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The Definitive Guide to Rosacea

Rosacea can be a frustrating, difficult to treat condition. There are four main components to rosacea that are not always recognised. Failure to recognise these components can compromise treatment results.

While rosacea is mostly a skin condition, eye involvement can affect vision.

Woman

What is Rosacea?

Rosacea is a chronic condition that mostly affects the skin in about 5-10% of the population. It most commonly starts after the age of 30 and is more frequent among women,1Gether L, Overgaard LK, Egeberg A, Thyssen JP. Incidence and prevalence of rosacea: a systematic review and meta-analysis. Br J Dermatol. 2018;179(2):282-289. doi:10.1111/bjd.16481. It mostly affects those with fair skin.

While rosacea is mostly a skin condition, eye involvement can have an impact on vision.

What causes rosacea (Pathogenesis)?

Unfortunately, the exact causes and development of rosacea are not fully understood.2Mc Aleer MA, Lacey N, Powell FC. The pathophysiology of rosacea. G Ital Dermatol Venereol. 2009;144(6):663-671.,3Dahl MV. Pathogenesis of rosacea. Adv Dermatol. 2001;17:29-45. However, there are known contributing factors and associations involved in the development of rosacea:

  • Immune dysfunction: abnormal functioning of the immune system, resulting in increased cathelicidin production. These are peptides that influence blood vessels, inflammation, mediate environmental influences, and increase mast cells in those with the condition.4Yamasaki K, Di Nardo A, Bardan A, et al. Increased serine protease activity and cathelicidin promotes skin inflammation in rosacea. Nat Med. 2007;13(8):975-980. doi:10.1038/nm1616,5Yamasaki K, Kanada K, Macleod DT, et al. TLR2 expression is increased in rosacea and stimulates enhanced serine protease production by keratinocytes. J Invest Dermatol. 2011;131(3):688-697. doi:10.1038/jid.2010.351,6Aroni K, Tsagroni E, Kavantzas N, Patsouris E, Ioannidis E. A study of the pathogenesis of rosacea: how angiogenesis and mast cells may participate in a complex multifactorial process. Arch Dermatol Res. 2008;300(3):125-131. doi:10.1007/s00403-007-0816-z,7Muto Y, Wang Z, Vanderberghe M, Two A, Gallo RL, Di Nardo A. Mast cells are key mediators of cathelicidin-initiated skin inflammation in rosacea. J Invest Dermatol. 2014;134(11):2728-2736. doi:10.1038/jid.2014.222
  • Skin flora: the Demodex folliculorum mite is found more frequently in the pilosebaceous units (hair follicle, hair shaft, and sebaceous gland) of sufferers.8Zhao YE, Wu LP, Peng Y, Cheng H. Retrospective analysis of the association between Demodex infestation and rosacea [published correction appears in Arch Dermatol. 2010 Dec;146(12):1412]. Arch Dermatol. 2010;146(8):896-902. doi:10.1001/archdermatol.2010.196,9Bonnar E, Eustace P, Powell FC. The Demodex mite population in rosacea. J Am Acad Dermatol. 1993;28(3):443-448. doi:10.1016/0190-9622(93)70065-2,10Forton F, Seys B. Density of Demodex folliculorum in rosacea: a case-control study using standardized skin-surface biopsy. Br J Dermatol. 1993;128(6):650-659. doi:10.1111/j.1365-2133.1993.tb00261.x,11Erbağci Z, Ozgöztaşi O. The significance of Demodex folliculorum density in rosacea. Int J Dermatol. 1998;37(6):421-425. doi:10.1046/j.1365-4362.1998.00218.x While there have been reports of a link between rosacea and Helicobacter pylori (which commonly resides in the stomach), no conclusive evidence of a link has been found.12Jørgensen AR, Egeberg A, Gideonsson R, Weinstock LB, Thyssen EP, Thyssen JP. Rosacea is associated with Helicobacter pylori: a systematic review and meta-analysis. J Eur Acad Dermatol Venereol. 2017;31(12):2010-2015. doi:10.1111/jdv.14352 Others have suggested a link with small intestinal bacterial overgrowth (SIBO). However, the evidence is not conclusive.13Egeberg A, Weinstock LB, Thyssen EP, Gislason GH, Thyssen JP. Rosacea and gastrointestinal disorders: a population-based cohort study. Br J Dermatol. 2017;176(1):100-106. doi:10.1111/bjd.14930
  • Vascular dysfunction: abnormal regulation of the blood vessels of the face and the nerve fibres that control them is a common feature, however, the mechanism is not well understood.14Aubdool AA, Brain SD. Neurovascular aspects of skin neurogenic inflammation. J Investig Dermatol Symp Proc. 2011;15(1):33-39. doi:10.1038/jidsymp.2011.8Mascarenhas NL, Wang Z, Chang YL, Di Nardo A. TRPV4 Mediates Mast Cell Activation in Cathelicidin-Induced Rosacea Inflammation. J Invest Dermatol. 2017;137(4):972-975. doi:10.1016/j.jid.2016.10.046
  • Ultraviolet light exposure is thought to contribute to rosacea development, but again, this is poorly understood.15Brauchle M, Funk JO, Kind P, Werner S. Ultraviolet B and H2O2 are potent inducers of vascular endothelial growth factor expression in cultured keratinocytes. J Biol Chem. 1996;271(36):21793-21797. doi:10.1074/jbc.271.36.21793,16Bielenberg DR, Bucana CD, Sanchez R, Donawho CK, Kripke ML, Fidler IJ. Molecular regulation of UVB-induced cutaneous angiogenesis. J Invest Dermatol. 1998;111(5):864-872. doi:10.1046/j.1523-1747.1998.00378.x,17Kulkarni NN, Takahashi T, Sanford JA, et al. Innate Immune Dysfunction in Rosacea Promotes Photosensitivity and Vascular Adhesion Molecule Expression. J Invest Dermatol. 2020;140(3):645-655.e6. doi:10.1016/j.jid.2019.08.436
  • Those with a family history of rosacea are more likely to develop the condition.18Abram K, Silm H, Maaroos HI, Oona M. Risk factors associated with rosacea. J Eur Acad Dermatol Venereol. 2010;24(5):565-571. doi:10.1111/j.1468-3083.2009.03472.x In particular, rosacea has been associated with a range of HLA genes. These genes are also associated with several autoimmune conditions.
Demodex mite is a cause of rosacea.

