General Measures
Education on skincare and lifestyle measures is crucial. Patients should:
- Record Symptoms: Identify triggers such as spicy food, temperature changes, sun exposure, cosmetics, medications, alcohol, certain foods, and stress.
- Skincare: Moisturize frequently, use gentle cleansers, avoid exfoliants and alcohol-based products, and use physical sunscreens with SPF ≥ 30.
- Avoid Triggers: Minimize exposure to known triggers to manage symptoms effectively.
Medical Treatments
Treatment for rosacea can be highly effective but often targets only one feature, requiring combination therapies for multiple features or severe cases:
- Transient Erythema: Topical alpha-adrenergic agonists (brimonidine, oxymetazoline), oral beta-blockers (carvedilol), oral clonidine.
- Persistent Erythema: Topical alpha-adrenergic agonists, intense pulsed light therapy, vascular laser.
- Inflammatory Papules/Pustules: Topical azelaic acid, ivermectin, metronidazole, erythromycin, oral tetracyclines (oxytetracycline, lymecycline, doxycycline), oral macrolides (erythromycin, azithromycin), oral isotretinoin (for refractory cases).
- Telangiectasia: Electrodesiccation, intense pulsed light therapy, vascular laser.
- Neurogenic Rosacea: Gabapentin, amitriptyline, oral beta-blockers, endoscopic sympathectomy.
- Phymatous Rosacea: Doxycycline, isotretinoin for inflamed cases, physical modalities (ablative CO2 laser, erbium laser, radiofrequency, surgical debulking) for non-inflamed cases.
- Ocular Rosacea: Increased dietary omega-3 fatty acids, warm compresses, eyelid cleansing, topical azithromycin or calcineurin inhibitors for mild to moderate cases, oral azithromycin or doxycycline for severe cases.
