Standard Treatment for Rosacea (Western Medicine)
Once a diagnosis of Rosacea is confirmed the standard approach to therapy will involve the use of a systemic antibiotic in combination with a topical antibiotic gel.
The oral antibiotics are used to halt progression of the disease and to reduce the extent of redness and facial flushing. The topical antibiotic gels are used to keep the symptoms under control. Since the antibiotics do not cure the disease there may be flare-ups once therapy is discontinued. Long term use of oral antibiotics is not recommended due to the possible development of sun sensitivity, development of resistant strains of bacteria, and exacerbation of GI related problems. The standard oral antibiotics recommended for the treatment of Rosacea include: Tetracycline, Minocin (minocycline and erythromycin. Isotretinoins (Accutane or Roaccutane) are sometimes considered as an alternative to oral antibiotics especially in cases of papopustular Rosacea. As described previously, Accutane is associated with a wide spectrum of side effects and should only be used when traditional therapeutic approaches have failed.
Topical Treatments for Rosacea
Metronidazole was the first topical treatment approved for the treatment of Rosacea in 1989. This product can be used to help reduce Rosacea flare-ups once the disease has been brought under control. The brand name for metronidazole in the US is MetroGel (MetroCream and MetroLotion) which contains 0.75% metronidazole. Noritate is another product that contains 1.0% metronidazole.
Once Rosacea has progressed to the stage where redlines (telangiectasia) are evident the only choices are corrective surgery or covering the redlines with makeup. Surgery involves injecting the blood vessels located in the face with concentrated salt water, which causes the vessels to constrict. Alternatively, laser surgery can cauterize the blood vessels, thereby restricting blood flow. A newer approach is "Mixed light pulse therapy" (Photoderm) which is not laser therapy but rather a series of light pulses are directed at the dermal layer of the skin. The treatment stimulates collagen synthesis, which results in a thickening of the skin and decreasing the visible signs of Rosacea.
An important adjunct to any therapeutic strategy to treat Rosacea involves lifestyle adjustments that minimize facial flushing. This may involve dietary restrictions, makeup, soap, sun restriction etc., which are customized to the individual patient.
Topical Steroids are not recommended to be used chronically to treat Rosacea. The initial response to topical steroids may be positive, however with time the use of steroids will exacerbate the condition.