Manal Abokwidir1, Steven R Feldman1. 1. Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, N.C., USA.
Abstract
BACKGROUND: Rosacea is a chronic inflammatory skin condition associated with four distinct subtypes: erythematotelangiectatic, papulopustular, phymatous, and ocular. PURPOSE: To review the different kinds of management for all subtypes. METHODS: We divided rosacea management into three main categories: patient education, skin care, and pharmacological/procedural interventions. RESULTS: Flushing is better prevented rather than treated, by avoiding specific triggers, decreasing transepidermal water loss by moisturizers, and blocking ultraviolet light. Nonselective β-blockers and α2-adrenergic agonists decrease erythema and flushing. The topical α-adrenergic receptor agonist brimonidine tartrate 0.5% reduces persistent facial erythema. Intradermal botulinum toxin injection is almost safe and effective for the erythema and flushing. Flashlamp-pumped dye, potassium-titanyl-phosphate and pulsed-dye laser, and intense pulsed light are used for telangiectasias. Metronidazole 1% and azelaic acid 15% cream reduce the severity of erythema. Both systemic and topical remedies treat papulopustules. Systemic remedies include metronidazole, doxycycline, minocycline, clarithromycin and isotretinoin, while topical remedies are based on metronidazole 0.75%, azelaic acid 15 or 20%, sodium sulfacetamide, ivermectin 1%, permethrin 5%, and retinoid. Ocular involvement can be treated with oral or topical antibacterial. Rhinophyma can be corrected by dermatosurgical procedures, decortication, and various types of lasers. CONCLUSION: There are many options for rosacea management. Patients may have multiple subtypes, and each phase has its own treatment.
BACKGROUND:Rosacea is a chronic inflammatory skin condition associated with four distinct subtypes: erythematotelangiectatic, papulopustular, phymatous, and ocular. PURPOSE: To review the different kinds of management for all subtypes. METHODS: We divided rosacea management into three main categories: patient education, skin care, and pharmacological/procedural interventions. RESULTS:Flushing is better prevented rather than treated, by avoiding specific triggers, decreasing transepidermal water loss by moisturizers, and blocking ultraviolet light. Nonselective β-blockers and α2-adrenergic agonists decrease erythema and flushing. The topical α-adrenergic receptor agonist brimonidine tartrate 0.5% reduces persistent facial erythema. Intradermal botulinum toxin injection is almost safe and effective for the erythema and flushing. Flashlamp-pumped dye, potassium-titanyl-phosphate and pulsed-dye laser, and intense pulsed light are used for telangiectasias. Metronidazole 1% and azelaic acid 15% cream reduce the severity of erythema. Both systemic and topical remedies treat papulopustules. Systemic remedies include metronidazole, doxycycline, minocycline, clarithromycin and isotretinoin, while topical remedies are based on metronidazole 0.75%, azelaic acid 15 or 20%, sodium sulfacetamide, ivermectin 1%, permethrin 5%, and retinoid. Ocular involvement can be treated with oral or topical antibacterial. Rhinophyma can be corrected by dermatosurgical procedures, decortication, and various types of lasers. CONCLUSION: There are many options for rosacea management. Patients may have multiple subtypes, and each phase has its own treatment.
Authors: Aimee M Two; Tissa R Hata; Teruaki Nakatsuji; Alvin B Coda; Paul F Kotol; Wiggin Wu; Faiza Shafiq; Eugene Y Huang; Richard L Gallo Journal: J Invest Dermatol Date: 2013-11-08 Impact factor: 8.551
Authors: James Q Del Rosso; Emil Tanghetti; Guy Webster; Linda Stein Gold; Diane Thiboutot; Richard L Gallo Journal: J Clin Aesthet Dermatol Date: 2020-06-01