What are the symptoms?

In 2017, the diagnostic criteria for rosacea were reclassified, which outlined the symptoms of the condition more clearly with distinct terminology. 19Gallo RL, Granstein RD, Kang S, et al. Standard classification and pathophysiology of rosacea: The 2017 update by the National Rosacea Society Expert Committee. J Am Acad Dermatol. 2018;78(1):148-155. doi:10.1016/j.jaad.2017.08.037,20Tan J, Almeida LM, Bewley A, et al. Updating the diagnosis, classification and assessment of rosacea: recommendations from the global ROSacea COnsensus (ROSCO) panel. Br J Dermatol. 2017;176(2):431-438. doi:10.1111/bjd.15122

Sypmptoms of rosacea - erythema/redness, papules & pustules, telangiectasia.
  • Persistent centrofacial erythema: chronic redness (erythema) of the central face. Erythema can also involve the ears, neck, scalp, and chest.
  • Phymatous changes: coarse, bumpy, irregularly thickened skin of the nose, chin, forehead, or cheeks.
  • Flushing or transient centrofacial erythema: intermittent, sometimes dramatic flushing of the skin, often associated with a warm sensation.
  • Inflammatory papules and pustules: most commonly of the central face. Can sometimes be confused for acne.
  • Telangiectasia: dilated, visible blood vessels, colloquially known as broken capillaries.
  • Ocular manifestations: redness, irritation, light sensitivity, blurred vision, and swelling of the eyelids.
  • Burning or stinging: sensation of the skin.
  • Skin sensitivity: sufferers also often have difficulty tolerating skin care products and cosmetics.21Wilkin JK. Use of topical products for maintaining remission in rosacea. Arch Dermatol. 1999;135(1):79-80. doi:10.1001/archderm.135.1.79
  • Oedema: swelling of the skin.
  • Dryness: dry sensation of the skin.

