Schöfer H
Klinik für Dermatologie, Venerologie und Allergologie, Klinikum der J.W. Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Deutschland.
Hautarzt. 2013 Jul;64(7):494-9. doi: 10.1007/s00105-012-2518-5.
Metronidazole and azelaic acid are the only topical medications approved for rosacea. All other topical treatments for rosacea and its special forms are used off-label. Topical steroids are not indicated in rosacea, because of their side effects (induction of steroid rosacea, high risk of facial skin atrophy, and high risk of rebound after cessation of therapy). Topical as well as systemic steroids are allowed only as initial and short term therapy for acute forms of rosacea (e.g. rosacea fulminans). Papular and pustular rosacea is the major indication for topical therapy. Sebaceous gland and connective tissue hyperplasia in glandular-hypertrophic rosacea as well as erythema in erythematous rosacea do not respond well to topical measures. A new active substance, the alpha-2-adrenoreceptor agonist brimonidine, will be approved soon for the topical treatment of erythema in rosacea. All severe forms of rosacea should initially be treated with a combination of topical and systemic agents. After improvement of the clinical symptoms, topical treatment alone is usually adequate to maintain the control.
甲硝唑和壬二酸是仅有的被批准用于治疗酒渣鼻的外用药物。所有其他用于酒渣鼻及其特殊形式的外用治疗均为超适应症使用。酒渣鼻不适用外用糖皮质激素，因为其副作用（诱发激素性酒渣鼻、面部皮肤萎缩风险高以及停药后反弹风险高）。仅在酒渣鼻急性形式（如暴发性酒渣鼻）的初始和短期治疗中允许使用外用及全身性糖皮质激素。丘疹脓疱型酒渣鼻是外用治疗的主要适应症。腺性肥大性酒渣鼻的皮脂腺和结缔组织增生以及红斑性酒渣鼻的红斑对外用措施反应不佳。一种新的活性物质，α-2肾上腺素能受体激动剂溴莫尼定，即将被批准用于酒渣鼻红斑的外用治疗。所有严重形式的酒渣鼻最初都应采用外用和全身性药物联合治疗。临床症状改善后，通常单独外用治疗就足以维持病情控制。
