Mild to moderate [few papules or pustules and mild to moderate persistent erythema]
· Metronidazole gel 0.75% OD or Metronidazole cream 1% OD – [Apply DAILY as directed – Come for review in 2 months]
· Intolerant/not responding Azelaic acid 15% gel BD [Apply DAILY as directed – May cause a mild burning or stinging sensation, but will improve in 1-2weeks – come for review in 2 months]
Severe or or no response to above
· Oxytetracycline 500mg BD (112, 250mg) [Take two tablets twice a day – Come for review in 2 months] or (if pregnant, reaction to sunlight…) Erythromycin 500mg BD (112, 250mg) [Take two tablets twice a day – Come for a review in 2 months]
· Review ever 2m
· Full 1-3m full dose
· Wean off over 2-6m
· 1/2 dose – 1/4 dose reduction every month
· Topical on alternate days
Occular symptoms
· Mild – [Eyelid hygine] [Lubricants] [Oxytetracycline]
· Urgent – Keratitis
· Routine – Resistant to maximal Rx
Referral
· Ophthalmology – Keratitis [urgent] Resistant ocular symptoms [routine]
· Dermatology – [psychosocial distress] [no response over 12w papulopustular] [Uncertain diagnosis]
· Plastics – [severe rhinophyma]
Patient information sheet
· http://www.patient.co.uk/health/Rosacea.htm