Abstract

A range of treatment options are available in rosacea, which include several topical (mainly metronidazole, azelaic acid, other antibiotics, sulfur, retinoids) and oral drugs (mainly tetracyclines, metronidazole, macrolides). In some cases, the first choice is a systemic therapy because patients may have sensitive skin and topical medications can be irritant. Isotretinoin can be used in resistant cases of rosacea. Unfortunately, the majority of studies on rosacea treatments are at high or unclear risk of bias. A recent Cochrane review found that only topical metronidazole, azelaic acid, and oral doxycycline (40 mg) had some evidence to support their effectiveness in moderate to severe rosacea and concluded that further well-designed, adequately-powered randomised controlled trials are required. In our practice, we evaluate our patients for the presence of two possible triggers, Helicobacter pylori infection and small intestinal bacterial overgrowth. When they are present we use adapted antibiotic protocols. If not, we use oral metronidazole or oral tetracycline to treat papulopustolar rosacea. We also look for Demodex folliculorum infestation. When Demodex concentration is higher than 5/cm(2) we use topical crotamiton 10% or metronidazole.

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Publisher Full Text

Publisher Full Text

Authors

Parodi A, Drago F, Paolino S, Cozzani E, Gallo R

Institution

Dermatology Department, University of Genoa, Viale Benedetto XV n.7, 16132 Genoa, Italy. aurora.parodi@unige.it

Source

Annales de dermatologie et de vénéréologie 138 Suppl 3: 2011 Nov pg S211-4

MeSH

Anti-Infective Agents
Cyclosporine
Dermatologic Agents
Dicarboxylic Acids
Humans
Immunosuppressive Agents
Isotretinoin
Keratolytic Agents
Lasers, Dye
Metronidazole
Mite Infestations
Naphthalenes
Phototherapy
Rosacea
Sulfacetamide
Tacrolimus
Tetracycline
Toluidines
Tretinoin

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22183101