How is acne rosacea treated?

Trigger factors that produce flushing should be avoided. These triggers vary greatly from patient to patient. Both oral and topical metronidazole are effective. Topical erythromycin, azelaic acid cream, and sodium sulfacetamide have also been shown to be effective treatments. Tetracycline, doxycycline, minocycline erythromycin are effective systemic therapies for rosacea. Subantimicrobial doses of doxycycline (40 mg extended release tablet) have been shown to decrease papulopustules in rosacea via antiinflammatory effects. Combined with topical azelaic acid or metronidazole there seems to be a synergistic effect.

Oral isotretinoin is helpful for severe resistant cases, but the drug is not as effective as when used for severe cystic acne, and relapses are more common. Oral antibiotics have little effect on flushing, telangiectasia, lymphedema, or rhinophyma. Isotretinoin may provide some benefit for early rhinophyma, but severe rhinophyma is best treated by surgical paring or electrosurgery. Persistent telangiectasia can be treated by a tunable dye vascular laser with good cosmetic results.

Fowler JF Jr: Combined effect of anti-inflammatory dose doxycycline (40-mg doxycycline, USP monohydrate controlled-release capsules) and metronidazole topical gel 1% in the treatment of rosacea, J Drugs Dermatol 6: 641–645, 2007.