Associated conditions

There have been reports of an association between rosacea and a range of other conditions. Most of these have been discounted after further review or studies. However, the following conditions do seem to have an association:

  • Inflammatory bowel disease. Ulcerative colitis sufferers seem to have an approximate 1.65 times likelihood of developing rosacea. For Crohns’ disease the risk was 1.49 times normal.22Spoendlin J, Karatas G, Furlano RI, Jick SS, Meier CR. Rosacea in Patients with Ulcerative Colitis and Crohn’s Disease: A Population-based Case-control Study. Inflamm Bowel Dis. 2016;22(3):680-687. doi:10.1097/MIB.0000000000000644
  • Basal cell carcinoma is a common skin cancer that is 1.5 times more common in rosacea sufferers compared to normal.23Li WQ, Zhang M, Danby FW, Han J, Qureshi AA. Personal history of rosacea and risk of incident cancer among women in the US. Br J Cancer. 2015;113(3):520-523. doi:10.1038/bjc.2015.217
  • Thyroid cancer has a reported 1.59 increased risk.24Li WQ, Zhang M, Danby FW, Han J, Qureshi AA. Personal history of rosacea and risk of incident cancer among women in the US. Br J Cancer. 2015;113(3):520-523. doi:10.1038/bjc.2015.217
  • Glioma has a risk ratio of 1.82.25Egeberg A, Hansen PR, Gislason GH, Thyssen JP. Association of Rosacea With Risk for Glioma in a Danish Nationwide Cohort Study. JAMA Dermatol. 2016;152(5):541-545. doi:10.1001/jamadermatol.2015.5549
  • Autoimmune conditions such as type 1 diabetes, coeliac disease, and multiple sclerosis occur more commonly in women with rosacea. Rheumatoid arthritis occurs more commonly in both men and women with the condition. The risk ratio ranges from about 1.5-2.5 for these conditions.26Egeberg A, Hansen PR, Gislason GH, Thyssen JP. Clustering of autoimmune diseases in patients with rosacea. J Am Acad Dermatol. 2016;74(4):667-72.e1. doi:10.1016/j.jaad.2015.11.004
  • Depression has a strong association, with a relative risk of 4.81 compared to normal.27Gupta MA, Gupta AK, Chen SJ, Johnson AM. Comorbidity of rosacea and depression: an analysis of the National Ambulatory Medical Care Survey and National Hospital Ambulatory Care Survey–Outpatient Department data collected by the U.S. National Center for Health Statistics from 1995 to 2002. Br J Dermatol. 2005;153(6):1176-1181. doi:10.1111/j.1365-2133.2005.06895.x
  • Migraines occur more commonly in female rosacea sufferers. The risk increases with an increasing range of 1.22 to 1.66 times normal.28Spoendlin J, Voegel JJ, Jick SS, Meier CR. Migraine, triptans, and the risk of developing rosacea: a population-based study within the United Kingdom. J Am Acad Dermatol. 2013;69(3):399-406. doi:10.1016/j.jaad.2013.03.027

In spite of these reports, experts do not recommend increasing screening at this time.

Associated conditions for rosacea.

Rosacea triggers

Rosacea triggers.

Historically, there have been many anecdotal reports of certain triggers causing a flare up, however, not all of these have been confirmed in quality studies:29Crawford GH, Pelle MT, James WD. Rosacea: I. Etiology, pathogenesis, and subtype classification. J Am Acad Dermatol. 2004;51(3):327-344. doi:10.1016/j.jaad.2004.03.030

  • Sunlight exposure, particularly high chronic exposure for some aspects
  • Hot or spicy foods and drinks
  • Alcohol
  • Physical exertion
  • Emotional triggers such as embarrassment or anger
  • Temperature changes

Coffee consumption appears to have a mild protective effect.30Li S, Chen ML, Drucker AM, et al. Association of Caffeine Intake and Caffeinated Coffee Consumption With Risk of Incident Rosacea in Women. JAMA Dermatol. 2018;154(12):1394-1400. doi:10.1001/jamadermatol.2018.3301


Rosacea treatment

Unfortunately, rosacea is a chronic condition for which there is no permanent cure. There are a range of effective treatments that can help with management. The key point to remember is that these treatments require ongoing usage to keep the condition under control.

Furthermore, different components of rosacea require different treatments. As such, we will largely organise the treatments by symptom groups.

