Table 1.
Subtypes of rosacea and different kinds of management
| Kinds of management | Subtypes of rosaceaa | Advantage | Disadvantage |
|---|---|---|---|
| Avoidance of environmental stimuli (sun, cold, hot), emotional stimuli (stress and anxiety), physiological stimuli (alcohol, caffeine, spicy foods, strenuous exercise) | 1, 2, 4 | Prevent flare and decrease symptoms | No research study, poor patient compliance |
| Skin care (blocking ultraviolet light, moisturizers) | 1–4 | Prevent flare and decrease symptoms | No research study, poor patient compliance |
| Topical treatment | |||
| Topical a-adrenergic receptor agonists 0.5% | 1 | Significantly reduce baseline erythema, cosmetic benefit | Lasts up to 10 h, does not work for all, and rebound erythema in some |
| Topical metronidazole, 1 and 0.75% | 1, 2, 4 | Effective in reducing erythema, papules, and pustules in moderate to severe rosacea | Irritation and dermatitis |
| Topical erythromycin eyedrops 1%, topical cyclosporine, clarithromycin, metronidazole | 4 | Effective treatment for severe ocular symptoms | Just for ocular rosacea |
| Topical sodium sulfacetamide, 10% sodium sulfacetamide with 5% sulfur | 1, 2 | Good for rosacea with concomitant seborrheic dermatitis, decrease inflammatory lesions and facial erythema | Dryness, erythema, or irritation |
| Topical azelaic acid, 15% gel and 20% cream | 1, 2 | Complete remission or marked improvement of erythema and inflammatory lesion counts | Irritation, dryness, and transient stinging and burning |
| Topical ivermectin 1% cream | 2 | Significant reduction in inflammatory lesion counts | Irritation, xerosis, and burning |
| Topical retinoids | 1, 2 | Reduce erythema, papules and pustules, and telangiectasias | Irritation, xerosis |
| Topical praziquantel ointment 3% b.i.d., topical permethrin cream 5% | 2 | Significantly reduces the papules and pustules, treat cutaneous demodicosis | Irritation, xerosis, and burning |
| Topical calcineurin inhibitors | 1, 2 | Treat papulopustules, significant improvement in erythema | Irritation, burning |
| Emerging topical treatments: topical serine protease inhibitors, topical cromolyn sodium 4% solution | 1, 2 | Play a role in the pathogenesis of rosacea, potential therapeutic target in rosacea | More clinical trials needed |
| Oral treatments | |||
| Oral antibiotic: tetracyclines of doxycycline <50 mg daily, erythromycin at a dose of 250 mg/ day; oral metronidazole at doses of 200 mg b.i.d. | 2, 4 | Anti-inflammatory effects of tetracyclines are the main mechanism of action in reducing rosacea symptoms; erythromycin in pregnancy | Gastrointestinal distress; metronidazole; neuropathy and seizures |
| Isotretinoin 0.5 - 1.0 mg/kg daily | 2, 3 | Effective treatment for severe papulopustular rosacea, refractory rosacea | Increase triglycerides, dryness, and joint pain. |
| Nonselective ß-blockers, a2-adrenergic agonist 0.05 mg b.i.d. | 1 | Decrease erythema and flushing | Reduction in blood pressure, responders are not clinically identifiable |
| Procedural treatments | |||
| Laser (long pulse-duration pulsed-dye laser, Nd:YAG) | 1, 2 | Treatment of facial telangiectasia, inflammatory lesions, reduce the purpura, treat the broken blood vessels | Pigmentation in dark skin, purpura |
| Nonlaser intense pulsed light | 1, 2 | Noninvasive and nonablative, effective for vascular form | Just the perilesional erythema |
| Botulinum toxin injection | 1 | Symptomatic relief for severe refractory facial erythema and flushing | Rarely may cause headache |
| CO2 laser | 3 | Treating thickening, powerful - shave down the bumps; less bleeding, seals blood vessels | Permanent hypopigmentation, hyperpigmentation in dark skin |
| Surgical procedures, dermabrasion, electrocautery | 3 | Scrape off unwanted skin | Bleeding and cutting too deep, may cause scarring and permanent color changes |
a
Subtypes of rosacea: 1 = erythematotelangiectatic rosacea; 2 = papulopustular rosacea; 3 = phymatous rosacea; 4 = ocular rosacea.