Andrei Metelitsa, MD, FRCPC, FAAD

Co-Director, Institute for Skin Advancement

Clinical Associate Professor, Dermatology

University of Calgary, Canada

Copyright © 2017 by Sea Courses Inc.

All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted in any

form or by any means – graphic, electronic, or mechanical, including photocopying, recording, or information storage and retrieval systems without prior written permission of Sea Courses Inc. except

where permitted by law.

Sea Courses is not responsible for any speaker or participant’s statements, materials, acts or

omissions.

Learning Objectives

Recognize subtypes of rosacea

Understand basic pathogenesis of

rosacea

Discuss new treatment modalities

▪ Medical therapy

▪ Topical and systemic agents

▪ Laser therapy

▪ Vascular lasers

Rosacea Epidemiology

Common inflammatory condition that affects 2-10% people

Characterized by facial redness, telangiectasias, flushing and inflammatory papules and pustules

Age of onset usually 30-50 years old

2-3 times more prevalent in females

More common in fair skinned people

Rosacea Subtypes

Vascular erythematotelangiectatic rosacea (ETR)

Inflammatory papulopustular rosacea (PPR)

Phymatous rosacea

Ocular rosacea

Management strategies

Patient education and reassurance▪ Avoidance of triggers▪ Gentle skin care ▪ Broad spectrum sun protection

Topical agents▪ Mild to moderate disease▪ Considered safe for long-term use

Oral (systemic) agents▪ Anti-inflammatory dose doxycycline approved for initial and

ongoing therapy▪ Antibiotics and isotretinoin used with caution due to potential

risks Laser and phototherapy Surgical intervention

Baldwin HE. J Drugs Dermatol. 2006;5(1):16-21. Bikowski JB, Goldman MP. J Drugs Dermatol. 2004;3(3):251-261. 6

Selected topical therapies for rosacea

Therapeutic options include:*▪ Azelaic acid 15% (Finacea gel)

▪ Metronidazole 1% and 0.75% (gel, lotion and cream)

▪ Ivermectin 1% cream (Rosiver cream in Canada/ Soolantra in US)

▪ Sodium sulfacetamide/sulfur (lotion and cream; formulations with sun protection)

▪ Brimonidine gel 0.33% (Onreltea in Canada /Mirvaso in US)

Can be used for both induction and maintenance therapy Potential side effects/complications include:

▪ Cutaneous irritation

▪ Antibiotic resistance

7

Selected systemic therapies for rosacea

Baldwin HE. J Drugs Dermatol 2012;11(6):725-730. Goldgar C et al. Am Fam Physician 2009;80(5):461-468, 505.

Comments

Health Canada approved; once daily; potential to reduce

antibiotic resistance; may lessen common SEs of class

Once or twice daily

Alternative for pregnant or breast-feeding woman; many drug

interactions

Once or twice daily; skin pigmentation; CNS effects

Twice daily

Anti-inflammatory

dose doxycycline 40

mg

Doxycycline 100 mg

Erythromycin 500 mg

Minocycline 50/100

mg

Tetracycline 250/500

mg

Papulopustular Rosacea: Canadian Clinical Guidelines 2016

Maintenance: Topical ivermectin or metronidazole or azelaic acid

ETR Rosacea: Canadian Clinical Guidelines 2016

Maintenance: Topical brimonidine or metronidazole and/or Laser/IPL

Phymatous Rosacea: Canadian Clinical Guidelines 2016

Rosacea PEARLs

▪ Chronic inflammatory skin condition of the central face often characterized by flushing, erythema, papules/pustules and telangiectasias

▪ Inflammatory process – neutrophils, lymphocytes and cathelicidins play a key role in the underlying inflammatory nature of rosacea

▪ Anti-inflammatory dose doxycycline effective and safe treatment

▪ New topicals for inflammatory lesions (ivermectin) and diffuse erythema (brimonidine)