Treatment - Stage II

Topical

There are several therapeutical options for stage II rosacea.
The topical antibiotics/ antiinfectives mentioned for stage I may also be used in stage II:
Metronidazole 0,75% - 2% (available as gel, cream or according to individual prescription)
Erythromycin 0,5% - 2%
Clindamycin 0,5% - 2%
Tetracycline 0,5% - 2%

Topical retinoids (tretinoin 0,025%, isotretinoin 0,2%) and retinaldehyde have also
been reported to suppress inflammatory lesions and reduce erythema. However, rosacea
symptoms often exacerbate during the first days to weeks of treatment.

A newly approved anti-inflammatory topical product contains azelaic acid, which is also used in the treatment of acne. Its exact mode of action in rosacea is unknown. For the treatment of papulopustular rosacea, a gel containing azelaic acid 15% is being used. Several surveys have demonstrated the efficacy of azelaic acid in rosacea patients.


Systemic

In addition to the above mentioned topical measures, stage II-rosacea may require systemic treatment. If so, one of the following oral antibiotics may be added to the treatment regimen.

Tetracycline hydrochloride 1 1,5 g daily, maintenance dose 250 500 mg daily
Minocycline 100 mg daily, maintenance dose 50 mg daily
Doxycycline 100 mg daily, maintenance dose 50 mg daily
Clarithromycin 500 mg daily, maintenance dose 250 mg daily

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