Rosacea: Where Are We Now?
May 2004 | Volume 3 | Issue 3 | Original Article | 251 | Copyright © May 2004
Joseph B. Bikowski, MD; and Mitchel p. Goldman, MD
Advances continue to be made in the classification and treatment of rosacea, a chronic dermatologic syndrome. A new empiric classification
system identifies 4 rosacea subtypes (erythematotelangiectatic, papulopustular, phymatous, and ocular) that may aid in more
precise diagnosis. Several new therapies have recently been approved for treatment of rosacea. Azelaic acid 15% gel is a new firsttier
topical agent proven effective in reducing inflammatory lesions and erythema. New formulations of metronidazole and sulfacetamide
10%/sulfur 5% that offer cosmetic or tolerability advantages are now available. Intense pulsed light therapy has demonstrated
effectiveness in reducing flushing, erythema, and telangiectases, with greater tolerability than existing laser systems. Other treatments
under investigation include low-dose doxycycline hyclate (which may provide greater safety than existing oral antibiotics), benzoyl
peroxide/clindamycin gel, and tacrolimus ointment (for steroid-induced rosacea). With this expanded armamentarium of medical
and light-based therapies, clinicians can now implement a multifaceted approach to treatment, crafting new treatment combinations
to address the unique and evolving features of rosacea in each individual patient.