The topical medications mentioned for stage II rosacea may also be used in stage III.
In addition to topical treatment, systemic medication with isotretinoin is recommended for stage III rosacea. Oral isotretinoin is effective in rosacea in a dose of 0,1 – 0,5 mg/kg body weight. The risks and adverse effects of this drug should be taken into consideration and may limit its use. Note: For female patients of childbearing age, the use of effective birth control is mandatory because of this drug’s teratogenic potential. Regular monitoring of cholesterine and triglyceride levels as well as liver enzymes is required during treatment. Simultaneous treatment with isotretinoin and oral tetracyclines is not indicated, as this could cause an increase in cranial pressure. Isotretinoin may worsen ophthalmic rosacea. .
If it is not advisable to treat a patients with isotretinoin, the use of oral antibiotics such as Tetracycline hydrochloride 1 – 1,5 g daily Minocycline 100-200 mg daily
is recommended for several months.