General strategies

Firstly, try to avoid triggers (such as spicy foods, alcohol, etc). The potential triggers are listed above.

Rigorous sun protection is routinely recommended. While evidence is not overly strong, there is an association with UV exposure.

Camoflauge, such as make-up can be used to mask the symptoms.

Sun protection for rosacea.

Skin care

Regularly moisturising the face twice a day has been shown to help with skin sensitivity.31Laquieze S, Czernielewski J, Baltas E. Beneficial use of Cetaphil moisturizing cream as part of a daily skin care regimen for individuals with rosacea. J Dermatolog Treat. 2007;18(3):158-162. doi:10.1080/09546630601121078 Cleansing the face at least once daily is recommended. Soap-free cleansers are less likely to disrupt skin barrier function and are better tolerated.32Wilkin JK. Use of topical products for maintaining remission in rosacea. Arch Dermatol. 1999;135(1):79-80. doi:10.1001/archderm.135.1.79,33Draelos ZD. Facial hygiene and comprehensive management of rosacea. Cutis. 2004;73(3):183-187. Skin care products that have the potential to cause irritation should also be avoided. These include toners and exfoliating acids as well as alcohol based gels and lotions.34Draelos ZD. Cosmetics in acne and rosacea. Semin Cutan Med Surg. 2001;20(3):209-214. doi:10.1053/sder.2001.27556

Vascular rosacea

Vascular rosacea components include erythema (redness), flushing, and telangiectasia. The most effective topical treatment is brimonidine (Mirvaso®). Unfortunately, the effect of brimonidine only lasts around 8 to 12 hours, results in rebound, and can increase erythema in surrounding areas.35Routt ET, Levitt JO. Rebound erythema and burning sensation from a new topical brimonidine tartrate gel 0.33%. J Am Acad Dermatol. 2014;70(2):e37-e38. doi:10.1016/j.jaad.2013.10.054,36Ilkovitch D, Pomerantz RG. Brimonidine effective but may lead to significant rebound erythema. J Am Acad Dermatol. 2014;70(5):e109-e110. doi:10.1016/j.jaad.2014.01.853,37Gillihan R, Nguyen T, Fischer R, Rajpara A, Aires D. Erythema in Skin Adjacent to Area of Long-term Brimonidine Treatment for Rosacea: A Novel Adverse Reaction. JAMA Dermatol. 2015;151(10):1136-1137. doi:10.1001/jamadermatol.2015.1252,38Docherty JR, Steinhoff M, Lorton D, et al. Multidisciplinary Consideration of Potential Pathophysiologic Mechanisms of Paradoxical Erythema with Topical Brimonidine Therapy. Adv Ther. 2016;33(11):1885-1895. doi:10.1007/s12325-016-0404-8

Clonidine is one of the most commonly used tablets to control flushing. However, the evidence of benefit is not strong.39Wilkin JK. Effect of subdepressor clonidine on flushing reactions in rosacea. Change in malar thermal circulation index during provoked flushing reactions. Arch Dermatol. 1983;119(3):211-214. doi:10.1001/archderm.1983.01650270029012

Lasers and intense pulsed light (IPL) are the most effective treatments and are well established, having been used extensively for decades. The energy emitted by these treatments is absorbed by the haemoglobin in blood vessels resulting in coagulation and destruction of the abnormal, superficial vessels. They are mostly used used to treat erythema and telangiectasia, however, have also been reported to help with flushing, sensitivity, and skin texture.40Neuhaus IM, Zane LT, Tope WD. Comparative efficacy of nonpurpuragenic pulsed dye laser and intense pulsed light for erythematotelangiectatic rosacea. Dermatol Surg. 2009;35(6):920-928. doi:10.1111/j.1524-4725.2009.01156.x,41Taub AF, Devita EC. Successful treatment of erythematotelangiectatic rosacea with pulsed light and radiofrequency. J Clin Aesthet Dermatol. 2008;1(1):37-40. PMID: 21103309,42Kassir R, Kolluru A, Kassir M. Intense pulsed light for the treatment of rosacea and telangiectasias. J Cosmet Laser Ther. 2011;13(5):216-222. doi:10.3109/14764172.2011.613480,43Bernstein EF, Kligman A. Rosacea treatment using the new-generation, high-energy, 595 nm, long pulse-duration pulsed-dye laser. Lasers Surg Med. 2008;40(4):233-239. doi:10.1002/lsm.20621

Papules and pustules

In contrast to the small number of treatments available for the vascular components of the condition. There are several treatments that are effective for papules and pustules.

