Acne Rosacea Treatment
Oral antibiotics and isotretinoin.
Both the skin and eye manifestations of Acne Rosacea respond to either tetracycline or erythromycin. One gm/day is used in divided doses. Resistant cases can be treated with 100 to 200 mg/day of minocycline or doxycycline and with 200 mg of metronidazole twice daily. Medication is stopped when the pustules have cleared. The response after treatment is unpredictable. Some sufferers 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. Sufferers who remain clear should periodically be given a trial without medication. However, many sufferers promptly revert to the low-dose oral regimen. Isotretinoin, 0.5 mg/kg/day for 20 weeks, was effective in treating severe, refractory Acne Rosacea; 85% had no relapse at the end of a year.
Topical therapy.
Topical metronidazole (Metrogel) is not as effective but may be used for initial treatment for mild cases or for maintenance after stopping oral antibiotics. Metronidazole is not very effective in inhibiting anaerobic P. acnes, but it may exert its therapeutic effect by inhibiting oxidative tissue injury by neutrophils. One study showed that clindamycin in a lotion base produced clinical results similar to those of oral tetracycline (250 mg four times a day for 3 weeks, then 250 mg twice a day for 9 weeks) and was superior in the eradication of pustules.
Sulfacetamide/sulfur lotion (Sulfacet, Novacet) controls pustules. Sulfacet-R is flesh colored and hides redness. They are effective alone or when used with oral antibiotics.
Sufferers 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.
sufferers who do not respond to antibiotics may have Demodex folliculorum mite infestation or tinea, in which the facial pustules and scales are usually localized to one cheek; a potassium hydroxide examination confirms the diagnosis. Crotamiton (Eurax) is reported to be effective. Lindane lotion or Sulfur & Salicylic Acid soap should also be effective.
what is Rosacea
Rosacea is a common chronic inflammatory disorder of the hair follicles, sebaceous glands and vasculature of the face. The role of Demodex mite in the pathogenesis of Rosacea is controversial.
Rosacea sufferers have recurrent flushing, exacerbated by heat (shower, hot drinks), spicy foods, sunlight, cold, alcohol, and stress. They have sensitive skin, and may complain of dry and gritty eyes.
The peak incidence of Rosacea is 30—50 yr; Females being more affected than Males.
Rosacea sufferers may develop erythema, telangiectases, papules, and pustules of central face; there are no comedones in contrast to acne. Sebaceous hyperplasia, seborrheic dermatitis and facial lymphedema are also more common.
There are 4 Major Subtypes of Rosacea:
Erythematotelangiectatic, papulopustular, ocular, and phymatous.
Chronic inflammation may progress to rhinophyma (enlarged nose; in males). Ocular involvement is also common (e.g., gritty, conjunctival injection, styes, photophobia).
Investigations include clinical diagnosis; uncommonly, skin biopsy is indicated to rule out lupus or sarcoidosis.
Similar conditions that needs to be differentiated from Rosacea are: Acne, lupus erythematosus, perioral dermatitis, sarcoidosis, seborrheic dermatitis.
Treatment of Rosacea is based on severity and subtype.
Lifestyle modification:
Avoid triggers; sun protection and avoidance; facial massage for lymphedema.
Topical antibiotics:
Metronidazole 0.75% gel or 1% cream bid.
Sodium sulfacetamide lotion 10% bid.
Oral antibiotics (moderate to severe cases with inflammatory papulopustular component):
Tetracycline 500 mg po bid
Minocycline 100 mg po od—bid.
Doxycycline 20 mg po bid (subantimicrobial dose therapy) or 100 mg po qd–bid.
Isotretinoin (low dose); less commonly, topical retinoids may be used.
Laser therapy (e.g., PDL, IPL) for telangiectases and ablative laser (e.g., CO2) for rhinophyma.
Camouflage makeup (e.g., Dermablend, Covermark) for erythema.
Ophthalmologist to assess for ocular Rosacea (blepharitis, conjunctivitis, episcleritis).
