Rosacea: The Treatment of Rosacea
Rosacea is a chronic cutaneous vascular disorder which is not curable, early recognition and treatment of rosacea can prevent progression to permanent disfigurement or blindness. Pharmacologic therapy, patient education and symptom management can provide symptom control and remission [26(6)].
Rosacea can be effectively treated with avoidance of triggers like sun and weather, stress and exercise, topical and oral therapy, both topical and oral retinoid therapy, topical vitamin C therapy and cosmetic surgery [15(3)].
Comparative study of medicines clarithromycin versus doxycycline in systemic treatment of mild and severe rosacea [36(12)] indicated that clarithromycin is a new perspective in rosacea treatment [37(5)]. Clindaymcin versus tetracycline where clindamycin lotion was found superior with safe and effective treatment for rosacea [32(1)].
Metronidazole versus oxytetracycline showed that there was no significant difference between them. However, metronidazole could be safe and effective drug for treatment of rosacea [102(4)].
Metronidazole was found to be effective against papules and pustules [1(7971)]. Metronidazole 0.75% rapidly reduced inflammatory lesions [21(4)]. However combination of oral tetracycline and metronidazole 0.75% gel resulted in remission after 6 months. 1% metrodinazole is found to be more significant than placebo [108(3)] however there are also reports on skin irritation, dryness and stinging. Metronidazole is most extensively studied therapy for rosacea but some patients have found response to clindamycin lotion (Cleocin) and sulfacetamide in different formulations.
An initial dose of oral antibiotic usually tetracycline in doses less than 0.5 g/day up to 1.5 g/day is prescribed for immediate control. Erythromycin, clarithromycin (Biaxin), ampicllin or oral metronidazole are also effective [105(2)].
Isotretinoin is found to be highly effective treatment in clearing of refractory rosacea lesions [25(10)]. The low dose isotretinoin and topical tretinoin cream therapy also appear to be beneficial in treatment of severe or recalcitrant rosacea [130(3)].
Retinaldehyde has also been found to have beneficial effects on the vascular component of rosacea [199(1)]. Benzoyl peroxide acetone gel has also been found to give significant results in topical treatment of acne rosacea [32(2)].
In case of corticosteroids preference is given to hydrocortisone 17-butyrate (HC 17-B Locoid) in treatment of rosacea [152(1)].
Nevertheless, telangiectasia and rhinophyma have to be treated surgically. Telangiectasia with pulse dye laser, sclerotherapy and diathermy however rhinophyma with CO2 laser, dermabrasion, sculpting with a scalpel or hot loop electro coagulation [105(2)].
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