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Table 1: Treatment options for rosacea subsets2
ProductFlushing and fixed erythemaInflammatory papules and pustulesOcularProtocol and comments*
Ivermectin cream 1%   +++   Well tolerated, once daily, greater efficacy than metronidazole and no concerns with antibiotic resistance
Azelaic acid gel   ++   Effective twice daily, may cause irritation and no concerns with antibiotic resistance
Metronidazole gel or cream 0.75%   +   Twice daily, less effective than ivermectin
Brimonidine gel 0.33% ++     Effective and fast-acting vasoconstrictor, patients should be warned about the possibility of rebound flush, which can limit usage
Eye lubricants     +++ Lid hygiene and warm eye compresses also important
Doxycycline MR 40 mg   +++   Once daily. Fewer side-effects and equivalent efficacy as full dose (100 mg). Sub-microbial dose reduces risk of antibiotic resistance compared with other antibiotics
Doxycycline 100 mg and 
Lymecycline 408 mg capules
  ++ ++ Less expensive, more side-effects.
Well tolerated, once daily
Oxytetracycline 250–500 mg   + + Twice daily, avoid taking with meals
Erythromycin/clarithromycin 250–500 mg   +   Twice daily, useful in pregnancy
Isotretinoin   ++   Useful in secondary care for resistant cases
Intense pulsed light (IPL) +++     Limited NHS availability
Pulsed dye laser (PDL) ++     Limited NHS availability and causes significant bruising
Clonidine 25–50 µg ++     Up to three times daily, improves flushing in some patients
Propranolol 10–40 mg +     Up to three times daily
Carvedilol 3.125–6.25 mg +     Up to three times daily
+++ = strong recommendation; ++ = moderate recommendation; = low recommendation.
* These comments are the opinions of the contributors, reviewed by the PCDS Executive Committee and do not consider NHS costs and local prescribing restrictions, if any.
Primary Care Dermatology Society. Rosacea—primary care treatment pathway. PCDS, 2016. Available at: www.pcds.org.uk/ee/images/uploads/general/Rosacea-Guidelines-FINAL.pdf Reproduced with permission.