Red facial rash with "granitos"

Journal of Family Practice, Sept, 2005 by Tricia Punsalan, Richard P. Usatine

Maintenance therapy

Because relapse occurs within weeks in about 25% of patients after the cessation of systemic therapy, topical therapy is usually used in an effort to maintain remission. (6) The required duration of maintenance therapy is unknown, but a period of 6 months is generally advised. After this time, some patients report that they can keep their skin free of papulopustular lesions with topical therapy applied on alternate days or twice weekly, whereas others require repeated courses of systemic medication. After a few years, the disease may disappear spontaneously.

Patient management

Our patient was counseled about her rosacea and given the web site address for the National Rosacea Organization. She was advised to avoid sun exposure as much as possible and to use sunscreen and a hat to protect her face. She was prescribed tetracycline 500 mg and topical metronidazole to be used twice daily. Follow-up was set for 1 month. At that time, patient will be offered the option of electrocoagulation of her most prominent telangiectasias.

REFERENCES

(1.) Wolf K, Johnson RA, Suurmond D. Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology. 5th ed. New York: McGraw-Hill; 2005.

(2.) Randleman J, Loft E. Ocular rosacea. eMedicine website. Available at: www.emedicine.com/oph/ topic115.htm. Accessed on August 2, 2005.

(3.) National Rosacea Organization Website. Available at rosacea.org/grading/gradingsystem.pdf. Accessed on August 2, 2005.

(4.) Wolf J, Parkerson, R. Preventing antibiotic resistance in the treatment of rosacea. Fam Pract Recertificafion 2005; 27:50-55.

(5.) Van Zuuren E, Graber M, Hollis S, Chaudhry M, Gupta A, Gover M. Interventions for rosacea. Cochrane Database Syst Rev 2005; (3):CD003262.

(6.) Powell F. Rosacea. N Engl J Med 2005; 352:793-803.

Tricia Punsalan, MS4 and Richard P. Usatine, MD University of Texas Health Sciences Center at San Antonio

FEATURE EDITOR

Richard P. Usatine, MD University of Texas Health Sciences Center at San Antonio

CORRESPONDING AUTHOR

Richard P. Usatine, MD, University of Texas Health Science Center at San Antonio, Department of Family and Community Medicine, MC 7794, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900. E-mail: usatine@uthscsa.edu

TABLE

Rosacea treatments
                             ODDS RATIO *
                             (MEDICATION
TREATMENT        DELIVERY    VS PLACEBO)

Azelaic acid     Topical         2.45
Metronidazole    Topical         5.96
Tetracycline       Oral          6.06

* Larger number indicates a more effective response
to treatment.