Management

There is no permanent cure for rosacea but treatments can ease symptoms. The aim should be complete skin clearance, where possible. Self-care measures include avoiding trigger factors as far as possible.

A number of OTC products can be helpful. Dry, sensitive skin can be a problem for rosacea patients. This can make shaving painful for some men. Gentle, soap-free wash products (syndets) and oil-free moisturisers can be helpful.

Green-tinted moisturisers can help to camouflage erythema. In addition, people may self-refer to the charity Changing Faces (changingfaces.org.uk), which provides education on the application of cosmetic camouflage creams and powders.

Effective sun protection measures including using high-factor sunscreens and avoidance of sunbeds can be helpful.

A private PGD for brimonidine gel (Mirvaso) may be in place in some pharmacies. Brimonidine is an alpha2-adrenoceptor agonist that reduces flushing by causing superficial vasoconstriction when applied topically. It acts within 30 minutes and reaches peak effect in three to six hours, after which the erythema returns.

The gel can make broken veins and papules look more prominent once the background redness is reduced. Topical brimonidine should be used once daily, as needed.

First-line treatment for mild-moderate papulo-pustular rosacea is ivermectin 10mg/g cream. This is thought to act by reducing the numbers of Demodex folliculorum on the skin.

Second-line treatments are metronidazole gel or azelaic acid gel.

Private PGDs

Private PGDs cover a wide range of conditions. Off-the-shelf PGDs, together with appropriate training, can be purchased from specialist companies to help set up a service for both acne and rosacea. For example, a PGD package for brimonidine tartrate 0.5% is available from PharmaDoctor.

Conclusion

Community pharmacists can expand their role in managing acne and rosacea. Familiarity with NICE first-line treatments, their use and referral points will help to prepare for practice.