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Updated 2024 AAFP guidelines for the management of rosacea.


Key sources

The following summarized guidelines for the evaluation and management of rosacea are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2024), the American Academy of Ophthalmology (AAO 2022), the British Association of Dermatologists (BAD 2021), and the Swiss Society of Dermatology and Venereology (SSDV 2017). ...
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Classification and risk stratification

Clinical classification
As per BAD 2021 guidelines:
Use the classification of phenotypes identified by Gallo et al when characterizing the clinical subtypes and symptoms of rosacea which encompasses the objective clinical signs and the subjective symptoms experienced by the patient with rosacea. Recognize that diagnostic phenotypes include characteristic fixed centrofacial erythema or phymatous changes; other features include flushing, papules or pustules, telangiectasia, ocular changes, burning or stinging sensations, edema, and dryness.
Take into account the older classification system for rosacea which was based on clinical signs: erythematotelangiectatic, papulopustular, phymatous, or ocular. Characterize the clinical subtypes and symptoms of rosacea affecting the patient according to these clinical signs.
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Medical management

Topical therapies: as per AAFP 2024 guidelines, offer the following agents as first-line topical therapy in patients with rosacea with papules and pustules:
ivermectin 1% cream
metronidazole 0.75% gel
azelaic acid 15% gel.

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  • Antibiotic therapy

  • Retinoids

  • Beta-blockers

  • Other agents

Nonpharmacologic interventions

Lifestyle modifications: as per AAFP 2024 guidelines, advise patients on rosacea trigger identification and avoidance.

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  • Skin care

  • Psychological support

Therapeutic procedures

Laser and intense pulsed light therapy: as per BAD 2021 guidelines, consider performing pulsed dye laser, Nd-YAG laser or intense pulse light in patients with rosacea where the main presenting feature is persistent facial erythema. Consult an appropriately qualified laser practitioner to ensure safe and high-quality practice.

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  • Botulinum toxin injections

Specific circumstances

Patients with rhinophyma: as per BAD 2021 guidelines, consider performing nasal de-bulking in patients with significant rhinophyma by laser ablation or surgical intervention depending on local expertise.

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  • Patients with ocular rosacea (nonpharmacologic management)

  • Patients with ocular rosacea (pharmacotherapy)

  • Patients with ocular rosacea (indications for referral)