Erythematotelangiectatic Rosacea When Topical Pharmacotherapy for Facial Erythema Has Not Worked

This protocol applies to patients with erythematotelangiectatic rosacea (subtype I) — centrofacial erythematous macules due to dilated capillaries, facial telangiectasias, and episodes of transient or persistent flushing, without inflammatory papules or pustules — in whom a first course of topical pharmacotherapy did not achieve adequate reduction of facial erythema.

Clinical Scenario

Centrofacially located erythematous macules due to dilated capillaries — predominantly on the nose and cheeks — with facial telangiectasias. Episodes of transient (flushing) or persistent erythema are present. Inflammatory papules and pustules are absent.

Why This Protocol Is Reached

A prior course of topical pharmacotherapy — including agents such as brimonidine gel, topical metronidazole, or topical azelaic acid — did not achieve the target: sufficient reduction of facial erythema. This next-line protocol is considered when that first-line goal is not met.

Next-Line Approach (Partial Overview)

The approach moves to laser and light-based therapy directed at facial erythema and telangiectasias — such as intense pulsed light (IPL) and related modalities. The complete set of options, selection criteria, and session details are available in the full protocol.

Treatment Goal

Reduction of facial erythema and telangiectasias.

Instant Access to Structured Evidence-Based Regimens

References

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.

Neodymium-doped, yttrium–aluminium–garnet (Nd:YAG), pulsed dye laser (PDL) or intense pulsed light (IPL) are physical options for facial erythema and telangiectasias.

Usually, one to four sessions are needed to achieve good results.

Conclusion: IPL (level of evidence: A) Nd:YAG (B), and PDL (B) treatment are recommended for rosacea subtype I.

Laser therapy can reduce erythema and telangiectasias.

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