Rosacea
ICD-10 L71.9 · ICD-11 ED90.0

Papulopustular Rosacea: What to Do When Topical Therapy Has Not Adequately Controlled Facial Lesions and Erythema

This protocol is for patients with papulopustular rosacea (subtype II) — inflammatory papules and pustules in the central region of the face with facial erythema — where an initial course of topical therapy did not achieve the expected reduction in lesion count and erythema.

Clinical Presentation

Inflammatory papules and pustules in the central region of the face, accompanied by facial erythema. These features characterise subtype II rosacea.

Previous Treatment — Targets Not Met

A prior course of topical therapy was used with the goal of reducing inflammatory lesion count and erythema — with the most marked lesion-count reduction expected around six weeks. When these targets have not been reached, escalation is indicated.

Next-Line Approach — Partial Overview

For cases where topical therapy has proven insufficient, systemic oral antibiotic therapy — which may be combined with ongoing topical treatment — is the approach at this level of severity. The specific agents, any combination strategy, and the full treatment algorithm remain in the complete protocol.

Goal: reduction of erythema and inflammatory lesions
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References

DOI: 10.1111/jdv.14349

In subtype II, inflammatory papules and pustules are seen in the central region of the face.

Inflammatory lesions such as papules and pustules as well as erythema occur in subtype II.

For more severe cases, systemical treatment or combinations thereof are recommended.

A combination of local and systemic therapies is recommended.

Several multicentre, randomized, double-blind, active control study with (n = 40, n = 91, n = 134, n = 269, n = 268), one retrospective study (n = 826), and a community-based assessment (ORCA), open-label study (n = 1197) yielded very good results in terms of reduction of erythema and inflammatory lesions.

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