Putting it all together
Dr. Stein Gold recommends that dermatologists use combination approaches in the treatment of rosacea, based on individual patient’s needs.
First, it’s important to get the inflammatory lesions under control rapidly, according to Dr. Stein Gold.
“Topical ivermectin can be quite effective for that, and was studied in patients with moderate to severe rosacea. We have a new azelaic acid foam that was recently approved that may be better tolerated than some of the other vehicles,” Dr. Stein Gold says.
Next, tackle other bothersome aspects of rosacea, including erythema.
“For that, you can use topical brimonidine or, possibly, oxymetazoline in the future,” she says. “Then, you can combine other modalities like laser therapy to treat the background blood vessels.”
Scratching the surface
Rosacea research looking at the microbiome of the skin—presence of bacteria, viruses, fungi and mites—is advancing.
“How all these different microbial concerns interact with each other, that’s a very interesting question. We’re just sort of touching the tip of the iceberg when it comes to knowing about what the interactions are between the various microbiota on the skin,” Dr. Thiboutot says.