Acne Rosacea Treatment

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DermnetDermatology
September 28, 2009

Dr. Thomas P. Habif MD discusses Acne Rosacea Treatment. See more at http://www.dermnet.com PLEASE RATE AND COMMENT!!! Treatment of rosacea Rosacea may be treated with both topical and oral med...

Dr. Thomas P. Habif MD discusses Acne Rosacea Treatment. See more at http://www.dermnet.com PLEASE RATE AND COMMENT!!!

Treatment of rosacea

Rosacea may be treated with both topical and oral medications.

Topical therapy

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

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

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

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

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.

Nicomide

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

Isotretinoin, 0.5 mg/kg/day for 20 weeks is effective in treating

severe, refractory rosacea. Much lower doses may be effective.

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