Management of Acne Rosacea in a 34-Year-Old Female with Doxycycline and Compounded Triple Rosacea Cream
Patient Presentation
A 34-year-old female presented to our dermatology clinic in Katy, Texas, with a chronic facial rash characterized by persistent pimples and redness. The patient reported that symptoms had been present for several years and were moderate in severity. She has a known history of rosacea, having previously undergone intense pulsed light (IPL) therapy, a course of isotretinoin (Accutane), and multiple topical treatments.
Clinical Examination
A focused facial examination revealed erythematous papules and pustules primarily distributed across the cheeks, nose, and chin—consistent with acne rosacea (L71.8).
The patient appeared well-developed, well-nourished, and in no acute distress. Dermatoscopic evaluation showed superficial telangiectasias and scattered inflammatory papules. No nodules or cystic lesions were observed.
Diagnosis
Acne Rosacea (L71.8) – distributed on the face and subxiphoid region.
The patient was counseled regarding the chronic nature of rosacea and the importance of trigger avoidance, sun protection, and consistent skincare.
Treatment Plan
After a detailed discussion of options, including laser therapy, topical agents, and oral medications, the patient elected to begin combination therapy consisting of oral doxycycline and a compounded triple rosacea cream.
Medication Regimen:
Morning Routine:
Wash with a gentle, non-irritating cleanser
Apply a broad-spectrum SPF 30+ moisturizer
Evening Routine:
Wash with a gentle cleanser
Apply the compounded triple rosacea cream (containing ivermectin, metronidazole, and azelaic acid)
Follow with a light moisturizer
Oral Therapy:
Doxycycline monohydrate 100 mg taken twice daily with food and a tall glass of water for 4 weeks
Counseling Provided:
Sun Protection: The patient was instructed to wear daily SPF and avoid direct sunlight to prevent photosensitivity associated with doxycycline.
Trigger Avoidance: Flare-ups can be provoked by alcohol, spicy foods, hot beverages, sun exposure, stress, and exercise.
Medication Effects:
Doxycycline: May cause sun sensitivity or gastrointestinal upset.
Ivermectin (Soolantra): Possible mild burning or stinging on application.
Metronidazole: May cause a metallic taste or transient redness.
Azelaic Acid (Finacea): Possible mild tingling or dryness.
The patient verbalized full understanding of the treatment plan and was scheduled for follow-up in six weeks to evaluate clinical response and tolerance.
Discussion
Rosacea is a chronic inflammatory skin condition that primarily affects the central face, often leading to persistent redness, papules, and visible blood vessels. Management focuses on controlling inflammation, reducing Demodex mite proliferation, and minimizing triggers that exacerbate symptoms.
At Village Dermatology in Katy and Houston, Texas, Dr. Reena Jogi utilizes a comprehensive treatment approach, combining oral anti-inflammatory therapy, custom-compounded topical formulations, and laser or light-based therapies when appropriate. This personalized care model helps patients achieve long-term remission and confidence in their skin health.
Conclusion
This case demonstrates effective management of chronic acne rosacea using a short course of oral doxycycline and a compounded triple rosacea cream. With adherence to skincare, trigger avoidance, and follow-up care, the patient is expected to experience a marked improvement in redness and inflammatory lesions.
