{"id":4401,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/rosacea\/"},"modified":"2024-10-11T10:27:55","modified_gmt":"2024-10-11T09:27:55","slug":"rosacea","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/dermatology\/rosacea\/","title":{"rendered":"Rosacea"},"content":{"rendered":"\n<h4 class=\"wp-block-heading\">Rosacea<\/h4>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"alignright is-resized\"><div class=\"wpcp-wp-lightbox-host wpcp-advanced-image-lightbox-icon-hover\"><img decoding=\"async\" src=\"\/files\/sites\/2\/Dermatology-Rosacea-Jan-2020-1.png\" alt=\"Dermatology Rosacea\" style=\"width:320px;height:215px\" \/><figcaption class=\"wp-element-caption\"><a class=\"wpcp-wp-lightbox-image-link\" data-wpcp-wp-lb-image=\"1\" href=\"https:\/\/dermnetnz.org\/#gsc.tab=1&#038;gsc.q=rosacea&#038;gsc.page=1\" target=\"_blank\" rel=\"noopener\">Search DermNet | DermNet (dermnetnz.org)<\/a><\/figcaption><a href=\"https:\/\/dermnetnz.org\/#gsc.tab=1&#038;gsc.q=rosacea&#038;gsc.page=1\" data-fancybox=\"wpcp-wp-wpcp-wp-1\" class=\"wpcp-lightbox-trigger wpcp-advanced-image-lightbox-icon wpcp-position-top-right wpcp-advanced-image-lightbox-icon-hover wpcp-global-lightbox-icon wpcp-lightbox-icon--global wpcp-lb-icon-style-default\" data-wpcp-lb-icon-source=\"global\" aria-label=\"Open image in lightbox\" data-thumb-src=\"https:\/\/dermnetnz.org\/#gsc.tab=1&amp;gsc.q=rosacea&amp;gsc.page=1\" data-wpcp-lb-single=\"1\" target=\"_blank\" rel=\"noopener\"><span class=\"wpcp-icon-container\"><svg viewBox=\"0 0 20 20\"><path d=\"M17.6585 16.025L14.2437 12.6198C15.1716 11.3338 15.6121 9.7613 15.4871 8.1819C15.362 6.60251 14.6795 5.11847 13.5607 3.99351C12.936 3.36206 12.1916 2.86066 11.3709 2.51845C10.5502 2.17623 9.66952 2 8.77995 2C7.89039 2 7.00969 2.17623 6.18899 2.51845C5.36829 2.86066 4.62395 3.36206 3.99919 3.99351C3.36594 4.61649 2.86312 5.35871 2.51992 6.17708C2.17673 6.99545 2 7.87365 2 8.76068C2 9.64772 2.17673 10.5259 2.51992 11.3443C2.86312 12.1627 3.36594 12.9049 3.99919 13.5279C5.11957 14.6901 6.62279 15.4103 8.23285 15.5562C9.84291 15.7022 11.4517 15.2641 12.7639 14.3224L16.1788 17.7275C16.3849 17.9034 16.6473 18 16.9186 18C17.1899 18 17.4523 17.9034 17.6585 17.7275C18.1138 17.16 18.1138 16.5925 17.6585 16.025ZM5.59278 12.0523C5.16258 11.6298 4.82094 11.1263 4.58774 10.5709C4.35455 10.0156 4.23446 9.41951 4.23446 8.81744C4.23446 8.21536 4.35455 7.6193 4.58774 7.06394C4.82094 6.50859 5.16258 6.00503 5.59278 5.58257C6.01644 5.15359 6.52144 4.81292 7.07838 4.58039C7.63532 4.34786 8.23308 4.22811 8.83687 4.22811C9.44066 4.22811 10.0384 4.34786 10.5954 4.58039C11.1523 4.81292 11.6573 5.15359 12.081 5.58257C12.5112 6.00503 12.8528 6.50859 13.086 7.06394C13.3192 7.6193 13.4393 8.21536 13.4393 8.81744C13.4393 9.41951 13.3192 10.0156 13.086 10.5709C12.8528 11.1263 12.5112 11.6298 12.081 12.0523C11.6573 12.4813 11.1523 12.822 10.5954 13.0545C10.0384 13.287 9.44066 13.4068 8.83687 13.4068C8.23308 13.4068 7.63532 13.287 7.07838 13.0545C6.52144 12.822 6.01644 12.4813 5.59278 12.0523Z\" \/><\/svg><\/span><\/a><\/div><\/figure>\n<\/div>\n\n\n<p class=\"wp-block-paragraph\">Rosacea is a chronic, relapsing disorder with intermittent or persistent facial flushing, telangiectasia, papules and pustules, in the absence of comedones. The rash usually involves forehead, cheeks &amp; chin, sparing the peri-orbital &amp; peri-oral areas. Not all signs may be present in the same patient.<br>It is more common in fair skinned people and peak incidence is 40-50 years.<br><br>Rosacea can also cause ocular symptoms in &gt; 50% of patients and can cause dry gritty eyes, conjunctivitis, blepharitis, episcleritis &amp; chalazion. Keratitis may be a more serious complication.