Although rosacea in Sydney predominantly affects adults between the ages of 30 and 50 years, clinicians routinely treat patients with rosacea well into their 60s, 70s and even 80s.

Sydney Rosacea patients less than 30 years of age, including children, often have ocular involvement.

Although rosacea is becoming increasingly widespread, most of the general Australian population knows very little about how to recognise or treat rosacea.

Patients with rosacea may assume that their redness and occasional papules and pustules are sunburn due to the sun.

Although there is no cure for rosacea, early recognition of the condition by both patients and clinicians is essential for effectively treating symptoms and maintaining long-term control.

Without effective treatment, some rosacea patients may develop ocular complications or facial disfigurement (ie, rhinophyma).

To progress further, refer Rosacea Treatment.

One of the most frequently raised concerns pertains to the order of application of skin care for rosacea where a topical medication (such as Metrogel) is being used.

As a general rule, rosacea medications with a gel or fluid texture should be applied after cleansing skin with a suitable rosacea cleanser, then ideally left to absorb for 5-10 minutes.

After 5-10 minutes, you can proceed with application of other suitable skin care, such as Rosacea Hydrating Serum and Rosacea Treatment Fluid (+ Sunscreen during the day).

If your skin is prone to counterproductive irritation from your gel or fluid-textured rosacea medication, you can apply it to freshly cleansed skin after Rosacea Hydrating Serum but before any other treatments, ideally waiting 5-10 minutes between the application of medication and further skin care.

Cream-textured medications are generally incompatible with other skin care products and are best avoided. If you must use them, you must ensure anything you apply afterwards is thicker than the medication to ensure better penetration.

If unrelenting irritation from medication occurs, you can also try applying medication once daily only, in the evening, as the final step of your skin care protocol, although you're more likely to benefit from discontinuing any topical medication which causes chronic irritation.

Even where medications don't provoke obvious reactions, long-term tolerability and other health concerns are an issue under surveillance. It should be noted that in recent times it has been shown that topically applied metronidazole is absorbed in sufficient amounts to produce systemic effects.

In summary, the most used order of application for skin care including topical metronidazole is as follows:

AM

Rosacea Cleanser

Rosacea De-Sensitizing Mist

Rosacea Hydrating Serum

Metrogel (AM or PM, maximum once daily)

Rosacea Treatment Fluid or Cream

Rosacea Sunscreen

PM

Rosacea Cleanser

Rosacea De-Sensitizing Mist

Metrogel (AM or PM, maximum once daily)

Rosacea Anti-Inflammatory Clearing Serum

Alternate PM Protocol

As per AM, minus Sunscreen, with the option of using Rosacea Cooling Lotion in place of Rosacea Treatment Fluid or Cream.