Compounding for Rosacea

Custom dermatological compounds that are efficacious and economical.

Safe + Effective Compounding for Rosacea

Safe + Effective Compounding for Rosacea

According to the U.S. government, more than 14 million people are living with rosacea. Affecting men, women and children, treatment requirements vary based on age and symptoms. Compounding allows medical treatment to be tailored to treat patient's diagnostic symptoms.1

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Rosacea is a common skin disease. Patients often present with a tendency to blush or flush readily. Such redness can become prominent and spread beyond the nose and cheeks to the forehead and chin and even the ears, chest, and back. If left untreated, the condition may worsen, and the redness may appear at all times, particularly in the center of the face. 2

Because of the many signs and symptoms of rosacea, there are four subtypes: 3


  • Subtype 1: Erythematotelangiectatic Rosacea: Symptoms include redness, flushing, and visible blood vessels.
  • Subtype 2: Papulopustular Rosacea: Symptoms include redness, swelling, and acne-like breakouts.
  • Subtype 3: Phymatous Rosacea: Skin thickens and has a bumpy texture.
  • Subtype 4: Ocular Rosacea: Symptoms include irritated and red eyes, swollen eyelids, and the appearance of something that looks like a sty.

Rosacea is a chronic and treatable condition that consistently impacts some groups of people, including, but not limited to:


  • People between the ages of 30 and 50 years old
  • Those with fair skin (i.e. blonde hair and/or blue eyes)
  • Those of Celtic or Scandinavian ancestry
  • Those with a family history of either rosacea and/or severe acne
  • Those who have a history of acne with associated cysts and/or nodules

While the cause of rosacea has not been established,
contributing factors may include: 4

  • Genetics: Rosacea runs in families, so it is probable genetics play a role
  • The immune system: Most people with acne-like rosacea have a hypersensitivity to the bacterium bacillus oleronius
  • A bacteria that causes infections in the intestines may also play a role: It is common for people who have rosacea to harbor H. pylori, although many people who do not have rosacea also host H. pylori
  • Demodex may play a role: Demodex is a mite that lives on the nose and cheeks, where rosacea often appears. People with rosacea often have large parasitemias, although people without rosacea may also carry significant Demodex parasitemias
  • Cathelicidin may cause redness and swelling: How the body processes cathelicidin, a protein that protects the skin from infection, may determine whether or not a person gets rosacea

As with the other chronic skin conditions discussed here, rosacea can greatly impact a person’s quality of life, resulting in compounded embarrassment, low self-esteem, anxiety, and depression. Fortunately, with treatment, both symptoms and quality of life can improve.

Patient education is a key component of rosacea treatment. Help the patient to identify triggers, which may include being overheated, exposure to the cold, and spicy foods. Photosensitivity to UV rays is a potential trigger, so educate patients by encouraging the use of a broad-spectrum sunscreen with a minimum of SPF 30 and the practice of good sun hygiene (seeking shade when outdoors and wearing a hat, sunglasses, and sun-protective clothing). Support patients by introducing a gentle rosacea-friendly skincare routine with mild products and gentle touch (no scrubbing!), as this practice can also help prevent flare-ups. Currently, there is no cure for rosacea. However, with some lifestyle changes and a tailored treatment plan, it can be controlled. 5

Treatment plans should be tailored to treat the symptoms of rosacea. 6

For redness:

  • Use adequate sun protection

  • Practice trigger management

  • Implement a gentle skincare routine

  • Use green-tinted makeup

  • Consider lasers or other light-based treatment

  • Use a compounded brimonidine tartrate topical gel

To treat acne-like breakouts, consider:

  • Azelaic Acid: Applied to the skin twice daily, helps to reduce symptoms of rosacea in 70 to 80% of patients (some patients even enter remission). Compounded Options: Azelaic Acid creams, pads and in-office peels solutions

  • Metronidazole: Available as a gel or cream. Reduces both redness and acne-like breakouts and is sufficient for remission in some patients. Compounded Options: Metronidazole and Metronidazole/Ketotifen topical creams

  • Sodium Sulfacetamide and Sulfur: Consider for combination therapies. It shows an efficacy of 65 to 78% decrease in acne-like breakouts after 6 to 8 weeks of use. Compounded Options: Clindamycin/Salicylic Acid /Sulfacetamide Sodium cleansing pads and Sulfacetamide Sodium/Salicylic Acid/Aloe Vera topical cream

  • Retinoids: Not suitable for active rosacea. Consider a vitamin A during dormant periods to prevent flare-ups.

  • Antibiotics: Reduces acne-like breakouts and redness and is effective as a first-response treatment. To prevent antibiotic resistance, consider low-dose doxycycline to mitigate future flare-ups.

  • Isotretinoin (Accutane): Accutane is approved for the treatment of severe cases. Reduces redness and acne-like breakouts. However, caution is recommended due to teratogenic properties.

  • Laser or light therapy: Patients typically require one to five treatments for the best results, plus a maintenance course.

Patients suffering from thickening skin (phyma) may benefit from isotretinoin to prevent the phyma from worsening. In advanced cases , surgery may have to be considered to remove the thickened skin.