Laser treatment for rosacea.

Topical rosacea treatments

For mild presentations, topical treatments are suitable. These include:

  • Metronidazole (Rozex®) is an antibiotic, however, its mechanism of action is not fully understand. It probably works through its anti-inflammatory properties. It normally takes about eight weeks to notice an effect, although improvement can occur within two weeks.44Bleicher PA, Charles JH, Sober AJ. Topical metronidazole therapy for rosacea. Arch Dermatol. 1987;123(5):609-614. doi:10.1001/archderm.1987.01660290077020,45Wolf JE Jr, Del Rosso JQ. The CLEAR trial: results of a large community-based study of metronidazole gel in rosacea. Cutis. 2007;79(1):73-80. Studies have shown approximately 40% to 60% improvement. 46Dahl MV, Jarratt M, Kaplan D, Tuley MR, Baker MD. Once-daily topical metronidazole cream formulations in the treatment of the papules and pustules of rosacea. J Am Acad Dermatol. 2001;45(5):723-730. doi:10.1067/mjd.2001.116219 Metronidazole can also improve erythema.
  • Azelaic acid has antibacterial, anti-inflammatory, and antioxidant properties. Overall it can result in 50% to 70% improvement of the acne-like components, with some direct comparison studies showing better efficacy than metronidazole. Maximal improvement with azelaic acid occurs after 12 to 15 weeks but can start working within 2 to 3 weeks. Azelaic acid can cause irritation for some people.47Bjerke R, Fyrand O, Graupe K. Double-blind comparison of azelaic acid 20% cream and its vehicle in treatment of papulo-pustular rosacea. Acta Derm Venereol. 1999;79(6):456-459. doi:10.1080/000155599750009906,48Elewski BE, Fleischer AB Jr, Pariser DM. A comparison of 15% azelaic acid gel and 0.75% metronidazole gel in the topical treatment of papulopustular rosacea: results of a randomized trial. Arch Dermatol. 2003;139(11):1444-1450. doi:10.1001/archderm.139.11.1444,49Mostafa FF, El Harras MA, Gomaa SM, Al Mokadem S, Nassar AA, Abdel Gawad EH. Comparative study of some treatment modalities of rosacea. J Eur Acad Dermatol Venereol. 2009;23(1):22-28. doi:10.1111/j.1468-3083.2008.02940.x Azelaic acid is also thought to improve erythema.
  • Antiparasitic creams can be used to target the Demodex mite as discussed above. Some studies have shown almost complete clearance of papules and pustules after 12 weeks. It is thought to be more effective than metronidzole.50van Zuuren EJ, Fedorowicz Z, Tan J, et al. Interventions for rosacea based on the phenotype approach: an updated systematic review including GRADE assessments. Br J Dermatol. 2019;181(1):65-79. doi:10.1111/bjd.17590,51Stein L, Kircik L, Fowler J, et al. Efficacy and safety of ivermectin 1% cream in treatment of papulopustular rosacea: results of two randomized, double-blind, vehicle-controlled pivotal studies. J Drugs Dermatol. 2014;13(3):316-323.,52Taieb A, Ortonne JP, Ruzicka T, et al. Superiority of ivermectin 1% cream over metronidazole 0·75% cream in treating inflammatory lesions of rosacea: a randomized, investigator-blinded trial. Br J Dermatol. 2015;172(4):1103-1110. doi:10.1111/bjd.13408 Ivermectin also helps with erythema.
Topical treatments for rosacea.

Oral rosacea treatments

For those with more extensive presentations, or when the condition fails to improve adequately with topical treatments, oral treatments are recommended.

