Rosacea TreatmentPatients who have severe rosacea often say that they feel that they are wearing a “mask of redness”. They feel that people look at their red faces and do not see them as individuals. We had a brief introduction to chronic rosacea and covered its background as well as its roots and treatment. Rather than repeat the information already contained in Chronic Rosacea Introduction Page, here we will focus mainly on the medications found to be of exclusive value in the treatment of rosacea. General ConsiderationsBefore the forthcoming discussion on topical and oral therapeutics in rosacea, some important general considerations will now be addressed. First, patient exposure to rosacea triggers, as presented in the previous chapter, must be minimized. Thus, patients should be educated on the avoidance of their specific flushing stimuli. General skin care should be addressed early on in the treatment of the disease. Poor tolerability of topical products is commonly encountered in rosacea, especially the ET subtype. The resultant irritant dermatitis typically presents as roughness and scaling, sometimes accompanied by itching, burning, or stinging (Dahl 2001; Lonne-Rahm et al. 1999). Thus, the selection of nonirritating cleansers, moisturizers, and make-up is essential, as harsh daily skin care regimens may negatively affect skin barrier function (Del Rosso 2005; Draelos 2004, 2006a; Laquieze et al. 2007). Topical AgentsTopical agents may be used alone or in combination with oral agents for maximum effect, especially during acute flares of the disease. In addition, topical therapy is generally required for long-term maintenance of remission (Dahl et al. 1998; Nielsen 1983). AntibioticsMetronidazole is one of the most commonly used topical agents in the treatment of rosacea. Although infrequently used in this condition, the oral form is also available for the more severe or recalcitrant cases. Topical metronidazole is available in different countries in a gel, cream, and lotion formulations, with concentrations ranging from 0.75 to 1%.Metronidazole is a synthetic nitroimidazole antibiotic. It is active against a variety of Gram-positive and Gram-negative, as well as some anerobic, bacteria and certain protozoans, likely through the disruption of microbial DNA (Lamp et al.1999). However, its role in the treatment of rosacea appears to involve a different mechanism of action, as bacteria are unlikely to be involved in the pathophysiology of the condition. Thus, it has been demonstrated that metronidazole possesses significant anti-inflammatory properties in the skin. Specifically, the agent was found to modulate neutrophil function by suppressing neutrophil-generated reactive oxygen species (ROS) in a dose-related manner (Akamatsu et al. 1990; Miyachi et al. 1986). More recently, inherent ROS scavenging and inactivating properties of metronidazole were also demonstrated in a skin lipid model (Narayanan et al. 2007). Azelaic AcidAzelaic acid is a 9-carbon-chain dicarboxylic acid derived from Pityrosporum ovale. It is available as a 20% cream and, more recently, as a 15% gel. Although both formulations have been successfully used in the treatment of inflammatory rosacea (Bjerke et al. 1999; Elewski et al. 2003; Maddin 1999; Thiboutot et al. 2003), the cream preparation contains significantly larger amounts of emulsifiers, which may lead to a greater potential for skin irritation (Draelos 2006b).The mechanism of action of azelaic acid in the treatment of rosacea has not been completely elucidated. The agent has antiproliferative, antibacterial, and antikeratinizing properties; however, these actions are unlikely to account for the improvement noted in rosacea. Instead, similar to metronidazole, azelaic acid appears to be a potent inhibitor of neutrophil-generated ROS and to possess free-radical scavenging properties (Akamatsu et al. 1991; Passi et al. 1991a, b). Sodium Sulfacetamide and SulfurBoth sodium sulfacetamide and sulfur have a long history of use in inflammatory rosacea (Lebwohl et al. 1995; Torok et al. 2005). Their mechanism of action in this condition is, however, unclear, but may involve anti-inflammatory properties of both agents.The combination of the two agents is available in a number of creams, lotions, gels, suspensions, cleansers, and masks. The concentrations of these ingredients may vary, though a combination of 10% sodium sulfacetamide and 5% sulfur is encountered most commonly. These products are now experiencing resurgence due to the recent availability of odor-masking formulations. Once- to twice-daily application regimen is most commonly used in the treatment of rosacea. RetinoidsRetinoids