How to Make your Doctor a Rosacea Expert

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

A. Erythema


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.

For more background see – Mirvaso, Metrogel, Finacea, IPL, Oracea and make-up.

B. Papules and Pustules


B1. Topical ivermectin

B2. Topical azelaic acid

B3. Topical metronidazole

B4. Oral doxycycline

B5. Oral tetracycline

B6. Oral isotretinoin

For more background see Soolantra, Finacea, Metrogel, Oracea, Tetracycline and Accutane.

C. Phyma


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

For more background see Isotretinoin, Tetracyclines, Surgical Ablation and Accutane.

D. Ocular


D1. Lid care and artificial tears

D2. Oral doxycycline

D3. Oral tetracycline

D4. Cyclosporine drops

D5. Referral to an ocular expert (ophthalmologist preferred)

For more background see Eyelid Care, Doxycycline, and Cyclosporine.

Rosacea Maintenance Therapy


For more background see Finacea, Oracea, Soolantra, Mirvaso, Metrogel, and Eyelid Care.

Article Abstract

Canadian Clinical Practice Guidelines for Rosacea

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.

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About the Author

About the Author: David Pascoe started the Rosacea Support Group in October 1998. .

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3 Reader Comments

  1. Excellent article David.

  2. “My best help was Soolantra at 1st but it wouldn’t get rid of the redness so my dermatologist gave me Rhofade to use with Soolantra and together at night they show a big difference unless I ate something spicy or got overheated outside. Now, after about 1 year or so I’m trying just Rhofade and that seems to be working great with the redness. I still get pimples on the chin and other places, even though I have taken tetracycline for years, this is stress, I just put Vicks vapor rub on the pimples before everything else and after 2 to 3 days the pimples will go away. I stopped buying the OTC items, never seems to work all the time.”

  3. “Tetracyclines dont work at all on phymatous Rosacea- try isotret low dose instead-really the treatment of choice for papules and pustules as well”

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