title: State of the art: systemic rosacea management.
abstract: Based on numerous trials, oral tetracyclines and most commonly their second-generation derivative doxycycline have become the main pillar in systemic rosacea treatment. However, the only preparation that has been approved so far in this setting is 40 mg doxycycline in an anti-inflammatory dosage and with a modified release formulation. With the introduction of this once-daily, non-antibiotic dosing of doxycycline, oral therapy is more commonly prescribed as first-line treatment in moderate to severe papulopustular rosacea. In addition, topical and oral strategies are often used in combination due to the more substantial improvements compared to monotherapy. Although several other non-approved oral agents like macrolides, isotretinoin, and carvedilol have been evaluated for systemic treatment and showed promising results, yet the experience with these drugs in rosacea is limited, and thus they should be reserved for special situations.
authors.affiliation: Department of Dermatology, Tübingen University Hospital, Tübingen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Schaller
authors.affiliation: Department of Dermatology, Venereology, and Allergology, University Hospital, Goethe-University, Frankfurt/M, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Schöfer
authors.affiliation: Department of Dermatology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Homey
authors.affiliation: Clinics for Dermatology and Allergology, Justus-Liebig-University, Giessen, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Gieler
authors.affiliation: Department of Dermatology and Allergology, HELIOS Hospital Wuppertal, Witten/Herdecke University, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Lehmann
authors.affiliation: Department of Dermatology, University Hospital Münster, Germany.
authors.forename: T A
authors.initials: TA
authors.lastname: Luger
authors.affiliation: Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Ruzicka
authors.affiliation: Department of Dermatology and UCD Charles Institute for Translational Dermatology,  University College Dublin, Dublin, Ireland.
authors.forename: M
authors.initials: M
authors.lastname: Steinhoff
mesh_terms: D000279:Administration, Cutaneous; D000287:Administration, Topical; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D003879:Dermatologic Agents / Q000008:administration & dosage; D019317:Evidence-Based Medicine; D005148:Facial Dermatoses / Q000175:diagnosis* / Q000188:drug therapy*; D005858:Germany; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage*; D018802:Patient-Centered Care / Q000379:methods; D012393:Rosacea / Q000175:diagnosis* / Q000188:drug therapy*; D063189:Symptom Assessment / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D003879:Dermatologic Agents; D007155:Immunologic Factors