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Rosacea

Guidelines

Guidelines Summary

Guidelines for the management of people with rosacea

Guidelines for the management of people with rosacea were published in May 2021 by the British Association of Dermatologists (BAD).^[19]

General recommendations

The British Association of Dermatologists (BAD) recommends advising people with rosacea to limit exposure to known aggravating factors such as alcohol, sun exposure, hot drinks, or spicy food.

BAD recommends classifying patients according to phenotypes using objective clinical signs and subjective symptoms.

BAD recommends avoiding long-term use of oral antibiotics in people with rosacea.

Topical therapies

BAD recommends offering either ivermectin, metronidazole, or azelaic acid as first-line topical treatment options to individuals with papulopustular rosacea.

BAD recommends considering topical brimonidine or oxymetazoline in people with rosacea where the main presenting feature is facial erythema.

Systemic therapies

BAD recommends offering azithromycin, clarithromycin, doxycycline 40 mg (modified release) daily, doxycycline 100 mg daily, erythromycin, lymecycline, or oxytetracycline as first-line treatment for more severe papulopustular rosacea.

BAD recommends avoiding minocycline in people with rosacea unless there are no other treatment options.

BAD recommends considering intermittent courses of low-dose isotretinoin (0.25 mg/kg) in people with persistent and severe rosacea.

Procedural therapies

BAD recommends considering pulsed dye laser, Nd:YAG laser, or intense pulse light for rosacea where the main presenting feature is persistent facial erythema.

BAD recommends considering nasal debulking for those with significant rhinophyma by laser ablation or surgical intervention.

Medication

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Media Gallery

Histopathology of rosacea. Perifollicular chronic inflammation and vascular ectasia. Courtesy of Dirk Elston, MD.
Mild papules and erythema. Courtesy of DermNet New Zealand (https://www.dermnetnz.org/imagedetail/2367).
Moderate papules and early pustules. Courtesy of DermNet New Zealand (https://www.dermnetnz.org/imagedetail/2369).
Severe erythema, papules, and pustules. Courtesy of DermNet New Zealand (https://www.dermnetnz.org/imagedetail/2371).

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Author

Agnieszka Kupiec Banasikowska, MD Consulting Staff, Georgetown Dermatology, PLLC

Agnieszka Kupiec Banasikowska, MD is a member of the following medical societies: American Academy of Dermatology, European Academy of Dermatology and Venereology

Disclosure: Nothing to disclose.

Coauthor(s)

Danielle Bolton, BS Medical Assistant, Georgetown Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Christen M Mowad, MD Professor, Department of Dermatology, Geisinger Medical Center

Christen M Mowad, MD is a member of the following medical societies: Alpha Omega Alpha, Noah Worcester Dermatological Society, Pennsylvania Academy of Dermatology, American Academy of Dermatology, Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

Additional Contributors

Saurabh Singh, MD Staff Physician, Department of Dermatology, Georgetown University/Washington Hospital Center

Disclosure: Nothing to disclose.

Andrea Leigh Zaenglein, MD Professor of Dermatology and Pediatrics, Department of Dermatology, Hershey Medical Center, Pennsylvania State University College of Medicine

Andrea Leigh Zaenglein, MD is a member of the following medical societies: American Academy of Dermatology, Society for Pediatric Dermatology

Disclosure: Received consulting fee from Galderma for consulting; Received consulting fee from Valeant for consulting; Received consulting fee from Promius for consulting; Received consulting fee from Anacor for consulting; Received grant/research funds from Stiefel for investigator; Received grant/research funds from Astellas for investigator; Received grant/research funds from Ranbaxy for other; Received consulting fee from Ranbaxy for consulting.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Ravi Ratnavel, MD, Mana Ogholikhan, MD, and Saurabh Singh, MD, to the development and writing of this article.

Rosacea Guidelines

Guidelines Summary

Guidelines for the management of people with rosacea

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