Guideline for the Treatment of Rosacea - PDF Document

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  1. Guideline for the Treatment of Rosacea Hull & East Riding Prescribing Committee Clinical Presentation: Subtype 3 - Phymatous rosacea. Thickening of the skin is seen with irregular surface nodularities, and enlargement. May occur on the nose (rhinophyma), chin, forehead, cheeks, or ears. Subtype 4 - Ocular rosacea. Characterised by ocular involvement, including inflammation of different parts of the eye and eyelid. Subtype 2 - Papulopustular rosacea. Persistent central facial erythema with transient, central face papules or pustules, or both. Subtype I – Erythematotelangiectatic rosacea. Flushing and persistent central facial erythema (redness) with or without telangiectasia. Lifestyle advice Avoid trigger factors Use a daily sunscreen Use gentle skin care Papules and pustules Severe Mild to Moderate 1st Line: Metronidazole 0.75% gel or cream AND Oral tetracycline (lymecycline or low dose doxycycline) or erythromycin 1st Line Metronidazole 0.75% topical gel or cream (for 3 months) 2nd Line Ivermectin 10mg/g cream (Soolantra) (by specialist advice for 3 months) Failure Failure 2nd line: Ivermectin 10mg/g Cream AND Oral antibiotics - as above and by specialist advice Success Relapse Success Relapse Failure Success Stop treatment Stop treatment Stop treatment Maintenance (may be necessary) This may be continuous (e.g. a reduced dose of oral treatment for 2–6 months followed by a 'drug holiday') Intermittent (e.g. using a topical treatment on alternate days or twice a week). 'Stepping down' from oral to topical treatment. Referral Criteria to secondary care    People with flushing, persistent erythema and telangiectasia that is causing psychological or social distress People with papulopustular rosacea that have not responded to 12 weeks of oral plus topical treatment. Consider isotretinoin oral (secondary care only), as per British Association of Dermatologistsguidance. This flow chart has been adapted from the NICE Clinical Knowledge Summaries (!scenario), and the British Association of Dermatologists( and The Primary Care Dermatology Society (PCDS) information on Rosacea. Prepared by: Dr R Zaman & S. Gaines, Hull & East Yorkshire Hospitals NHS Trust Approved by HERPC Jan 2018 Date of Preparation: 13/07/2017 Review date: Jan 2021