To treat ocular rosacea:

  • Apply warm compresses to the eye

  • Cleanse with a gentle eye cleanser

  • Use eye drops and eye medication

  • Prescribe an antibiotic, if needed

Subtype 1: Erythematotelangiectatic Rosacea

Grade Typical Features Therapeutic Approach
1
Mild
  • Occasional mild flushing

  • Faint persistent erythema (redness)

  • Telangiectases (spider veins) (rarely)

  • Identification of triggers

  • Appropriate skincare regimen

  • Non-irritating cosmetics to conceal the redness

2 Moderate
  • Frequent flushing

  • Moderate persistent erythema

  • Several distinct telangiectases

In addition to the above:

  • Prescription topical therapies

  • Laser and light therapy

  • Electrosurgery to treat telangiectases and reduce redness and flushing

3
Severe
  • Severe flushing

  • Pronounced and persistent erythema

  • Possible edema may emerge

  • Prominent telangiectases

  • Possible sensations of burning, stinging, roughness, or scaling of the skin

In addition to the above, flushing may be modulated by drugs such as:

  • NSAIDs

  • Alpha-agonists

  • Beta-blockers

  • HRT can treat menopausal flushing

Psychological counseling can help control emotion-induced flushing.

Subtype 2: Papulopustular Rosacea

Grade Typical Features Therapeutic Approach
1
Mild
  • Several plaque-free papules or pustules

  • Mild persistent redness (erythema)

  • Topical therapy

  • Oral antibiotics

  • Topical medication alone may be sufficient to maintain results.

2
Moderate
  • Many plaque-free papules or pustules

  • Moderate persistent redness (erythema)

  • Consider an oral antibiotic

  • Consider a sub-antimicrobial anti-inflammatory dose until remission

  • Combine or follow with a long-term topical or oral anti-inflammatory therapy

3
Severe
  • Numerous and/or extensive papules or pustules with or without plaques

  • Severe persistent erythema

  • Sensations of burning and stinging

  • In refractory cases, alternative oral and topical therapies may be used

  • Gentler skincare regimen may address burning and stinging

Subtype 3: Phymatous Rosacea

Grade Typical Features Therapeutic Approach
1
Mild
  • Patulous follicles (no contour changes)

  • Treat as per Subtype 1 and Subtype 2

  • Consider carefully-monitored isotretinoin to reduce incipient rhinophyma

2
Moderate
  • Contour changes (no nodular component)

In addition to the above, consider surgical therapy such as
cryosurgery, radiofrequency ablation, electrosurgery, heated scalpel,
electrocautery, tangential excision combined with scissor sculpturing, skin grafting,
and dermabrasion; CO₂ or erbium. YAG lasers may be used as a bloodless scalpel
to remove excess tissue

3
Severe
  • Contour changes with nodular component

As indicated above.

Subtype 4: Ocular Rosacea

Grade Typical Features Therapeutic Approach
1
Mild

Symptoms affecting the eyelid margin and meibomian glands

  • Artificial tears

  • Cleansing of eyelashes

2
Moderate

Symptoms affecting the inner eyelid, tear secretion, and/or ocular surface

In addition to the above, consider:

  • Ophthalmic antibiotic ointment for eyelashes

  • Oral antibiotic

Consult with an ophthalmologist if severity increases.

3
Severe
  • Advanced or nonresponsive disease of the eyelid margin or ocular surface

  • Episcleritis, iritis, or keratitis as well as cornea damage and possible vision loss

Ophthalmologist care is required. Options include:

  • Topical steroid

  • Alternative oral medications

  • Assess for surgery

Topical therapies are used to treat inflammatory papules, pustules, and erythema of rosacea. These agents are antibacterial, antiprotozoal, keratolytic, comedolytic, or vasoconstrictors.

VLS Pharmacy | New Drug Loft can customize therapies to allow for easy adjustment of your rosacea treatment plan. Options include:

  • HRT for menopausal flushing

  • Ophthalmic antibiotic ointment

  • Oral antibiotics

  • Topical steroids

  • NSAIDs

  • Alpha-agonists

Please note: information on this site is not intended as medical advice and the medications listed are not specific to any individual. The content is intended to inform as to what may be possible. Listed medications and/or compounded formulas are not necessarily those compounded at VLS Pharmacy & New Drug Loft . Please speak with your prescribing clinician about your specific needs.

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As a 503A pharmacy, VLS Pharmacy* is committed to providing high-quality formulations of sterile and non-sterile compounded medications to you and your patients. Thanks to rigorous testing measures, we guarantee the safety, stability, purity, sterility, and quality of each formulation from preparation to administration. We use high-quality, active pharmaceutical ingredients sourced directly from PCCA, the leader of superior-quality APIs. Additionally, our pharmacy network meets USP <795> non-sterile standards and USP <797> sterile compounding guidelines. We’re also proud to host one of the first pharmaceutical labs built to USP <800> standards for handling hazardous drugs.

All of our medications undergo third-party potency and stability testing, and we complete high-sensitivity rapid endotoxin detection on-site. These measures allow for shorter delivery times to the patient without compromising our product quality. Because we source all of our active ingredients from PCCA, we also promise an additional level of pre-formulation testing, as PCCA ingredients undergo 14 high-level checks and reviews in order to pass inspection.

*New Drug Loft is also a 503A compounding pharmacy but specializes in strictly non-sterile compounding and therefore abides by USP <795> only.

For almost three decades, our team has been committed to serving our network of physicians and patients. We appreciate the opportunity to share our expertise as we develop advanced compounded formulations for those who need and want more than what is commercially available. We work hard to achieve excellence in all areas of our business -- from investment and advancement to personalized customer service and rigorous in-house and third-party safety testing and quality assurance. We are proud to prove the best, individualized medical solutions, compounded as needed.

Our 503A pharmacy network specializes in providing custom-made sterile and non-sterile compounded medications to physicians and patients across the country. Each prescription is crafted and delivered with a commitment to the highest level of quality, safety and service.

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