Rosacea is a chronic condition and although it can be put in remission for a significant period of time, it is not curable. Topical therapy is generally recommended to maintain and treat this condition.
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The main treatments for rosacea are topical and oral antibiotics, anti-inflammatory agents, azelaic acid derivatives, laser surgery, avoidance of flare factors and special make-up techniques. There is no cure for rosacea.
A typical initial treatment course for mild to moderate rosacea would consist of employing a topical agent containing metronidazole (the antibacterial agent in Metrogel and Noritate) with or without an oral tetracycline derivative (Dynacin, minocycline, Doryx, doxycycline) depending on the presenting severity of the disease. Other topical agents commonly and successfully used for the treatment of rosacea include azelaic acid (Finacea and Azelex), Sulfacetamide with or without Sulfur (Plexion TS, Rosac AC, Klaron, Ovace, Sulfacet). Second tier oral antibiotics include erythromycin derivatives, sulfa derivatives and ampicillin.
Once a good response is achieved with the combination oral and topical antibiotics, the oral antibiotics are usually discontinued after 2-4 months. Remissions induced this way last much longer and are maintained in about twice as many individuals who remain on topical metronidazole therapy. Many people with moderate to severe rosacea are unable to discontinue their oral medications and stay clear.
Rosacea that is resistant to antibiotics usually benefits from treatment with oral isotretinoin (Accutane) . Accutane can be employed in different dosing strategies for this purpose. Some use a regular dosage for a few months to induce a remission, whereas others employ a low-dosage strategy.
Laser treatment has become a mainstream and important method for controlling rosacea. In people with rosacea, the blood vessels of the face dilate more than average and often don’t go back to their more closed resting state when the stimulus( such as heat, a glass of wine, the sun) is gone. Over time, the vessel loses its ability to constrict or close altogether. This is when thin red lines on the face appear, often popularly referred to as “broken blood vessels”. These cannot be removed by medical therapy. Another way to approach people who don’t respond to oral antibiotics is to try laser surgery to eradicate or reduce the number of dilated blood vessels on the face. This often reduces the redness significantly and there is often a reduction in the flushing episodes and the breakouts as well. There are many different vascular lasers that can very effectively treat this problem. Most of these types of lasers have extremely low risks involved, although multiple treatment sessions may be necessary to achieve the desired results, and maintenance therapy (1-2 times per year) will probably be necessary.