Treating Rosacea

An Inflammatory Disorder

Rosacea is a chronic, inflammatory skin disorder that affects an estimated
14 million Americans. It causes a spectrum of symptoms and signs that may include flushing, erythema, edema, telangiectasia, papulopustular eruptions, and phymatous changes. The central area of the face is most often affected, and the disease adopts a relapsing/remitting and sometimes progressive course. At least 20% of rosacea patients also have ocular symptoms.¹

Four primary subtypes of rosacea have been recognized based on clinical appearance:

1. erythematotelangiectatic
2. papulopustular
3. phymatous
4. ocular¹

All are believed to be manifestations of a common underlying inflammatory mechanism.

Current Treatment Options

Treatment is symptom-oriented and varies by subtype:

• Erythematotelangiectatic rosacea is generally resistant to topical and oral therapy. Laser and phototherapy have shown promise in patients with this subtype
• Papulopustular rosacea, in contrast, responds well to both topical treatments and oral antibiotics
• Phymatous rosacea generally requires surgical or laser ablation, although early use of isotretinoin may shrink the volume of rhinophymata
• Ocular rosacea responds well to oral agents in the tetracycline class

Topical agents are considered benign and safe for long-term use, while oral antibiotics are generally reserved for flares or severe recurrent disease, either alone or in combination with topicals. Concerns over the long-term use of oral antibiotics are based on side effect profile (photosensitivity, GI upset, and vaginal candidiasis, for example) and the potential for promoting antimicrobial resistance.

For information on rosacea, see our literature library.

Figure 1