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Rosacea

Clinical Cases

Case 1. Erythemato-telangiectatic rosacea

  • 55-year-old woman
  • Chronic flushing, erythema and telangiectasias on cheeks, nose
  • Not responding to topical antibiotics

Treatment

  • Discontinue topical antibiotics
  • Topical brimonidine 0.33% gel (Mirvaso)
  • Photoprotection, sunscreen use advised, appropriate skin care (gentle facial cleanser and moisturizer)
  • Identify and avoid triggers of flushing
  • Consider referral to laser treatment for vascular features

Case 2. Papulo-pustular rosacea

  • 40-year-old woman
  • Long-standing erythematous papules, plaques on the cheeks, nose, chin, forehead
  • Skin lesions are exacerbated by sun exposure and alcohol consumption
  • No response to topical antibiotics alone

Treatment

  • Low-dose doxycycline 40 mg p.o. daily
  • 5% sulfur/10% sulfacetamide wash daily
  • Topical metronidazole (1% cream or gel)
  • Photoprotection, sunscreens advised; appropriate skin care (gentle facial cleanser and moisturizer)
  • Avoid alcohol consumption, sun exposure

Follow-up visit at 6 weeks

  • Lesions improved
  • Discontinue doxycycline
  • Continue topical metronidazole
  • Continue photoprotection and skin care
  • Continue to avoid alcohol consumption and other triggers

Case 3. Rosacea with ocular symptoms

  • 25-year-old woman
  • Recurrent erythematous papules on cheeks, nose, forehead with associated blepharitis, conjunctival erythema and edema, foreign body sensation
  • Topical antibiotic lotion alleviates skin but not ocular symptoms
  • No clear triggers for symptoms

Treatment

  • Tetracycline 500 mg p.o. b.i.d. (oral tetracyclines are first-line treatment for ocular rosacea)
  • Metronidazole 1% cream or gel applied b.i.d. to skin lesions
  • Photoprotection, sunscreens advised; appropriate skin care with gentle facial cleanser and moisturizer
  • Refer to an opthalmologist if needed

Follow-up visit at 6 weeks

  • Lesions improved, no ocular signs present
  • Continue metronidazole 1% cream or gel applied b.i.d. to skin lesions
  • Continue photoprotection, skin care