- Medications, Creams, and The Missing Ingredient
Rosacea is a chronic disease that cannot be cured. With rosacea treatment by a good physician, it can however, be controlled.
A good treatment strategy and a few simple lifestyle changes can change rosacea from an intolerable burden to a manageable condition. Medical attention and patient involvement are the keys to coping with rosacea and the cornerstone of rosacea treatment.
Medical care centers around local, topical therapy and systemic rosacea treatment. Finding out which one will work best will often take some trial and error, and it is not possible to predict a patient's response to any given therapy. Fortunately, the efficacy of these rosacea treatments has, for the most part, been clearly established and the side effects are few and manageable.
There are many choices for topical, and local rosacea treatments, and metronidazole is often used. Topical means that the medication is formulated as a cream and rubbed into the affected areas; local means it is applied only to a specific, affected area.
Metronidazole is a synthetic antibiotic, and although it is not completely understood why it is effective (it most likely works because it has anti-inflammatory properties) for rosacea, there is no doubt that it is works. There have been several studies that clearly showed that topical metronidazole, applied in 0.75% or 1.0% concentrations, made a significant improvement in easing the signs and symptoms of rosacea;
the mean number of pustules and papules was reduced
the number of inflammatory lesions decreased
the patients suffered far less from erythema (redness of the skin)
Azelaic acid is another popular topical therapy used as a rosacea treatment. It is a naturally occurring saturated acid that has been used for treating acne and hyperpigmentation, and it is useful in treating rosacea because it has anti-inflammatory and antibacterial activity. Again, as with metronidazole, there have been several well-controlled studies that have proven that azelaic acid can make a big difference in diminishing erythema and inflammatory lesions.
Other drugs that can be used are sodium sulfacetamide/sulfur preparations (they have been effective) and more traditional antibiotics such as erythromycin, clindamycin and tetracycline; these appear to be less effective than oral tetracycline, and there is no information comparing them with metronidazole cream.
The exact cause of rosacea is not known. There is evidence that there are genetic and environmental influences, there is evidence that it is an inflammatory disorder, and there is evidence (less convincing) that it is an infection with the bacteria Helicobacter pylori. Given that it not clear why rosacea happens, it was natural step to try systemic methods as a form of rosacea treatment, and these have been used with some success. Systemic simply means that the therapy is delivered to all parts of the body, not just applied to the area where the erythema and the lesions are.
There are strong suggestions (but no definitive proof) that oral antibiotics such as the tetracyclines - tetracycline, doxycycline, minocycline - can be effective rosacea treatments. Clarithromycin, ampicillin, and erythromycin have also been tried. It's not known if these are as effective as the tetracyclines, and it is not known which of any of the antibiotics is the best choice. Metronidazole can be used, and there is some evidence that it compares favorably with tetracycline. Finally, isotretinonin - a drug of the class called retinoids that decrease the production of sebum - is the drug of choice for certain variants of rosacea, for rhinophyma, and for patients with severe pustular lesions
But even with skillful medical intervention, successful rosacea treatment depends on the patient being involved with treating his or her illness. Although rosacea treatment that the patient can initiate is not as effective as drugs or lasers in alleviating the discomfort of rosacea, the basic nature of the disease is that it waxes and wanes, and people with roseacea can take some steps that will help reduce the frequency of the signs and symptoms.
Diet alteration (some foods seem to trigger attacks) is helpful. Always use sunscreen; direct sunlight may cause erythema. Treat your skin gently. Never rub or scrub your face and use gentle, non-abrasive cleaners and creams. And avoid - or at least manage - stress; stress can cause flare-ups.
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