Acne Rosacea Treatment
Treatment of rosacea
Rosacea may be treated with both topical and oral medications.
Rosacea may respond to treatment with topical antibiotics. Topical antibiotic are not as effective as oral antibiotics but may be used for initial treatment for mild to moderate cases and for maintenance after stopping oral antibiotics.
Metronidazole Tris commonly prescribed. MetroGel, MetroCream and MetroLotion are available in a 0.75% concentration and are applied twice each day. Noritate cream is 1% metronidazole and it is effective when applied once each day. Bedtime application is usually the most convenient. Clindamycin in a lotion or gel base is used to treat acne.
It is sometimes effective for rosacea.
Sulfacetamide/sulfur lotions are effective as monotherapy. Sulfacet-R is flesh colored and hides redness. It is also available in a tint free base. Plexion is available as a lotion and wash. AVAR Green has a green base and attenuates erythema. Rosac is a cream based form of sulfacetamide and sulfur that contains sunscreens. Sunlight makes rosacea worse. Cream based medications are best for patients with dry skin. There are many other formulations.
Azelaic acid 15% gel or Finacea is effective and well tolerated in the treatment of papulo-pustular rosacea. Both pustules and erythema respond.
Oral antibiotics are effective and reliable treatment for rosacea. Both the skin and eye manifestations respond. They are more effective than topical preparations and used as first line therapy for moderate to severe rosacea. Low doses of medication may be effective. The starting dose for doxycycline is 20, 50, 75 or 100 mg once or twice each day.
Tetracycline or erythromycin are started at 500 mg twice each day.
Resistant cases can be treated with minocycline 50, 75 or 100 mg twice daily.
Medication is stopped when the pustules have cleared. The response after treatment is unpredictable. Some patients clear in 2 to 4 weeks and stay in remission for weeks or months. Others flare and require long-term suppression with oral antibiotics. Treatment should be tapered to the minimum dosage that provides adequate control. Patients who remain clear should periodically be given a trial without medication.
Patients who are reluctant to take oral antibiotics may improve with a preparation of nicotinamide and vitamins called Nicomide. This product has antiinflammatory properties.
Isotretinoin, 0.5 mg/kg/day for 20 weeks is effective in treating severe, refractory rosacea. Much lower doses may be effective.
Patients resistant to conventional treatment were treated with oral isotretinoin, 10 mg/d, for 16 weeks. Papular and pustular lesions, telangiectasia and erythema were significantly reduced at the end of 16 weeks.
Patients with rhinophyma may benefit from specialized procedures performed by plastic or dermatologic surgeons. These include electrosurgery, carbon dioxide laser, and surgery. Unsightly telangiectatic vessels can be eliminated with careful electrocautery.