are used extensively in the treatment of acne vulgaris. Though their use in rosacea is significantly less common, it has been evaluated in several studies (Altinyazar et al. 2005; Ertl et al. 1994).The mechanism of action of retinoids in rosacea is not completely clear. Various anti-inflammatory properties of retinoids, including an antioxidant effect on the neutrophil system, have been demonstrated (Liu et al. 2005; Tenaud et al. 2007; Yoshioka et al. 1986). It has also been suggested that an additional mechanism may involve down-regulation of angiogenesis associated with the disease. To that effect, it has been shown that retinoids have an inhibitory effect on the expression of vascular endothelial growth factor (VEGF) and its receptor, though this effect is not mediated by the retinoic acid receptors (RARS) (Cho et al. 2005; Lachgar et al. 1999). Future studies will need to determine whether additional anti-inflammatory or antiproliferative properties of retinoids may be involved in the improvement of symptoms and signs of rosacea. Demodex Mites TreatmentAccording to studies mentioned below the page, Demodex mites might play a role in causing chronic rosacea. Dealing with these tiny creature would help with treating rosacea.Ungex Control shampoo was formulated for treatment of mild and severe stages of head demodicosis. Complex of natural oils, herbal extracts and minerals helps to boost the immune system of the skin. Stimulates metabolism of hair follicles and scalp infected with the skin parasites. The shampoo effectively reduces Demodex population.This unique shampoo is exceptionally designed to help to eliminate Demodex mites from your hair and skin. It is formulated for dry skin and hair, this Shampoo gently cleanses away Demodex mites, alleviating skin inflammation issues, such as acne, rosacea, demodicosis, dandruff, hair loss, and itchiness. Oral AgentsOral agents are frequently utilized as part of a multiagent regimen in the setting of acute rosacea flares. Once the flare has resolved, the oral agent may be discontinued, with remission maintained through the use of topical therapies, as described above. AntibioticsAmong the oral agents used in the treatment of rosacea, the tetracycline family of antibiotics is employed most often. With rising concerns about the emergence of resistant bacterial strains, the recognition of anti-inflammatory properties of these agents with subsequent development of lower-dose regimens represents an important therapeutic advancement.The most commonly-used agents in this category include tetracycline (oxytetracycline and tetracycline hydrochloride), minocycline, and doxycycline. Tetracycline is available as 250 mg or 500 mg tablets or capsules, usually taken twice daily. Minocycline is formulated as capsules or tablets, with doses ranging from 50 to 100 mg twice daily. Finally, doxycycline is available in capsules, tablets, and enteric-coated tablets in 20, 50, 75, and 100 mg dosages typically administered twice daily. Additionally, a 40 mg once daily formulation, containing 30 mg of immediaterelease and 10 mg of delayed-release doxycycline, is now available and has been approved by the FDA for this condition. IsotretinoinThe use of isotretinoin, or 13-cis retinoic acid, in rosacea has been less extensive as compared to that in acne vulgaris. Nonetheless, this may be a valuable agent in severe and recalcitrant cases of the inflammatory (PP) subtype of the disease. In addition, its beneficial effect in rhinophyma and rosacea fulminans, extremely treatment-resistant presentations of rosacea, has also been demonstrated (Jansen et al. 1994; Jansen & Plewig 1998). Isotretinoin is available as 5, 10, 20, 30, and 40 mg capsules and is administered once daily with fatty meals to improve absorption.Numerous dosing regimens have been attempted in studies on treatment of rosacea. Originally, doses of 0.5–2 mg/kg/day have been evaluated and found to result in significant and longterm improvement in the inflammatory lesions of rosacea (Hoting et al. 1986; Schell et al. 1987; Turjanmaa & Reunala 1987). The proof is in the resultsUngex has formulated a product which has helped thousands of people around the world deal with their rosacea problem. When you work with us, we will ensure you receive the highest quality products and treatment plan to help permanently treat your rosacea.References:Acne and Rosacea: Epidemiology, Diagnosis and Treatment by David J GoldbergRosacea Diagnosis and Management by Frank PowellCauses of Rosacea: Demodex Mites & Microbes Read more:Chronic RsaceaWhat are Demodex mites?How to kill Demodex mites?Can Demodex Mites Cause Seborrheic Dermatitis?