新人999玫瑰痤疮如何治疗配图，仅供参考
Papulopustular rosaceaCombining topical treatments with oral antibiotics may be needed for papulopustular rosacea. Topical treatments include metronidazole,azelaic acid,ivermectin and dapsone.
Ivermectin (1% cream) is useful for mild to moderate rosacea. It has an anti-inflammatory effect as well as having an effect on Demodex mites,which may activate the local immune response to produce the pustules. It is applied once daily for up to four months,and the course may be repeated if needed.,Topical dapsone is a sulfone antibacterial with anti-inflammatory actions. It was recently approved for acne in Australia,but in the USA it is approved for rosacea. Dapsone 7.5% gel is applied once daily for up to 12 weeks. It should be avoided in those with known glucose-6-phosphate dehydrogenase deficiency.
Oral antibiotics used in papulopustular rosacea include minocycline,doxycycline,erythromycin,clarithromycin and clindamycin. Their effectiveness at sub-antimicrobial doses is mostly due to their anti-inflammatory properties rather than a direct antimicrobial mechanism. Although bacteria may contribute to this form of rosacea,evidence for this is scant.
Doxycycline 40 mg per day is commonly given in the USA as a sub-antimicrobial dose. The risk of resistance at this dose is less than with higher doses. In Australia 50 mg daily is used (range 25–100 mg). Photosensitivity is the main adverse effect,and sun avoidance or sunscreens may be required,especially during the summer months. Minocycline is probably a more effective agent but the increased risk of pigmentation,liver disorders and lupus-like syndrome limits its long-term use.
The goal of oral therapy is to improve the rosacea to a point where control is achieved by topical therapies. Treatment duration varies from four weeks to supress flares to many months for long-term disease suppression. With lower doses,adverse effects like headache,photosensitivity,diarrhoea and mucosal candidiasis are relatively uncommon. The antibiotics should be taken with food.,Erythromycin and clarithromycin are generally used in patients who are intolerant or have refractory disease to tetracyclines (e.g. doxycycline,minocycline). Topical or oral erythromycin is sometimes used in pregnant women with papulopustular rosacea.
Oral isotretinoin is usually reserved for patients who are intolerant to oral or systemic therapies. Its effect is thought to be secondary to the downregulation of the local cutaneous immunity,although an alteration in the lipid environment of the skin cannot be excluded. Low-dose isotretinoin (10 mg daily) may be effective and have less adverse effects. The teratogenicity and adverse effects of isotretinoin requires routine clinical and laboratory monitoring for safety. Referral to a dermatologist is therefore recommended.","department":"
