Rosacea topical antibiotics

Another topical antibiotic, metronidazole, is effective in the treatment of acne rosacea. Metronidazole is a synthetic nitroimidazole derivative that reduces inflammation by an unknown mechanism. Other selected topical antibiotics are listed in Table 41.2. 

Although topical antibiotics are used frequently in the management of ocular rosacea, no firm evidence demonstrates their efficacy as a sole therapeutic agent. Topical steroids, however, are effective for treating the inflammatory aspects and frequently are used four times daily in conjimction with antibiotics in combination products such asTobraDex (tobramycin-dexamethasone), Pred-G (gentamicin-prednisone), or Maxitrol (neomycin-polymyxin B-dexamethasone). Because of potential steroid-induced side effects, chronic use of these agents should be avoided. 

Topical antibiotics (erythromycin [42] and clindamycin [43]) are not commonly used in rosacea. They reduce neutrophil chemotaxis and oxygen-free radical synthesis [44]. These drugs are usually well tolerated uncommon and mild side effects are erythema, dryness, and burning [45]. 

In papulo-pustular rosacea 25-30% salicylic acid peeling is utilized in association with systemic treatment with metronidazole or antibiotics and topical treatment as for erythrosis (Figs. 1715,1716 and i/.i/)-... 

Azelaic acid is an antibiotic agent that inhibits microbial cellular protein synthesis. It is indicated in the topical treatment of mild to moderate inflammatory acne vulgaris (cream) topical treatment of papules and pustules of mild to moderate rosacea. 

It is not unusual to see a flare of acne or rosacea post-operatively. Systemic antiinflammatory antibiotics can help resolve the flare before scarring occurs. Systemic antibiotics and topical anti-acne agents should be used in combination to quell the flare-up. 

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