When Rosacea Resists Standard Therapies

[Guide]

If you have been treating your rosacea and the treatments are not responding to the standard treatments offered by your dermatologist, this is an old article, written in 2008, which doesn't even mention the gold standard of treatment for rosacea, but you may find it helpful if you haven't heard of any of these treatments. All these treatments are mentioned in the category: 

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"As you’re already aware, standard FDA-approved therapies for rosacea include topical preparations: metronidazole, clindamycin, azelaic acid, sulfur, sodium sulfacetamide and oral medications: tetracycline, doxycycline and minocycline. As all dermatologists know, these therapies sometimes do not work, so an awareness of off-label uses of other medication groups and approaches is useful to avoid treatment failure, patient frustration and dermatologist exasperation. I will focus on four groups and approaches: retinoids, anti-parasitic agents, Helicobacter pylori treatment and second-generation macrolides." The Dermatologist

Short Term Steroid Treatment
Sometimes if your rosacea is severe your physician may prescribe short term steroid treatment, usually an oral systemic steroid like Prednisone or in some cases a topical prescription steroid. For short term, steroids are impressive in attenuating intractable rosacea. [1] Just be forewarned, that long term steroid treatment for rosacea is a disaster waiting to happen. 

Other Treatments
There are other options or alternatives also reported using Immunosuppressants, i.e., Topical Calcineurin Inhibitors (TCIs), anti-inflammatory treatments, anti-parasitic agent treatments,  oral ivermectin and metronidazole,  secondary therapy, Timolol Maleate 0.5%, Artesunate, the ZZ Cream, other prescriptions, demodex treatments (non prescription), other demodectic prescription treatments, (i.e., Benzyl Benzoate and Crotamiton, Permethrin), Azithromycin [2], probiotics (probiotic therapy), or a growing list of non prescription or over the counter treatments (our affiliate store). The RRDi is an armamentarium database of rosacea treatment options and will continue as such as long as donations continue to keep our non profit organization going. 

Low Dose Isotretinoin
"For severe or antibiotics-recalcitrant disease, daily low-dose isotretinoin has also been reported to be effective." [3]

Natural Treatments
Some prefer natural or holistic treatments for rosacea. Our forum on those proposed can be found here: 

Forum Home > Forums > Member Forum > Rosacea Topics > Non Prescription > Natural Treatments

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End Notes

[1] Prednisone

"A patient with severe papulopustular rosacea (PPR) and severe background erythema responded well to a treatment regimen consisting of a short course of antibiotics in combination with a corticosteroid, followed by monotherapy with isotretinoin."

Drugs R D. 2016 Sep; 16(3): 279–283. Published online 2016 Sep 13. doi: 10.1007/s40268-016-0141-0
A Tailored Approach to the Treatment of a Patient with a Severe Dynamic Manifestation of Rosacea: A Case Report
Martin Schaller and Lena Gonser

[2] "Oral azithromycin dosing 500 mg/day for 2 weeks is effective for treatment of intractable rosacea."

J Korean Med Sci. 2011 May; 26(5): 694–696.Published online 2011 Apr 21. doi: 10.3346/jkms.2011.26.5.694
Oral Azithromycin for Treatment of Intractable Rosacea
Jae-Hong Kim, Yoon Seok Oh, and Eung Ho Choi

[3] Low-dose isotretinoin vs. minocycline in the treatment of rosacea