Medical treatment classically has been limited to the avoidance of stimulation factors, appropriate cleanliness, and treatment of secondary infection and inflammation with antibiotics and steroids. Treatment with X-ray and radium seemed promising in the 1920s when it was shown to reduce sebaceous activity in acneiform conditions. Unfortunately, it took nearly 20 years to determine that it lead to a greater incidence of skin cancer and thyroid tumors. More ancient remedies involving herbs, spices, potions, and rituals were ineffective, but at least they did less harm. Modern topical therapy includes cleansing the skin with detergents that have defatting effects, avoiding creams or ointments.
Topical corticosteroids have no place in the treatment of rosacea.
It is true that they can be effective over a short period, but the disease recurs after it is discontinued and long term use can lead to steroid-damaged skin. Long term use is contraindicated because of risk of polyneuropathies and possible carcinogenic effects. It remains to be seen whether this agent will be able to alter the natural history of the disease process. Once the violaceous, hypertrophic, bulbous stage of the disease becomes manifest, only surgical manipulation can reverse the deformity. Regression with or without medical therapy simple does not occur.