Mild to moderate – few papules or pustules and mild to moderate persistent erythema

• Metronidazole gel 0.75% OD or Metronidazole cream 1% OD
• Intolerant or not responding, use Azelaic acid 15% gel BD – May cause a mild burning or stinging sensation, but will improve in 1-2 weeks
• Review at 2 months

Severe or or no response to above

• Oxytetracycline 500mg BD
• If pregnant or reaction to sunlight – Erythromycin 500mg BD
• Review at 2 months
• Intend to wean off at 2-6 months

Referral

• Ophthalmology – Keratitis (urgent), resistant ocular symptoms (routine)
• Dermatology – psychosocial distress, no response over 12w, papulopustular, uncertain diagnosis
• Plastics – severe rhinophyma