This protocol applies to patients who present with centrofacially located erythematous macules caused by dilated capillaries — most prominently on the nose and cheeks — accompanied by episodes of transient or persistent facial erythema (flushing) and visible facial telangiectasias. Inflammatory papules and pustules are absent in this presentation.
Management is centred on topical pharmacotherapy targeting facial erythema. A registered topical vasoconstrictive agent is available for this presentation and can show initial responses within 30 minutes of application. An oral agent may additionally be considered off-label for the flushing component. The full selection criteria, complete range of agents, and their sequencing are detailed in the structured protocol.
Reduction of facial erythema.
DOI: 10.1111/jdv.14349
Patients with subtype I have centrofacially located erythematous macules due to dilated capillaries in the face, especially on the nose and cheeks.
Episodes of transient erythema (flushing) or non-transient (persistent) erythema can occur.
Erythema of the face, flushing and telangiectasias are the main symptoms of ETR.
Brimonidine 0.33–1% gel 3 mg/g, a vasoconstrictive alpha-2 adrenergic receptor agonist, once daily, is registered for subtype I rosacea.
Conclusion: Brimonidine is recommended for moderate-to-severe subtype I rosacea (level of evidence: A).
First responses can be seen within 30 min.
As an off-label therapy, carvedilol, for example at a dosage of 6.25 mg twice a day, can be considered (D).
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