GUIDELINES IN DERMATOLOGY

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ROSACEA

Ayşe Serap Karadağ1
Gizem Pehlivan Ulutaş2

1Private Practice of Dermatology, İstanbul, Türkiye
2University of Health Sciences, Haseki Training and Research Hospital, Department of Dermatology, İstanbul, Türkiye

Karadağ AS, Pehlivan Ulutaş G. Rosacea. In: Kutlubay Z, editor. Guidelines in Dermatology. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.191-208.

ABSTRACT

Rosacea is a common, chronic, inflammatory skin disorder predominantly affecting the central face. Characterized by recurrent cycles of flare-ups and remissions, the condition manifests with flushing attacks, persistent erythema, telangiectasias, papulopustular lesions, phymatous changes, and ocular involvement. The pathogenesis is attributed to genetic factors, neurovascular and immune dysregulation, microbial factors, and various environmental triggers. Different pathways likely dominate in the development of the diverse clinical features of the disease.

The treatment of rosacea involves a multifaceted approach, including basic general measures and skincare practices, topical and systemic medications, as well as laser and light-based therapies. At the initial stage, disease control and prevention of relapses necessitate patient education, avoiding known triggers identified for each individual, establishing and adhering to an appropriate skincare routine, ensuring year-round photoprotection, and, when appropriate, providing psychological support. Treatment decisions are guided by the clinical subtype of rosacea and patient-specific characteristics.

For patients with persistent erythema and telangiectasias, topical alpha receptor agonists such as brimonidine and oxymetazoline are recommended due to their vasoconstrictive effects. Laser (e.g., pulsed dye laser (PDL), KTP, Nd: YAG) and light-based systems are also effective options. Patients experiencing frequent flushing attacks may benefit from systemic beta-blockers, antidepressants, or hormone replacement therapy in postmenopausal women.

For cases dominated by inflammatory papulopustular lesions, first-line treatments include topical agents such as metronidazole, azelaic acid, and ivermectin. Severe or refractory cases may require systemic tetracyclines or macrolide antibiotics, or low-dose isotretinoin, in combination with topical therapies. Phymatous changes, which usually arise after prolonged disease duration, may respond to early low-dose isotretinoin. Advanced cases often require ablative laser therapy or electrosurgical techniques.

In ocular rosacea, maintaining eyelid hygiene and ensuring sun protection are foundational steps. Topical antibiotics, cyclosporine, and ivermectin are often sufficient in most cases, while severe cases may necessitate systemic antibiotics.

In conclusion, the management of rosacea begins with patient education and trigger avoidance and often requires a combination of medical therapies and device-based treatments tailored to the patient’s needs.

Keywords: Rosacea; Treatment; Guideline; Medical treatment; Lasers and light-based treatments

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