  • Tetracycline antibiotics have been used for decades and their efficacy is well established. While these are antibiotics, it is thought that their mechanism of improvement is through their anti-inflammatory properties.53Korting HC, Schöllmann C. Tetracycline actions relevant to rosacea treatment. Skin Pharmacol Physiol. 2009;22(6):287-294. doi:10.1159/000235550Yamasaki K, Di Nardo A, Bardan A, et al. Increased serine protease activity and cathelicidin promotes skin inflammation in rosacea. Nat Med. 2007;13(8):975-980. doi:10.1038/nm1616 Studies have shown that on average, doxycycline treatment clears 90% of papules and pustules.54Torresani C, Pavesi A, Manara GC. Clarithromycin versus doxycycline in the treatment of rosacea. Int J Dermatol. 1997;36(12):942-946. doi:10.1046/j.1365-4362.1997.00301.x,55Akhyani M, Ehsani AH, Ghiasi M, Jafari AK. Comparison of efficacy of azithromycin vs. doxycycline in the treatment of rosacea: a randomized open clinical trial. Int J Dermatol. 2008;47(3):284-288. doi:10.1111/j.1365-4632.2008.03445.x Normally a three-month course of doxycycline is used which can induce long-term remissions. Repeat courses are used when the condition flares. However, Tetracycline use for rosacea has been associated with a 1.56 risk of Crohns’ disease and 1.34 for ulcerative colitis and this seems to correlate with the duration of tetracycline use.56Li WQ, Cho E, Khalili H, Wu S, Chan AT, Qureshi AA. Rosacea, Use of Tetracycline, and Risk of Incident Inflammatory Bowel Disease in Women. Clin Gastroenterol Hepatol. 2016;14(2):220-5.e53. doi:10.1016/j.cgh.2015.09.013
  • Retinoid medications are very effective for the treatment of papules and pustules including at very low doses.57Gollnick H, Blume-Peytavi U, Szabó EL, et al. Systemic isotretinoin in the treatment of rosacea – doxycycline- and placebo-controlled, randomized clinical study. J Dtsch Dermatol Ges. 2010;8(7):505-515. doi:10.1111/j.1610-0387.2010.07345.x It is starting to become a favoured option due to the possibility of antibiotic resistance with tetracycline antibiotics.

Other rosacea treatments

  • While lasers are very effective for the vascular component of rosacea, they are less effective for papules and pustules. Studies have reported mixed results.

Phymatous skin changes

  • Retinoids have also been shown to be effective in the management of mild phymatous changes and to minimise the risk of recurrence.58Gollnick H, Blume-Peytavi U, Szabó EL, et al. Systemic isotretinoin in the treatment of rosacea – doxycycline- and placebo-controlled, randomized clinical study. J Dtsch Dermatol Ges. 2010;8(7):505-515. doi:10.1111/j.1610-0387.2010.07345.x,59Plewig G, Nikolowski J, Wolff HH. Action of isotretinoin in acne rosacea and gram-negative folliculitis. J Am Acad Dermatol. 1982;6(4 Pt 2 Suppl):766-785. doi:10.1016/s0190-9622(82)70067-2
  • Surgery and laser ablation are typically used for advanced, disfiguring changes.
Tablet medication for rosacea.

Disclaimers

Mirvaso® Statement

Mirvaso is prescription medicine for the treatment of facial erythema in rosacea. Mirvaso has risks and benefits. Ask your doctor if Mirvaso is right for you. If you have side effects, see your doctor.

For details on precautions and side effects consult your doctor or go to medsafe.govt.nz.

Clinic fees will apply and you will need to have your Mirvaso prescription dispensed at a pharmacy which you will need to pay for.

Mirvaso can be prescribed for up to three months per prescription. Follow-up appointments and repeat prescriptions may be necessary to complete a course of treatment. Mirvaso should only be prescribed by a registered medical practitioner.

Galderma Australia Pty Ltd, distributed in New Zealand by Healthcare Logistics, Auckland, NZ.

Azelaic acid Statement

Azelaic acid is prescription medicine for the treatment of acne vulgaris. Azelaic acid has risks and benefits. Ask your doctor if azelaic acid is right for you. If you have side effects, see your doctor.

For details on precautions and side effects consult your doctor or go to medsafe.govt.nz.

Clinic fees will apply and you will need to have your azelaic acid prescription dispensed at a pharmacy which you will need to pay for.

