On September 9, 2026, an educational event on the topic “Aspects of diagnosis and the choice of a patient management protocol for rosacea” was held in the conference hall of the Novotel Bishkek City Center hotel, organized with the support of Nature’s Bounty.

The lecturer was Dinara Kochorbaevna Aimukambetova, chief freelance dermatocosmetologist at the Ministry of Health of the Kyrgyz Republic, lecturer in the professorial course of dermatovenereology and dermatocosmetology at the S.B. Daniyarov Kyrgyz State Medical Institute for Retraining and Advanced Training, chief physician of the Viva Profi clinic, dermatocosmetologist, and trichologist.

The lecture covered current aspects of rosacea diagnosis, the specifics of choosing patient management tactics, and approaches to selecting an appropriate treatment protocol.

The event provided a platform for the professional exchange of knowledge and experience, as well as discussion of modern approaches to the diagnosis and management of patients with dermatological diseases.

Conducting such educational events helps improve the professional competence of specialists and the development of modern dermatological care in the Kyrgyz Republic.

The S.B. Daniyarov Kyrgyz State Medical Institute for Retraining and Advanced Training continues to support the professional development of medical specialists and the participation of its faculty in educational and scientific-practical events.

Aspects of rosacea diagnosis

Diagnosis of rosacea is primarily clinical and based on the analysis of diagnostic criteria. [ 1 , 2 ]

Diagnostic criteria

To make a diagnosis, it is sufficient to have at least one diagnostic (primary) phenotype or a combination of at least two major features : [ 1 , 2 ]

• Diagnostic (self-sufficient) signs:
  • Persistent erythema of the central area of ​​the face (recorded for at least 3 months).
  • Phymatous changes (hypertrophy of the sebaceous glands and connective tissue, most often in the nasal area – rhinophyma). [ 1 , 2 , 3 , 4 ]
• Major features (requires a combination of two or more):
  • Papules and pustules (inflammatory nodules and pustules).
  • Hot flashes (transient erythema caused by triggers).
  • Telangiectasias (spider veins and spider veins).
  • Ocular symptoms (ophthalrosacea: blepharitis, conjunctivitis, gritty sensation in the eyes). [ 1 , 2 , 3 ]
• Minor signs (complete the picture): burning, tingling, dryness, tightness of the skin, swelling of the face. [ 1 ]

Differential diagnosis and research

Rosacea is differentiated from acne, perioral and seborrheic dermatitis, systemic lupus erythematosus (SLE) and demodicosis. [ 1 ]

• Laboratory minimum: microscopy of scrapings for Demodex mites (its excess aggravates the course of the disease, but is not the primary cause).
• Instrumental methods (optional): dermatoscopy (assessment of vascular pattern), videocapillaroscopy, Dopplerography.
• Interdisciplinary approach: examination by a gastroenterologist (connection with Helicobacter pylori ) and an endocrinologist. [ 1 , 2 , 3 , 4 , 5 ]

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2. Selection of treatment protocol (phenotype-oriented therapy)

Treatment is selected based on the patient’s predominant symptoms. The ultimate goal is to achieve maximum remission and restore the epidermal barrier. [ 1 ]

Basic protocol for all patients (Skincare & Lifestyle)

• Elimination of triggers: avoid spicy, hot foods, alcohol, baths, saunas, and aggressive cosmetic procedures (scrubs, harsh peels).
• Gentle care: use of mild cleansers (syndets) and restorative barrier creams with physiological lipids.
• Photoprotection: year-round use of SPF 30–50+ (physical filters are preferred – zinc oxide, titanium dioxide). [ 1 , 2 , 3 , 4 ]

Medication and hardware protocols based on phenotypes

Dominant phenotype	Local (topical) therapy	Systemic therapy	Hardware/surgical methods
Transient and persistent erythema (vascular phenotype)	Brimonidine tartrate (rapid vasoconstriction for 8-12 hours).	Antiangiogenic drugs (as indicated).	Intense pulsed light ( IPL) therapy and vascular lasers (PDL, Nd:YAG) are the “gold standard” for removing telangiectasias.
Papulopustular elements (mild/moderate)	Ivermectin 1% (anti-inflammatory + anti-demodectic action), Azelaic acid 15% , Metronidazole 0.75-1% .	Usually not required, priority is given to external remedies.	Superficial gentle peels (almond, gluconolactone) during the calming period.
Papulopustular elements (severe course)	A combination of topical agents (eg, ivermectin in the evening + azelaic acid in the morning).	Subtitrated doses of doxycycline (40 mg/day – anti-inflammatory, not antibacterial effect) or systemic isotretinoin in ultra-low doses.	Laser techniques are used strictly after the acute inflammation has been relieved.
Phymatous changes (rhinophyma)	Ineffective at advanced stages.	Systemic isotretinoin (only in the initial stages to reduce the volume of sebaceous glands).	Surgical excision , CO2 laser or radio wave resurfacing of excess tissue.
Ophthalmic rosacea	Eyelid hygiene (blepharolotions), artificial tear preparations, local metronidazole or fusidic acid.	Systemic tetracyclines (doxycycline) for severe cases.	Consultation and joint management of the patient with an ophthalmologist.

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3. Management algorithm: from exacerbation to support

1. Remission induction phase (4–12 weeks): relief of acute inflammation with combination or monotherapy (e.g., Ivermectin cream + systemic Doxycycline if necessary). [ 1 , 2 ]
2. Vascular disorder correction phase: after the inflammatory elements have subsided, a course of IPL or laser therapy (3–5 procedures) is prescribed to eliminate persistent redness and telangiectasias. [ 1 , 2 ]
3. Maintenance therapy (long-term): intermittent (several times a week) application of topical agents (ivermectin, azelaic acid) in combination with continuous protective care to prevent relapses. [ 1 ]