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