title: Rosacea Management.
abstract: BACKGROUND
  Rosacea is a chronic inflammatory skin condition associated with four distinct subtypes: erythematotelangiectatic, papulopustular, phymatous, and ocular.
  
  
  OBJECTIVE
  To review the different kinds of management for all subtypes.
  
  
  METHODS
  We divided rosacea management into three main categories: patient education, skin care, and pharmacological/procedural interventions.
  
  
  RESULTS
  Flushing is better prevented rather than treated, by avoiding specific triggers, decreasing transepidermal water loss by moisturizers, and blocking ultraviolet light. Nonselective β-blockers and α2-adrenergic agonists decrease erythema and flushing. The topical α-adrenergic receptor agonist brimonidine tartrate 0.5% reduces persistent facial erythema. Intradermal botulinum toxin injection is almost safe and effective for the erythema and flushing. Flashlamp-pumped dye, potassium-titanyl-phosphate and pulsed-dye laser, and intense pulsed light are used for telangiectasias. Metronidazole 1% and azelaic acid 15% cream reduce the severity of erythema. Both systemic and topical remedies treat papulopustules. Systemic remedies include metronidazole, doxycycline, minocycline, clarithromycin and isotretinoin, while topical remedies are based on metronidazole 0.75%, azelaic acid 15 or 20%, sodium sulfacetamide, ivermectin 1%, permethrin 5%, and retinoid. Ocular involvement can be treated with oral or topical antibacterial. Rhinophyma can be corrected by dermatosurgical procedures, decortication, and various types of lasers.
  
  
  CONCLUSIONS
  There are many options for rosacea management. Patients may have multiple subtypes, and each phase has its own treatment.
authors.affiliation: Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, N.C., USA.
authors.forename: Manal
authors.initials: M
authors.lastname: Abokwidir
authors.affiliation: Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, N.C., USA.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Feldman
keywords: Azelaic acid; Demodex; Inflammatory lesion; Isotretinoin; Ivermectin; Laser; Ocular rosacea; Rosacea