- Patients should be advised to avoid direct sunlight and wear a high factor sun block daily.
- If triggers can be identified, they should be avoided.
- Consider referral for cosmetic camouflage
- Psychological support may be considered for both emotional triggers and consequences of rosacea
- Intermittent therapy can be considered for those with very occasional flare-ups, but maintenance therapy may reduce the frequency of inflammatory flares.
- Patients with rosacea often have sensitive skin. Advise washing with a cream instead of soap and to avoid irritant cosmetics.
Patient Information Leaflets:
British Association of Dermatologists Patient Information Leaflets: Rosacea
Developed October 2016
- Flushing, often made worse by alcohol, spicy foods, hot drinks, temperature changes or emotion
- Erythema with peri-ocular sparing
- Inflammatory lesions
- Erythematous papules
- No comedones (these are a sign of acne vulgaris)
- Ocular rosacea: posteria blepharitis (Meibomian gland dysfunction)
- Pyoderma faciale: painful large erythematous nodules, pustules and erosions. May scar.
Criteria for referral to Community Dermatology services:
- Doubt over diagnosis
- Optimisation of combination treatment in non-responders
- For initiation of brimonidine gel (Mirvaso) for patients still suffering discomfort secondary to erythema despite treatment with medications suggested above,
Criteria for referral to Secondary care:
- Severe disease, development of pyoderma faciale
- Erythema and telangiectasia, for consideration of laser treatment
Criteria for referral to Ophthalmology:
- Severe ocular rosacea with keratitis or uveitis
Criteria for referral to Plastic Surgery:
- Severe phymatous disease (Rhinophyma patients severe enough to warrant treatment should be referred to laser first rather than plastics.)