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Rosacea — SCE Dermatology MCQ

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EasyInflammatory DermatosesRosaceaSCE Dermatology

A 48-year-old woman presents with recurrent episodes of facial flushing, persistent centrofacial erythema, papules, and pustules but no comedones. She has telangiectasia on her nose and cheeks. What is the most appropriate first-line treatment for her papulopustular disease?

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Correct answer: E — Topical Metronidazole 0.75%

For papulopustular rosacea (subtype 2), topical Metronidazole is a well-established first-line treatment. Alternatives include topical Ivermectin 1% cream (which has shown superiority in some studies) and topical Azelaic acid 15%. Oral tetracyclines (Doxycycline) are added for moderate-to-severe papulopustular disease. The absence of comedones distinguishes rosacea from acne. Topical corticosteroids are contraindicated on the face for rosacea as they worsen the condition. Low-dose oral Isotretinoin is reserved for refractory cases.

Reference: BAD 2021 Guidelines for management of rosacea