Rosacea is one of the difficult inflammatory dermatoses to be treated. Management of rosacea may include the following:
I. Avoid factors causing facial flushing, such as:
* Sun (use light oil-free facial sunscreens).
* Spicy or hot food.
* Hot showers, baths and warm rooms.
* Oil-based facial creams. Use water-based make-up.
II. Systemic antibiotics:
1. Tetracyclines (Doxycycline or minocycline)
III. Topical agents (mild-moderate cases): avoid topical corticosteroids, although they may give some improvement within first 2-3 weeks due to their antiinflammatory and vasoconstrictive effects but usually they result in exacerbation or deterioration later on..
1. Metronidazole cream or gel
2. Azelaic acid cream or lotion
3. Ivermectin cream (controlling demodex mites and as an anti-inflammatory agent).
4. Brimonidine gel is used to treat facial redness. It results in short-term vasoconstriction but has no effects on telangiectasia.
5. Calcineurin inhibitors such as tacrolimus ointment and pimecrolimus cream are reported to help some patients with rosacea.
IV. Isotretinoin (in resistant cases and may be needed in low dose for long periods). Contraindication in patients with eye involvement.
V. Clonidine (an alpha2-receptor agonist) and carvedilol (a non-selective beta blockers with some alpha-blocking activity) may reduce the vascular dilatation that results in flushing. Side effects may include low blood pressure, GI symptoms, dry eyes, blurred vision and low heart rate.
VI. Vascular laser or IPL: for persistent telangiectasia.
VII. Surgery for rhinophyma: Reshaping the nose surgically or with carbon dioxide laser.