Acne Rosacea

Acne rosacea is either a variant of rosacea, or the worsening of rosacea following a course of unsuitable treatment(s).
Acne rosacea is characterized by the appearance of papules and pustules, similar to those caused by acne, in areas affected by rosacea. Acne rosacea is generally blamed on overgrowth of the demodex mite. Hair follicles, especially those of the face, primarily host the Demodex folliculorum mite, which has adapted to live within the follicle, where it feeds on cellular debris combined with sebaceous secretions. Demodex mites are present in all individuals and therefore are not considered a pathogenic parasite.
In individuals presenting with acne rosacea, the number of demodex mites will be considerably more than the norm, and they may appear in bundles of up to a dozen at a time.

This has led to the theory that acne rosacea is nothing more than the inflammatory consequence of a demodex mite overgrowth. However, others suggest that an excess of demodex is the result of topical products that have been applied to areas already affected by rosacea.
It’s likely that both hypotheses have some truth: with its dilated and superficialized vessels, rosacea already encourages the growth of the demodex mite. In addition, the continuous application of creams in an attempt to improve rosacea only encourages these mites to proliferate even more.

Treatment

Based on the pathogenetic theory that explains demodex proliferation, antiparasitic drugs such as metronidazole or ivermectin are commonly used to treat acne rosacea. However, metronidazole is often ineffective when applied topically, so needs to be taken orally in cycles of two to three weeks, to then be repeated. Long term use of metronidazole has resulted in some liver and bladder toxicity. While ivermectin is even more toxic than metronidazole, it is now available topically as a cream. Ivermectin has a high absorption rate into skin with acne rosacea, so it is recommended to apply in short cycles of two to three weeks.

DermaClub recommends

In the evening, apply the Micropeeling lotion (Glicosal lotion) to acne-prone areas. The skin should be clean and dry, free from makeup. To remove makeup and cleanse the skin, it is recommended to use a non-foaming cleanser (Eudermic Cleansing Base). This type of cleanser keeps the skin soft and ready to absorb the Micropeeling lotion.
The lotion should be applied using a cotton pad soaked in the lotion, usually 7-10 drops are sufficient. Gently massage the treatment area in circular motions, passing and re-passing the cotton pad over the same area until the lotion is fully absorbed (when the pad is dry). Avoid vigorous rubbing to prevent redness from friction. After applying the Micropeeling lotion, do not wash the skin or apply any other products. The following morning, the skin can be washed with just water, and no moisturizer or other cosmetics should be applied.
Makeup is allowed but only with products that can be applied with a brush, such as mineral makeup (Sun Clay) or non-comedogenic polyglycerol-based concealers with natural mineral pigments (Argillina Skin Color). Both of these products are non-comedogenic. Avoid using colored creams (foundations) as they can cause folliculitis and comedones, especially for those prone to acne.