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Rhinophyma<\/h4>\n\n\n\n<div class=\"wp-block-media-text is-stacked-on-mobile\" style=\"grid-template-columns:22% auto\"><figure class=\"wp-block-media-text__media\"><img loading=\"lazy\" decoding=\"async\" width=\"624\" height=\"934\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Rosacea-NOSE.png\" alt=\"Rosacea nose\" class=\"wp-image-15379 size-full\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Rosacea-NOSE.png 624w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Rosacea-NOSE-200x300.png 200w\" sizes=\"auto, (max-width: 624px) 100vw, 624px\" \/><\/figure><div class=\"wp-block-media-text__content\">\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<div class=\"wp-block-media-text is-stacked-on-mobile\" style=\"grid-template-columns:28% auto\"><figure class=\"wp-block-media-text__media\"><img loading=\"lazy\" decoding=\"async\" width=\"684\" height=\"1024\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Rosacea-nose-2.png\" alt=\"Rosacea nose\" class=\"wp-image-15378 size-full\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Rosacea-nose-2.png 684w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Rosacea-nose-2-200x300.png 200w\" sizes=\"auto, (max-width: 684px) 100vw, 684px\" \/><\/figure><div class=\"wp-block-media-text__content\">\n<p class=\"wp-block-paragraph\">Less commonly, rosacea can develop Rhinophyma where the shape and size of the nose changes<\/p>\n<\/div><\/div>\n<\/div><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">All images on this page are sourced from <a href=\"https:\/\/dermnetnz.org\/\" target=\"_blank\" rel=\"noopener\">DermNet | Dermatology Resource (dermnetnz.org)<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>R.C 24-05-24<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h3 class=\"wp-block-heading\">Referral Guidelines<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Severe unresponsive disease for consideration of isotretinoin<\/li>\n\n\n\n<li><em>Refer to Plastic Surgery<\/em>&nbsp;for consideration of laser or surgical therapy:\n<ul class=\"wp-block-list\">\n<li>Rhinophyma<\/li>\n\n\n\n<li>Severe Telangiectaisa<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><em>Refer to Ophthalmology<\/em>&nbsp;for&nbsp;associated keratitis.<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h3 class=\"wp-block-heading\">Management<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>General Advice<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Give patient information sheet<\/li>\n\n\n\n<li>Advise about oil-free products<\/li>\n\n\n\n<li>Advise on UV protection<\/li>\n\n\n\n<li>Cosmetic camouflage may be helpful for flushing, erythema and telanglectasia which will not respond to topical or oral antibiotics<\/li>\n\n\n\n<li>Avoid exacerbating factors: spicy foods, alcohol, hot drinks, caffeine, temperature changes, sun exposure<\/li>\n\n\n\n<li><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">Avoid topical steroids where possible<\/mark><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Topical Therapy<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>For mild to moderate rosacea.<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Use topical agents for 2-3 months then intermittently as required<\/li>\n\n\n\n<li>Metronidazole gel or cream od<\/li>\n\n\n\n<li>Azelaic acid 15% gel or 20% cream od<\/li>\n\n\n\n<li>Ivermectin cream 10mg\/g od<\/li>\n\n\n\n<li>Brimonidine 0.33% gel for temporary improvement of erythema as required od<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Systemic therapy<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>For mild to moderate rosacea.