Do you sometimes feel that you are better read than your doctor when it comes to rosacea? Well this might be the case, especially when you consider that there are so many medical conditions for your doctor to consider, and the generally easily available medical information available on the internet. Of course the quality of the medical information found on the internet will greatly influence your ability to access the best possible treatments for you. Lets see if we can significantly boost the amount of good quality information on the internet right here and now.
A recently published paper in the Journal of Cutaneous Medicine and Surgery is intended for Canadian health care providers, including pharmacists, nurse practitioners, family physicians, dermatologists, and other clinicians involved with care of patients with rosacea. So it is the sort of freshly minted published paper that you could take to your doctor when seeking the latest and greatest treatments available for rosacea.
The recommendations in this paper titled “Canadian Clinical Practice Guidelines
for Rosacea” started with the 2015 Cochrane review Interventions for Rosacea and adds flushing and maintenance therapy. Thanks to the similarity of treatments available throughout North America, this paper is equally valuable for rosaca sufferers in the US and Canada – and indeed as is the case of the recommendations detailed all of the EU and Australia as well.
The 2015 Cochrane review was covered by Rosacea News as Its official–Mirvaso, Soolantra and Oracea make the grade as proven rosacea treatments
Might not be Rosacea
The paper starts with a short section suggesting some other conditions that might be confused with rosacea based on symptom similarity.
- Flushing: carcinoid syndrome, systemic mastocytosis, benign cutaneous flushing and perimenopause, medullary carcinoma of the thyroid, and pancreatic and renal cell tumors
- Centrofacial erythema: photodamage, systemic lupus erythematosus, facial dermatitis, seborrheic dermatitis, psoriasis, and keratosis rubra pilaris faceii
- Papules/pustules: acne vulgaris (characterized by presence of comedones) and folliculitis
- Phymatous changes: nonmelanoma skin cancer, granulomatous infiltration (which may be infectious in origin such as rhinoscleroma or noninfectious such as sarcoidosis), and B and T-cell lymphomas
A1. Topical brimonidine
A2. Topical metronidazole
A3. Topical azelaic acid
A4. Vascular laser or intense pulsed light therapy
A5. Oral doxycycline
A6. Skin care and camouflage
A Warning on Erythema and Mirvaso
“For fixed erythema of rosacea, only brimonidine tartrate has high-quality evidence for its efficacy, and nearly half of patients show no improvement or worsen with its use”. One can read many reports of symptomatic worsening at the Mirvaso User Reviews page.
B. Papules and Pustules
B1. Topical ivermectin
B2. Topical azelaic acid
B3. Topical metronidazole
B4. Oral doxycycline
B5. Oral tetracycline
B6. Oral isotretinoin
C1. Topical retinoids
C2. Oral tetracycline or doxycycline
C3. Ablative laser surgery, using CO2 or Er:YAG modalities, or surgery, including electrosurgery and cryosurgery
C4. Oral isotretinoin
D1. Lid care and artificial tears
D2. Oral doxycycline
D3. Oral tetracycline
D4. Cyclosporine drops
D5. Referral to an ocular expert (ophthalmologist preferred)
Rosacea Maintenance Therapy
J Cutan Med Surg, May 17, 2016
Asai Y, Tan J, Baibergenova A, Barankin B, Cochrane CL, Humphrey S, Lynde CW, Marcoux D, Poulin Y, Rivers JK, Sapijaszko M, Sibbald RG, Toole J, Ulmer M, Zip C.
Rosacea is a chronic facial inflammatory dermatosis characterized by background facial erythema and flushing and may be accompanied by inflammatory papules and pustules, cutaneous fibrosis and hyperplasia known as phyma, and ocular involvement. These features can have adverse impact on quality of life, and ocular involvement can lead to visual dysfunction.
The past decade has witnessed increased research into pathogenic pathways involved in rosacea and the introduction of novel treatment innovations.
The objective of these guidelines is to offer evidence-based recommendations to assist Canadian health care providers in the diagnosis and management of rosacea.
These guidelines were developed by an expert panel of Canadian dermatologists taking into consideration the balance of desirable and undesirable outcomes, the quality of supporting evidence, the values and preferences of patients, and the costs of treatment.
The 2015 Cochrane review “Interventions in Rosacea” was used as a source of clinical trial evidence on which to base the recommendations.
Get Your Copy
I can’t put a copy of the PDF online as that would be breaching the rights of the copyright holders, but if you would like a copy of this 14 page PDF to take to your doctor then please send me an email and ask for a copy of the Canadian Clinical Practice Guidelines.
- Standard classification of rosacea
- Standard grading system for rosacea
- Rosacea Subtypes, How are they related?
- The Official Rosacea Treatments
- Treating Each Rosacea Symptom
- What is the Best Treatment for Rosacea?
- AARS, The Best Rosacea Topicals
- Metrogel, Finacea and Oracea are Best for Rosacea
- Its official–Mirvaso, Soolantra and Oracea make the grade as proven rosacea treatments