Other treatments There are a number of other treatments which have limited evidence related to their efficacy but which might be helpful in some cases. - Anti-inflammatories: It has already been stated that topical steroids will aggravate rosacea; however, some have found the topical calcineurin inhibitors (tacrolimus and pimecrolimus) helpful. Oral non- steroidal anti-inflammatories such as diclofenac might also be helpful in reducing facial redness, but it is important to be aware of the potential serious side effects (e.g. peptic ulceration). Isotretinoin: This drug was discussed extensively in the section on acne and its potential side effects discussed at length. It may be helpful particularly for those who do not respond to antibiotics; however, a low dose over a prolonged period of time is likely to be needed. Clonidine: This is an example of an alpha 2 receptor antagonist which may reduce vascular dilatation which leads to the facial flushing. Side effects are usually mild but may include low heart rate and blood pressure, dry eyes, blurred vision and gastrointestinal disturbance. Vascular laser: May be used to treat telangiectasia successfully. Other methods if lasers are not available include sclerotherapy (injections of strong saline solution), diathermy or cautery. Intense pulsed light has been shown in a small study to have significant impact on the erythema and telangiectasia, an effect which was maintained at 6 months (Papageorgiou et al., 2008). Surgery: This may be necessary for people with rhinophyma in order to reshape the nose.
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