Treating Rosacea

Antibiotics taken orally are usually effective in controlling rosacea. Why antibiotics work is not known, since rosacea is not an infectious disease. Treatment only controls rosacea. Most persons with this condition need to continue taking antibiotics for months to years.

Alternative Antibiotic-Free Treatment

The following is an excerpt from a published interview given by Dr. Ellerin to Skin & Allergy News.

Antibiotic-Free Regimen for Rosacea

FAJARDO, P. R. — Cryotherapy combined with a triple ingredient cream may avert the need for oral antibiotics in more than one-third of patients with moderate to severe rosacea.

The therapy may be an alternative for patients who do not want to take oral antibiotics, Dr. Philip Ellerin said at the annual meeting of the Noah Worcester Dermatological Society.

He reported results of a study of the cryotherapy/cream combination treatment in 91 of his patients between 1991 and 1995. All the patients had grade 2, 3, or 4 rosacea, said Dr. Ellerin, of Tufts and Boston University Schools of Medicine.
The triple ingredient cream consists of equal parts of Metro Gel (mctronida-zole), Nizoral (ketoconazole), and a non-fluorinated midpotency steroid.

He treated the patients with a 2-3 second cryotherapy point spray directed at the papules and pustules. "You want to use a very short spray with light pressure to prevent blistering," he said.
The cryotherapy causes the lesions to lighten and flatten within about 3-4 days, he said. He found that 36% of his patients on the cryotherapy/cream combination avoided the use of oral antibiotics. The combination therapy controlled rosacea lesions for at least 6 months.

"The cryotherapy causes the lesions to lighten and flatten within about 3-4 days." Dr. Ellerin

Dr. Ellerin has the pharmacist mix up 45-g batches of the cream, which the patient applies twice a day after cryotherapy. He typically begins with the nonfluorinated steroid Dermatop (prednicarbate 1%), progressing to Westcort (hydrocortisone valcrate 0.2%), 1% hydrocortisone, and 1/2% hydrocortisone in subsequent batches. If the patient still is responding to all four batches of cream he will substitute a moisturizer for the steroid in the fifth batch.

"You have to substitute a moisturizer for the steroid toward the end of therapy because the Metro Gel /Nizoral mix alone can cause burning, redness, and irritation," said Dr. Ellerin, who has a private dermatologic practice in Burlington, MA.

The key to the therapy is the use of a nonfluorinated steroid cream. "Steroid creams have been associated with the development of steroid rosacea," Dr. Ellerin said. "But some researchers believe that it is the fluorinated steroids that lead to this condition."

A recent new development added to the above Rosacea regimen has been found to rapidly improve the redness. The new development is IPL (Intense Pulsed Light) photo-facial treatment. This treatment is also known by the trade name of EpiFacial®. When IPL treatments have been followed by the application of a special Vitamin-K cream, the results have been extremely gratifying.