![]() As compresses dry out the skin very effectively, they should only be applied for a limited period of time (eg a few days) and each application should be followed by repeated application of metronidazole cream. In the case of severe rash with numerous or confluent Pustules and extensive Exudation, the tetracycline dose is doubled until the severity reduces to ‘moderate’.įor marked oedema, saline compresses (lasting 15 minutes, 2-3 compresses three times a day) are very helpful for rapid clearance of the inflammation. ![]() 4,5,6,7,8 Grade 3 - Severe General Recommendationįor severe acneiform eruptions, dermatological treatment as used in moderate rash is intensified. 9 ProductsĬontinue with/withold the selected EGFRI-treatment regimen, as recommended in the current and relevant SmPC and according to the patient’s condition. Generally a swab is also taken and screened to generate an antibiotic sensitivity profile, so that the antibiotic can be switched appropriately in case of resistance. If superinfection with Staphylococcus aureus occurs, a penicillinase-resistant penicillin (eg flucloxacillin 500 mg tid) or cephalosporin (eg cefuroxime axetil 500 mg bid) may be added for 5 days (tetracyclines are rarely active against S. Like metronidazole, tetracyclines are not administered for their antibiotic properties but rather for their anti-inflammatory properties usually they are given for several months. 9 Doxycycline 100 mg qd (which may cause photosensitivity) or lymecycline 300 mg qd are alternatives. It is however avoided by some because of the rare occurrence of drug-induced lupus, hepatitis or hyperpigmentation. Minocycline 100 mg qd is probably most effective because of its high penetration in the Pilosebaceous unit. The preferred type of tetracycline may vary. 1 The initiation of oral tetracyclines is mostly based on clinical judgement (insufficient response to topical metronidazole, extensive disease). Oral antibiotics, and more specifically tetracyclines, should be used for moderate acneiform eruption. 4,5,6,7,8 Grade 2 – Moderate General Recommendation Metronidazole 2.0% preparation in cetomacrogol cream, or 0.75% topical cream.Ĭontinue with/withold the selected EGFRI-treatment regimen, as recommended in the current and relevant SmPC and according to the patient’s condition.Steroids are advised by some authors 3 while others state that they should be avoided on the face and trunk as the possible risks (induction of steroidal Rosacea or acne, atrophy, Telangiectasia, chronic abuse with tachyphylaxis and steroid dependence) outweigh the advantages. The use of topical steroids is controversial. 2 Topical anti-acne agents such as erythromycin, clindamycin and benzoyl peroxide are effective but much more aggressive as they are meant for young, resilient, acne-affected skin. 1,2 Metronidazole is preferred (as a 2% preparation in cetomacrogol cream or as 0.75% topical cream) because of its mildness, as it is normally used for the very sensitive skin of Rosacea patients. Topical antibiotics, such as metronidazole cream, clindamycin or erythromycin, used twice-daily or as needed. Early intervention is important treatment of Papules or Pustules with a topical antibiotic may help to mitigate lesion severity.
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