{"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\"><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 href=\"https:\/\/dermnetnz.org\/#gsc.tab=1&amp;gsc.q=rosacea&amp;gsc.page=1\">Search DermNet | DermNet (dermnetnz.org)<\/a><\/figcaption><\/figure>\n<\/div>\n\n\n<p>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><\/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>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>All images on this page are sourced from <a href=\"https:\/\/dermnetnz.org\/\">DermNet | Dermatology Resource (dermnetnz.org)<\/a><\/p>\n\n\n\n<p><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><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><strong>Topical Therapy<\/strong><\/p>\n\n\n\n<p><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><strong>Systemic therapy<\/strong><\/p>\n\n\n\n<p><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><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><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><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><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":{"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":11,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4401\/revisions"}],"predecessor-version":[{"id":21186,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4401\/revisions\/21186"}],"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}]}}