Management is based on the presenting clinical features and can sometimes need more than one treatment. It is important to note that rosacea is a long term condition and can improve with treatment and relapse over time. The treatment aim should be complete skin clearance if possible. HINT: Try taking a picture before and after to gauge treatment success.
Redness and Flushing: Mirvaso. Mirvaso (brimonidine) should be applied once daily as a when required basis. Mirvaso can reduce redness within 30 minutes reaching peak action at 3-6 hours. If there is improvement continue treatment when required, ideally until skin is clear.
Tender, inflamed, sore red bumps or pus filled spots: Soolantra (ivermectin), once daily for 8-12 weeks. If Soolantra is not tolerate then Rozex (metronidazole) gel/cream may be tried as twice daily application. Soolantra acts as a an anthelmintic and insecticidal preparation whereas Rozex is a antibiotic gel/cream. If there is little or no improvement trial a combination of topical cream and Efracea (doxycycline modified release) 40mg once daily capsules for 8-12 weeks.
Moderate to Severe inflamed, infected pus filed spots: A combination of Soolantra, applied once daily, together with Efracea (doxycycline modified release) 40mg once daily capsules for 8-12 weeks. If Soolantra is not tolerated you may use Rozex and Efracea. If there is improvement continue combination treatment for up to 12-16 weeks. If there is no improvement consult your GP/dermatologist.
Treatment Failure or Psychological Distress: Consult a GP or a dermatologist.
Specialist treatments include oral isotretinoin, electrodessication, intense pulsed light, laser therapy, and many more.