DermHelpCentral

Granulomatous Rosacea

This is a helpful reference:

Lee GL, Zirwas MJ.
Granulomatous Rosacea and Periorificial Dermatitis: Controversies and Review of Management and Treatment. Dermatol Clin. 2015 Jul;33(3):447-55.
Abstract: Granulomatous rosacea and periorificial dermatitis are common skin conditions affecting the face. This article examines the historical origin, causes, clinical presentation, and management strategies for these entities.

Link to Full Text: Download Granulomatous Rosacea Review

Rosacea: Useful Review (2017)

Rosacea: A Comprehensive Review

by Esther J. van Zuuren, M.D.
Leiden University Medical Centre, The Netherlands

N Engl J Med November 2, 2017

This complete and helpful NEJM feature article begins with a case vignette highlighting Rosacea. Evidence supporting various therapies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author’s clinical recommendations.

You can access the article here (it is provided by the NEJM free of charge. The author is a paid consultant for Galderma, a pharmaceutical company that makes a popular oral and prescription medications for Rosacea.

These images are from the NEJM article:

 

Demodeciasis Treatment

Case report of a 34 yo man with proven Demodex-Rosacea who was treated with 200 mg/kg ivermectin with subsequent weekly topical permethrin. The protocol  showed impressive treatment efficacy.
See pdf of article: Download Demodeciasis Ivermectin

Updae on the management of Rosacea

This is a helpful review with special reference to isotretinoin.  It is available free full text.

Abstract. Refining diagnostic criteria has identified key characteristics differentiating rosacea, a chronic skin disorder, from other common cutaneous inflammatory conditions. The current classification system developed by the National Rosacea Society Expert Committee consists of erythematotelangiectatic, papulopustular, phymatous, and ocular subtypes. Each subtype stands as a unique entity among a spectrum, with characteristic symptoms and physical findings, along with an intricate pathophysiology. The main treatment modalities for rosacea include topical, systemic, laser, and light therapies. Topical brimonidine tartrate gel and calcineurin inhibitors are at the forefront of topical therapies, alone or in combination with traditional therapies such as topical metronidazole or azelaic acid and oral tetracyclines or isotretinoin. Vascular laser and intense pulsed light therapies are beneficial for the erythema and telangiectasia, as well as the symptoms (itching, burning, pain, stinging, swelling) of rosacea. Injectable botulinum toxin, topical ivermectin, and microsecond long-pulsed neodymium-yttrium aluminum garnet laser are emerging therapies that may prove to be extremely beneficial in the future. Once a debilitating disorder, rosacea has become a well known and manageable entity in the setting of numerous emerging therapeutic options. Herein, we describe the treatments currently available and give our opinions regarding emerging and combination therapies.

Also see:  All About Rosacea.

Rosacea

Rosacea is a red facial rash that most often affects those aged 30 to 60, especially those with fair skin, blue eyes and of Celtic origin. It may be transient, recurrent or persistent. (The image is from Fitzpatrick's Handbook)

Rosacea used to be called ‘acne rosacea’ but it is quite different from acne. There are red spots (papules) and sometimes pustules in both conditions, but in rosacea they are dome-shaped rather than pointed and there are no blackheads, whiteheads, deep cysts, or lumps. Rosacea may also result in reddened skin, scaling and swelling of affected areas.

You can read more at DermNet.org.nz.

or eMedicine.com

or the the Rosacea Factsheet (Printable Version):

Only the patient can decide how much rosacea affects her or him.  For the more serious cases, oral therapy is quicker and more predictable.  While there is no cure for rosacea, it can be controlled in most persons with therapies that are not too onerous or expensive.  Oral antibiotics are more successful for the acne-like lesions of rosacea than the erythema (redness).

Triggers can  exacerbate your rosacea should be identified and avoided if possible. These factors are unique to each patient and include:
Hot or cold temperatures
Wind
Hot drinks
Caffeine
Exercise
Spicy food
Alcohol
Emotions
Topical products that irritate the skin
Medications that cause flushing (such as niacin)
Remember that not all of these will be triggers in your case, but some may play a role and can, perhaps, be avoided.

Treatment
General Measures

    * Where possible, reduce factors causing facial flushing (see Triggers)
    * Avoid oil-based facial creams. Use water-based make-up
    * Never apply a topical steroid  to rosacea
    * Use light oil-free facial sunscreen
    * If possible eep your face cool
    * Minimize your exposure to hot or spicy foods, alcohol, hot showers and baths and warm rooms if you think these are triggers.

Oral Antibiotics
This is the mainstay for patients with acne-like lesions.  The most effective are doxycycline and minocycline.
Doxycycline can cause a bad sunburn and is used during the winter months
Minocycline does not cause sunburn but can stain teeth if taken for more than six months at a time.  It is used during the summer.
After the rosacea improves the dose can be tapered slowly to find the lowest maintenance level.

Topical Therapy
Metronidazole is the only agent which has been proven effective by multiple clinical studies.  It is available in 0.75%  (used 2 times a day) and 1% strengths (used once a day).  Here's a good overview of topical therapy for rosacea.

Basic Skin Care
Wikipedia has a good page on helpful skin care suggestions fro persons with rosacea.  It does not appear to have commercial bias.