Rosacea Management

Abstract

Background: Rosacea is a chronic inflammatory skin condition associated with four distinct subtypes: erythematotelangiectatic, papulopustular, phymatous, and ocular.

Purpose: To review the different kinds of management for all subtypes.

Methods: We divided rosacea management into three main categories: patient education, skin care, and pharmacological/procedural interventions.

Results: Flushing is better prevented rather than treated, by avoiding specific triggers, decreasing transepidermal water loss by moisturizers, and blocking ultraviolet light. Nonselective β-blockers and α₂-adrenergic agonists decrease erythema and flushing. The topical α-adrenergic receptor agonist brimonidine tartrate 0.5% reduces persistent facial erythema. Intradermal botulinum toxin injection is almost safe and effective for the erythema and flushing. Flashlamp-pumped dye, potassium-titanyl-phosphate and pulsed-dye laser, and intense pulsed light are used for telangiectasias. Metronidazole 1% and azelaic acid 15% cream reduce the severity of erythema. Both systemic and topical remedies treat papulopustules. Systemic remedies include metronidazole, doxycycline, minocycline, clarithromycin and isotretinoin, while topical remedies are based on metronidazole 0.75%, azelaic acid 15 or 20%, sodium sulfacetamide, ivermectin 1%, permethrin 5%, and retinoid. Ocular involvement can be treated with oral or topical antibacterial. Rhinophyma can be corrected by dermatosurgical procedures, decortication, and various types of lasers.

Conclusion: There are many options for rosacea management. Patients may have multiple subtypes, and each phase has its own treatment.

Keywords: Azelaic acid; Demodex; Inflammatory lesion; Isotretinoin; Ivermectin; Laser; Ocular rosacea; Rosacea.

Fig. 1

Treatment algorithm of rosacea.