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 Metronidazole gel or azelaic acid 1st, then consider Oxytet, doxy or erythro
Brimonidine cream - useful for flushing, can be used prn, causes pruritis, expensive - ? role
Needs 2-6/12 to suppress and 2/3 recur, 10% indefinately
warn about eye Sx (leratitis with ulceration can be an emergency) and give lubricants and eyelid advice

Chronic skin disease of unknown aetiology
fair skinned, NOT comedonal
more in females, worse in males

''Features''
affects nose, cheeks, forehead
flushing is often first Sx (?? after alcohol but not cos of xs alcohol) - not usually responds to Abs - try propranolol or clonidine
Telangiectasia are common
later - persistent erythema with papules and pustules - no comedones - ?laser Rx - not on NHS
rhinophyma (mostly males)
blepharitis and conjunctivitis - problems occur in 50% pts - can lead on to corneal ulceration and dec VA - usually lubricants and eyelid care, beware keratitis - refer

''Management''
Topical Metronidazole (mild Sx - few pustules, no plaques) or azelaic acid - need 8/52 to see result
systemic abs - Oxytetracycline, Doxycycline or Erythromycin
Isotretinoin can be used in 2ndary care
high factor sunscreen
camouflage cream
laser therapy for telangiectasia
Brimonidine - alpha agonist, effective against flushing, SE - pruritis and burning, expensive


need to withdraw Rx slowly else can get rebound (takes 2-6/12)
2/3 relapse w'in 2 yrs and 10% require indefinate Rx