What are the treatment guidelines for patients with rosacea?

Updated: Jun 03, 2021
  • Author: Agnieszka Kupiec Banasikowska, MD; Chief Editor: William D James, MD  more...
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Answer

Guidelines for the management of people with rosacea were published in May 2021 by the British Association of Dermatologists (BAD). [19]

General recommendations

The British Association of Dermatologists (BAD) recommends advising people with rosacea to limit exposure to known aggravating factors such as alcohol, sun exposure, hot drinks, or spicy food.

BAD recommends classifying patients according to phenotypes using objective clinical signs and subjective symptoms.

BAD recommends avoiding long-term use of oral antibiotics in people with rosacea.

Topical therapies

BAD recommends offering either ivermectin, metronidazole, or azelaic acid as first-line topical treatment options to individuals with papulopustular rosacea.

BAD recommends considering topical brimonidine or oxymetazoline in people with rosacea where the main presenting feature is facial erythema.

Systemic therapies

BAD recommends offering azithromycin, clarithromycin, doxycycline 40 mg (modified release) daily, doxycycline 100 mg daily, erythromycin, lymecycline, or oxytetracycline as first-line treatment for more severe papulopustular rosacea.

BAD recommends avoiding minocycline in people with rosacea unless there are no other treatment options.

BAD recommends considering intermittent courses of low-dose isotretinoin (0.25 mg/kg) in people with persistent and severe rosacea.

Procedural therapies

BAD recommends considering pulsed dye laser, Nd:YAG laser, or intense pulse light for rosacea where the main presenting feature is persistent facial erythema.

BAD recommends considering nasal debulking for those with significant rhinophyma by laser ablation or surgical intervention.


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