Management
Management involves identifying and avoiding any precipitating factors. All sources of heat, such as excessively hot baths or showers, saunas, direct radiant heat and hot beverages should be avoided. Exposure to ultraviolet light should be limited and sunscreen used. Intake of spicy food and alcohol should be reduced or eliminated. An extractor fan in the kitchen to minimise the heat
from steam while cooking may be worthwhile. Cotton sheets and as few blankets as possible will minimise overheating at night and excessive room heating during winter should be avoided.
First line treatments are topical antibiotics, eg. metronidazole 0.75% gel twice daily. Alternatively clindamycin 2% lotion may be used. If the alcohol base is too drying, it can be reformulated in Cetaphil lotion. If there is no improvement after eight weeks, systemic antibiotics should be started eg. Tetracycline 250mg QID, minocycline or doxycycline 50mg BD. If these agents cause nausea or photosensitivity, erythromycin 500mg BD or metronidazole 200mg may be used. Treatment time is at least eight weeks and some patients require long term maintenance therapy. Severe recalcitrant rosacea may require isotretinoin. Facial erythema can be difficult to treat, may be unresponsive to antibiotics, but persistent telangiectasia can be helped by vascular laser therapy.
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Complications
Rhinophyma, a bulbous swelling of the nose due to sebaceous gland hyperplasia is the commonest complication of rosacea. This can be treated surgically by paring or CO2 laser therapy. Up to 50% of patients have inflammatory ocular complications such as conjunctivitis or blepharitis. Rosacea keratitis needs early recognition and treatment with steroid eyedrops to prevent corneal
scarring.
Tip
Avoid potent steroids in rosacea, and only use hydrocortisone for short periods.
Dr Graham Ellis practises in the Goonellebah Medical Centre, Lismore, NSW, Australia.
