This handout is for rosacea (dermatology lens). Your care team identified this based on: persistent centrofacial (cheeks/nose/chin/forehead) erythema with periodic intensification — a rosco-diagnostic phenotype for rosacea (tan et al, global rosco 2017; pmid 27718519).
Other reasons your team may use this plan: phymatous skin change (patulous follicles, skin thickening, fibrosis — most often rhinophyma) — independently rosco-diagnostic for rosacea (global rosco 2017; pmid 27718519); recurrent facial flushing, inflammatory papules/pustules without comedones, and/or telangiectasia — major rosacea features triggering phenotype-led workup (global rosco 2019; pmid 31392722); lid-margin telangiectasia, blepharitis, foreign-body sensation, dryness, recurrent chalazia ± keratitis — ocular rosacea entry (global rosco 2019; pmid 31392722).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| broad_spectrum_photoprotection | — | — | — | Global ROSCO 2019 (PMID 31392722) — daily broad-spectrum SPF≥30 (UV is a dominant flare trigger and aggravates erythema/telangiectasia); foundational for every phenotype. |
| trigger_avoidance_and_gentle_non_soap_skincare | — | — | — | Global ROSCO 2019 (PMID 31392722) — identify/avoid personal triggers (heat, sun, alcohol, spicy food, hot drinks, emotional stress, exercise), use gentle non-soap cleanser + bland emollient, avoid irritants/astringents. |
| stop_facial_topical_corticosteroid | — | — | — | Chronic facial topical corticosteroid causes and perpetuates steroid-induced rosacea/perioral dermatitis — STOP the steroid, anticipate and counsel a withdrawal flare, bridge with non-steroid topical (ivermectin/azelaic) ± oral doxycycline; topical steroid is NOT a rosacea treatment. |
Plan: Rosacea — feature-targeted phenotype ladder (global ROSCO 2017/2019; van Zuuren GRADE/Cochrane)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Chronic-disease maintenance: lifelong photoprotection + trigger-diary + gentle non-soap skincare habit, maintenance topical (ivermectin/azelaic/metronidazole) to sustain remission (relapse is common after stopping — ~⅔ within 36 wk for topical agents), brimonidine rebound-erythema counselling, periodic ocular review, psychosocial/QoL surveillance, and a clear step-up/step-down plan toward the complete-clearance target. Dermatology continuity for any systemic agent; reassess the diagnosis if the course remains atypical or steroid-driven.
Guideline: Global ROSacea COnsensus (ROSCO) phenotype consensus — Tan et al, Br J Dermatol 2017;176(2):431-438 (PMID 27718519, DOI 10.1111/bjd.15122: persistent centrofacial erythema OR phymatous change independently diagnostic; transition to phenotype-led diagnosis/classification) updated by Schaller et al global ROSCO 2019, Br J Dermatol 2020;182(5):1269-1276 (PMID 31392722, DOI 10.1111/bjd.18420: phenotype management algorithm, complete-clearance target, combination therapy, burden dialogue). Evidence base: van Zuuren phenotype systematic review + GRADE, Br J Dermatol 2019;181(1):65-79 (PMID 30585305, DOI 10.1111/bjd.17590) + Cochrane "Interventions for rosacea" (PMID 25919144, DOI 10.1002/14651858.CD003262.pub5). Supporting pivotal trials: ivermectin phase 3 (Stein JDD 2014 PMID 24595578), ivermectin vs metronidazole ATTRACT subanalysis (Schaller Dermatol Ther 2016 PMID 27432169) + ivermectin systematic review/NNT (Ebbelaar Dermatol Ther 2018 PMID 29943217), brimonidine RCT (Layton JEADV 2015 PMID 26416154), oxymetazoline pooled phase 3 REVEAL (Stein-Gold JDD 2018 PMID 30500142) + 52-wk REVEAL (Draelos JAAD 2018 PMID 29409914), minocycline 1.5% foam phase 3/OLE (Stein Gold JCAD 2020 PMID 33282103), rosacea-in-pregnancy/fulminans review (Gomolin Dermatol Online J 2021 PMID 34391325)