1.  Background Information / Important Principles

Important Principles:

  • 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.

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2.  Information Resource for Patients and Carers

Patient Information Leaflets:
British Association of Dermatologists Patient Information Leaflets: Rosacea

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3. Development and Updates to this Pathway

Developed October 2016

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4. Training and Further Resources

Additional Resources:
British Association of Dermatologists
Primary Care Dermatology Society
Derm Net NZ: The Dermatology Resource

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5.  Patient Presents with Rosacea

Clinical Features:

  • Flushing, often made worse by alcohol, spicy foods, hot drinks, temperature changes or emotion
  • Erythema with peri-ocular sparing
  • Inflammatory lesions
  • Erythematous papules
  • Pustules
  • No comedones (these are a sign of acne vulgaris)
  • Rhinophyma
  • Ocular rosacea: posteria blepharitis (Meibomian gland dysfunction)
  • Pyoderma faciale: painful large erythematous nodules, pustules and erosions. May scar.

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6.  Treatment

See Leeds Health Pathways treatment guidelines

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7.  Criteria for Referral

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.)

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