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Rosacea - Management
Basis for recommendation
CKS did not identify any authoritative, UK-based, guidelines on the management of rosacea. Recommendations on follow up and subsequent maintenance of rosacea are based on expert opinion described in narrative reviews [Berth-Jones, 2004; Powell, 2005; Diamantis and Waldorf, 2006].
- CKS recommends people should be followed up after 12 weeks, as this reflects a reasonable individual trial period to assess whether treatment has been effective.
- Most randomized controlled trials (RCTs) of interventions for rosacea have assessed response at 4–15 weeks, but mainly at the higher end of this range [van Zuuren et al, 2005].
- The effect of treatment for rosacea often has a gradual onset, and some experts believe there is little point in discontinuing treatment before 3 months [Berth-Jones, 2004]. However, prescribing longer courses of treatment without monitoring is not recommended, especially for systemic drugs, as they may cause adverse effects without significant benefit [Powell, 2005].
- Rosacea is a chronic, relapsing condition, which in general does not spontaneously resolve. However, RCTs studying the disorder have generally been performed over the short term, so recommendations on maintenance are based mainly on clinical experience and pragmatism [Powell, 2005].
- Most people will benefit from maintenance or intermittent treatment, as rosacea often relapses after a successful course of treatment. For example, two studies found that the rate of relapse after stopping a course of tetracycline was 25% after 1 month, 50–60% after 6 months, and 70% after 1–4 years [Baldwin, 2006].
- One longer-term RCT randomized people who had been successfully treated with oral tetracycline and topical metronidazole (n = 88) to receive maintenance treatment with metronidazole gel or placebo (gel vehicle). After 6 months, metronidazole gel significantly reduced the likelihood of relapse and the number of residual lesions compared with placebo [Dahl et al, 1998].
- Combining oral and topical treatment has not been studied in controlled trials, but is a reasonable practice for people with severe disease.
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