapy or surgery.
- Persistent telangiectasias respond well to vascular lasers or intense pulsed light therapy.
Recent Developments
- Microencapsulated 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, as discussed in a review 1.
- 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.
Treatment Success
- Treatment success depends on consistent adherence to both trigger avoidance and prescribed medications, with most patients requiring ongoing maintenance therapy to prevent flares, as emphasized in a study 1.
- The long-term efficacy and safety of modified-release doxycycline as monotherapy was demonstrated in a two-part study 1, highlighting the importance of maintenance therapy in rosacea management.
From the FDA Drug Label
To use AZELEX® Cream for the full prescribed treatment period. If sensitivity or severe irritation develop with the use of AZELEX® Cream, treatment should be discontinued and appropriate therapy instituted. Due in part to the low pH of azelaic acid, temporary skin irritation (pruritus, burning, or stinging) may occur when AZELEX® Cream is applied to broken or inflamed skin, usually at the start of treatment.
The management of rosacea with azelaic acid (TOP) involves:
- Using the cream for the full prescribed treatment period.
- Being aware of potential skin irritation (pruritus, burning, or stinging) and taking steps to manage it, such as applying the cream only once a day or stopping treatment until the irritation subsides.
- Discontinuing treatment if severe irritation develops and seeking alternative therapy. 2
From the Research
Rosacea Management Overview
- Rosacea is a chronic cutaneous disorder that affects primarily the face, characterized by erythema, telangiectasia, and inflammatory lesions including papulo-pustules and swelling 3.
- The essential component of the disease is the persistent erythema of facial skin, and episodes of flushing are common 3.
Treatment Options
- Topical medications such as azelaic acid, metronidazole, and sulfacetamide/sulfur are commonly used to treat rosacea 3, 4.
- Oral antibiotics such as tetracyclines, and oral retinoids alone or in combination are also used to treat rosacea 3, 4.
- Light therapies such as intense pulsed light and pulsed dye laser are best used for the erythemato-telangiectatic type of rosacea 3.
- Topical brimonidine, oxymetazoline, ivermectin, tacrolimus, pimecrolimus, low-dose modified-release tetracyclines, and botulinum toxin are new additions to the therapeutic armamentarium 3, 4.
Specific Treatment Recommendations
- Topical brimonidine and oxymetazoline are recommended for persistent erythema 4.
- Topical azelaic acid, ivermectin, metronidazole, minocycline, and oral doxycycline, tetracycline, and isotretinoin are recommended for papules and pustules 4.
- Vascular lasers and light devices are recommended for telangiectases 4.
- Omega-3 fatty acids and cyclosporine ophthalmic emulsion are recommended for ocular rosacea 4.