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Later, the inflammatory component predominates, with persistent erythema with follicular papules, papulopustules and pustules. The development of phyma, which usually occurs on the acral localizations, is the most severe manifestation. For the treatment of rosacea, the interdisciplinary guideline committee, with representatives of the German Dermatological Society (DDG), the Professional Association of German Dermatologists (BVDD), the German Opthalmological Society (DOG), the Society for Dermopharmacy (GD), the Swiss Society for Dermatology and Venereology (SGDV) and the German Rosacea Aid e.\u00a0V., recommends the avoidance of trigger factors and topical applications of metronidazole, azelaic acid or ivermectin. For symptomatic treatment of persistent centrofacial erythema, the topical vasoconstrictors brimonidine or oxymetazoline can also be used. Systemic therapy is recommended for therapy\u2010resistant and severe forms of rosacea papulopustulosa. The drug of choice is low\u2010dose doxycycline. Alternatively, low\u2010dose isotretinoin can be recommended. Ocular rosacea should be treated with lid margin hygiene. For topical treatment, ciclosporin eye drops, azithromycin, ivermectin or metronidazole are suggested.<\/jats:p>","DOI":"10.1111\/ddg.14849","type":"journal-article","created":{"date-parts":[[2022,8,5]],"date-time":"2022-08-05T08:21:03Z","timestamp":1659687663000},"page":"1147-1165","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":64,"title":["S2k guideline: Rosacea"],"prefix":"10.1111","volume":"20","author":[{"given":"Benjamin M.","family":"Clanner\u2010Engelshofen","sequence":"first","affiliation":[{"name":"Department and Clinic for Dermatology and Allergology University Hospital Munich  LMU Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominik","family":"Bernhard","sequence":"additional","affiliation":[{"name":"Department and Clinic for Dermatology and Allergology University Hospital Munich  LMU Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonja","family":"Dargatz","sequence":"additional","affiliation":[{"name":"Deutsche Rosazea Hilfe e.V. 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