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Treatment of rosacea.

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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  • 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