Treatment - Rosacea conglobata and rosacea fulminans
In general, topical steroids should not be used in rosacea. The only exception is rosacea fulminans.
High-potency corticosteroids such as clobetasol-17-propionate may be useful by reducing the inflammation when applied in addition to the systemic treatment.
A combination regimen including isotretinoin (0,5 - 1 mg/kg body weight daily)and oral corticosteroids such as prednisone (0,5 – 1 mg/kg body weight daily) is recommended. In women, oral contraceptives with antiandrogen properties may be added.
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.
In rosacea conglobata, draining sinuses can be treated by intralesional injection of corticosteroids (such as triamcinolone acetonide), although sometimes, complete excision of the lesion is mandatory.