Rosacea: a review of current topical, systemic and light-based therapies.
Rosacea is a common chronic inflammatory disorder of the facial skin characterized by periods of exacerbation, remission and possible progression. The principle subtypes include erythematotelangiectatic rosacea, papulopustular rosacea, phymatous rosacea and ocular rosacea. Although the pathogenesis is unknown, rosacea is largely recognized as an inflammatory disorder. Individual subtypes are likely a result of different pathogenic factors and respond best to different therapeutic regimens. The non-pharmacologic approach to therapy is adequate skin care, trigger avoidance and photoprotection; in addition, there are several topical, herbal, systemic and light based therapies available. Standard Food and Drug Administration (FDA) approved treatments include topical sodium sulfacetamide, metronidazole, and azelaic acid. Anti-inflammatory dose doxycycline, a controlled-release 40 mg formulation offers a non-antibiotic, anti-inflammatory treatment option. Combination of azelaic acid or topical metronidazole with anti-inflammatory doxycycline appears to have a synergistic effect. Oral isotretinoin may be effective for phymatous rosacea and treatment resistant rosacea. Light based therapies with pulsed dye laser and intense pulsed light are effective in treatment of erythema and telangiectasias. As our knowledge of rosacea and its therapeutic options expand, a multifaceted approach to treatment is warranted.
Kennedy Carney
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Department of Dermatology, University of Alabama at Birmingham, Birmingham AL, USA.
Cantrell
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Elewski
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BE
D000279:Administration, Cutaneous; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003358:Cosmetics / Q000009:adverse effects; D003879:Dermatologic Agents / Q000145:classification / Q000627:therapeutic use*; D004032:Diet / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D054025:Lasers, Dye / Q000627:therapeutic use; D028022:Low-Level Light Therapy; D008297:Male; D008924:Mite Infestations / Q000150:complications; D010789:Phototherapy; D008517:Phytotherapy; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy; D016032:Randomized Controlled Trials as Topic; D012393:Rosacea / Q000145:classification / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology / Q000469:parasitology / Q000517:prevention & control / Q000628:therapy*; D012867:Skin / Q000098:blood supply / Q000382:microbiology / Q000469:parasitology
D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D003358:Cosmetics; D003879:Dermatologic Agents