<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>2-3 months courses required intermittently<\/li>\n\n\n\n<li>Lymecycline 408mg od<\/li>\n\n\n\n<li>Doxycycline 100mg od<\/li>\n\n\n\n<li>Erythromycin 500mg bd<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Therapeutic Tips<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>If no improvement after 3 months switch to alternative antibiotic<\/li>\n\n\n\n<li>Intermittent or continuous antibiotics may be required if recurrent flares and there is scope to use low dose antibiotics in the longer term once symptoms have settled (e.g. doxycycline 50-100mg daily)<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Management of Ocular Symptoms<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Lid hygiene &#8211; clean the eyelids using cotton wool soaked in cooled, boiled water<\/li>\n\n\n\n<li>Artificial tears &#8211; should be applied liberally throughout the day. If necessary a lubricating ointment, sometimes containing an antibiotic preparation may be used at night<\/li>\n\n\n\n<li>Systemic tetracyclines are the most effective treatment for ocular rosacea. Erythromycin can be taken orally for patients intolerant of tetracyclines<\/li>\n\n\n\n<li>Retinoids should be&nbsp;<strong>avoided<\/strong>&nbsp;in patients with significant ocular problems as they can worsen symptoms and lead to a severe keratitis<\/li>\n\n\n\n<li>Troublesome ocular symptoms that persist despite of treatment should be referred to an ophthalmologist.&nbsp;<strong>Patients with potentially more serious symptoms such as keratitis should be referred for urgent specialist assessment.<\/strong><\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">For Patients<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"http:\/\/www.bad.org.uk\/shared\/get-file.ashx?id=229&amp;itemtype=document\" target=\"_blank\" rel=\"noreferrer noopener\">http:\/\/www.bad.org.uk\/shared\/get-file.ashx?id=229&amp;itemtype=document<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/patient.info\/skin-conditions\/skin-rashes\/rosacea\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/patient.info\/skin-conditions\/skin-rashes\/rosacea<\/a><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">For Health Professionals<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"http:\/\/www.pcds.org.uk\/clinical-guidance\/rosacea\" target=\"_blank\" rel=\"noreferrer noopener\">http:\/\/www.pcds.org.uk\/clinical-guidance\/rosacea<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/cks.nice.org.uk\/rosacea-acne\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/cks.nice.org.uk\/rosacea-acne<\/a><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Rosacea Rosacea is a chronic, relapsing disorder with intermittent or persistent facial flushing, telangiectasia, papules and pustules, in the absence of comedones. The rash usually involves forehead, cheeks &amp; chin, sparing the peri-orbital &amp; peri-oral areas. Not all signs may be present in the same patient.It is more common in fair skinned people and peak<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":3853,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[109],"class_list":["post-4401","page","type-page","status-publish","hentry","category-rosacea"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/dermatology\/rosacea\/\" rel=\"tag\">Rosacea<\/a>","rttpg_excerpt":"Rosacea Rosacea is a chronic, relapsing disorder with intermittent or persistent facial flushing, telangiectasia, papules and pustules, in the absence of comedones. The rash usually involves forehead, cheeks &amp; chin, sparing the peri-orbital &amp; peri-oral areas. Not all signs may be present in the same patient.It is more common in fair skinned people and peak","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4401","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=4401"}],"version-history":[{"count":0,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4401\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3853"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=4401"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=4401"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}