Brief Answer:
Isotretinoin can be considered along with Noritrate gel Or Azaleic acid gel

Detailed Answer:
Hello. Thank you for writing to us

I have gone through your question and I have understood your concern.

Rosacea is a chronic condition which commonly affects fair skinned individuals.
It mainly affects centrofacial region i.e nose and malar area, forehead, chin region and is characterized initially by flushing followed by persistent background erythema, telangiectasis, acne and in late stages by tissue proliferation e.g rhinophyma.

1) Oral treatment is commonly with tetracyclines group of antibiotics like doxycycline, minocycline etc Or with Macrolides like azithromycin, erythromycin roxithromycin etc. These antibiotics help control redness and acne in rosacea. Since rosacea is chronic, therefore patients with rosacea may require long term Or repeated courses of oral antibiotics and therefore there is a concern for side effects like alteration of intestinal flora and abdominal pain, diarrhea etc.

2) Oral Isotretinoin (a derivative of Vitamin A) also works very well for rosacea. It is mainly useful for acne in rosacea, however it does'nt help with flushing or erythema. It is a good alternative to oral antibiotics and can be considered in your case. However, there is a specific precaution with isotretinoin, that it should not be used during pregnancy as it can cause fetal malformations and therefore needs can be used only in females who can assure adequate contraception during therapy. It is a prescription drug, available in USA as part of iPLEDGE program.

3) In addition, topical preparations like metronidazole, azaleic acid, clindamycin etc help to keep rosacea under control and also reduce the need for oral treatment. Other topical options include pimecrolimus cream, adapalene gel.
Recently a newer drug i.e topical brimonidine gel has been approved by FDA for treatment of redness and flushing associated with rosacea. It is a topical vasoconstrictor and helps reduce flushing by reducing blood flow though skin.

4) Light based therapies like Intense pulse light (IPL) and 585nm Pulse XXXXXXX laser (PDL) help reduce redness and telangiectasis in rosacea.

So there are a lot of options for treatment in rosacea and therapy can be individualised.

Your doctor can consider starting you on Isotretinoin in place of doxycycline, with the condition that you can assure adequate contraception.
Topically you should continue with either metronidazole gel (Noritrate) Or Azaleic acid 20% gel. They would help with both acne as well as erythema and flushing.
In addition you can take a sessions of IPL to keep flushing and erythema under control
Use a good sunscreen during the day to protect from sun.
Avoid any cosmetics. Avoid hot meals, spices, hot coffee etc as these can all exacerbate rosacea.

Regards

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