Azelaic acid can be prescribed for up to three months per prescription. Follow-up appointments and repeat prescriptions may be necessary to complete a course of treatment. Azelaic acid should only be prescribed by a registered medical practitioner.

Seqirus (NZ) Ltd, Auckland, NZ.

Clonidine Statement

Clonidine is prescription medicine for the treatment of menopausal flushing. Clonidine has risks and benefits. Ask your doctor if clonidine is right for you. If you have side effects, see your doctor.

For details on precautions and side effects consult your doctor or go to medsafe.govt.nz.

Clinic fees will apply and you will need to have your clonidine prescription dispensed at a pharmacy which you will need to pay for.

Clonidine can be prescribed for up to three months per prescription. Follow-up appointments and repeat prescriptions may be necessary to complete a course of treatment. Clonidine should only be prescribed by a registered medical practitioner.

Teva Pharma (New Zealand) Limited.

Rozex® Statement

Rozex is prescription medicine for the treatment of inflammatory papules, pustules and erythema of rosacea. Rozex has risks and benefits. Ask your doctor if Rozex is right for you. If you have side effects, see your doctor.

For details on precautions and side effects consult your doctor or go to medsafe.govt.nz.

Clinic fees will apply and you will need to have your Rozex prescription dispensed at a pharmacy which you will need to pay for.

Rozex can be prescribed for up to three months per prescription. Follow-up appointments and repeat prescriptions may be necessary to complete a course of treatment. Rozex should only be prescribed by a registered medical practitioner.

Galderma Australia Pty Ltd, distributed in New Zealand by Healthcare Logistics, Auckland, NZ.

References

  • 1
    Gether L, Overgaard LK, Egeberg A, Thyssen JP. Incidence and prevalence of rosacea: a systematic review and meta-analysis. Br J Dermatol. 2018;179(2):282-289. doi:10.1111/bjd.16481
  • 2
    Mc Aleer MA, Lacey N, Powell FC. The pathophysiology of rosacea. G Ital Dermatol Venereol. 2009;144(6):663-671.
  • 3
    Dahl MV. Pathogenesis of rosacea. Adv Dermatol. 2001;17:29-45.
  • 4
    Yamasaki K, Di Nardo A, Bardan A, et al. Increased serine protease activity and cathelicidin promotes skin inflammation in rosacea. Nat Med. 2007;13(8):975-980. doi:10.1038/nm1616
  • 5
    Yamasaki K, Kanada K, Macleod DT, et al. TLR2 expression is increased in rosacea and stimulates enhanced serine protease production by keratinocytes. J Invest Dermatol. 2011;131(3):688-697. doi:10.1038/jid.2010.351
  • 6
    Aroni K, Tsagroni E, Kavantzas N, Patsouris E, Ioannidis E. A study of the pathogenesis of rosacea: how angiogenesis and mast cells may participate in a complex multifactorial process. Arch Dermatol Res. 2008;300(3):125-131. doi:10.1007/s00403-007-0816-z
  • 7
    Muto Y, Wang Z, Vanderberghe M, Two A, Gallo RL, Di Nardo A. Mast cells are key mediators of cathelicidin-initiated skin inflammation in rosacea. J Invest Dermatol. 2014;134(11):2728-2736. doi:10.1038/jid.2014.222
  • 8
    Zhao YE, Wu LP, Peng Y, Cheng H. Retrospective analysis of the association between Demodex infestation and rosacea [published correction appears in Arch Dermatol. 2010 Dec;146(12):1412]. Arch Dermatol. 2010;146(8):896-902. doi:10.1001/archdermatol.2010.196
  • 9
    Bonnar E, Eustace P, Powell FC. The Demodex mite population in rosacea. J Am Acad Dermatol. 1993;28(3):443-448. doi:10.1016/0190-9622(93)70065-2
  • 10
    Forton F, Seys B. Density of Demodex folliculorum in rosacea: a case-control study using standardized skin-surface biopsy. Br J Dermatol. 1993;128(6):650-659. doi:10.1111/j.1365-2133.1993.tb00261.x
  • 11
    Erbağci Z, Ozgöztaşi O. The significance of Demodex folliculorum density in rosacea. Int J Dermatol. 1998;37(6):421-425. doi:10.1046/j.1365-4362.1998.00218.x
  • 12
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