In 2017 the Global Rosacea Consensus Panel agreed on the latest treatment recommendations for rosacea. Their overall points were:
1) Skincare is fundamental (more on that in my post on How To Manage Rosacea)
2) Treatment should be based on the phenotype (= symptoms the patient presents)
3) If several symptoms appear in a patient, which is often the case, they can be treated simultaneously with different agents/modalities.
REDNESS & TELANGIECTASIAS
Unfortunately there’s no high-quality evidence for flushing treatments, which emphasizes the complexity of the disease. Transient redness (=comes and goes) can be treated with cream and pills that constrict the vessels in the skin. Persistent redness and telangiectasias (chronic dilated vessels) can both be treated with IPL (intense pulsed light) and PDL (pulsed-dye laser) and the latter with electrodesiccation and other laser options.
PAPULES & PUSTULES
These symptoms are (according to severity) treated with 1) Creams with anti-inflammatory properties that also kill the mites 2) Oral antibiotics in submicrobial doses used for their anti-inflammatory properties
3) Oral vitamin A which has anti-angiogenic effects (improving redness and flushing), alters skin microbiome and changes composition of sebum/skin fatty acids (ref. 3).
For treatment of ocular rosacea (rosacea involving the eye) see table below.
Which treatment(s) have you tried?
1) Schaller et al. “Rosacea treatment update: recommendations from the
global ROSacea COnsensus (ROSCO) panel” Br J Dermatol 2017; 176:465–471
2) Valentín, Sheila et al. “Safety and efficacy of doxycycline in the treatment of rosacea” Clinical, cosmetic and investigational dermatology vol. 2 129-40. 12 Aug. 2009 PMCID: PMC3047926
3) M. Rademaker “Very low-dose isotretinoin in mild to moderate papulopustular rosacea; a retrospective review of 52 patients.” Australas J Dermatol. 2018 Feb;59(1):26-30. doi: 10.1111/ajd.12522.