Second-line Therapies for Rosacea
In some Rosacea cases when antibiotics don't achieve best results, orally administrated Accutane containing izotrentinoin and topical trentinoin called Retin-A might have better effects. Although these products reduce papules and pustules, the question about their efficiency persists as they worsen erythema and teleangiectasia.
Other secondary antibiotics are trimethoprim-sulfamethoxazole commercially called Bactrim and Septra, Dapsone, Primaquine, Chloroquine (Aralen). Also oral Prednison can be used but the effects of all these products on Rosacea are not entirely known.
Corticosteroids are not to be applied directly on the face as they produce a Rosacea-like syndrome or worsen pre-existing Rosacea; they can also induce low-potency.
The only known agents for ocular symptoms of Rosacea are Tetracycline and Doxacycline. Also used for short-time treatments are corticosteroids with very beneficial effects on the ocular symptoms of Rosacea, but can only be administrated under the supervision of an ophthalmologist. Oral isotrentionoin three times a week 10 mg and liquid tears have improved dryness and recalcitrant cases.
Antibiotics might be successful for pustules and papules but they show no effects on erythema and teleangiectasia; to prevent flushes you must necessarily avoid personal triggers. Other methods are Clonidine particularly for woman on menopause and ß-blockers such as Propranolol or Nadolol, which might reduce redness through constriction of the vessels.
Teleangiectasia is one of the most common problems related to Rosacea. It can be treated by laser-beams and IPL with best results and shows recurrence in about 5 to 20 percent of the cases. Post-interventional hyper pigmentation of the area appears in some of the cases.
Primer stages of rhynophema in Rosacea can be cured with antibiotics but further development will surely need surgical intervention such as dermabrasion, cryosurgery and cutting out hypertrophic tissues by electro surgery or laser-technology.
Recent studies have proven the high importance of the VEGF (vascular endothelial growth factors) in skin diseases like Rosacea. To adapt expressions of VEGF in the skin appear retinoids. A very good result has isotrentinoin applied on the skin. In the future new products targeted on the anomalies of the skin will develop.
Azelex, azelaic acid is considered to be a very appropriate cure for skin acne, available as cream, safe and well tolerated. A comparation study on azelaic acid and local metronidazole has proven approximately the same effects and side-effects.
Patients must be informed about the potential treatments to keep Rosacea under control; there is no cure but avoiding triggers and appropriate measures can minimize symptoms and prevent its progression.
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