Treating Rosacea and Melasma in Lebanon: A Dermatologist's Roadmap

Rosacea and melasma are two of the most common pigment/inflammation concerns in Lebanese dermatology clinics. Both worsen with sun exposure — non-negotiable daily SPF 50 broad-spectrum is the foundation of any plan.

Rosacea — recognise the subtype

• Erythemato-telangiectatic — persistent redness and visible vessels.
• Papulopustular — bumps and pustules that mimic acne but spare comedones.
• Phymatous — thickened skin, usually nose (rhinophyma), mostly men.
• Ocular — gritty eyes, lid inflammation; often missed.

What works

• Topical metronidazole, azelaic acid 15%, ivermectin 1% — first-line for the papulopustular form.
• Brimonidine gel — short-term redness reduction.
• Oral doxycycline (sub-antimicrobial dose) for inflammatory flares.
• Vascular lasers / IPL for visible vessels (multiple sessions).
• Trigger diary — common Lebanese triggers: arak, spicy mezze, hot showers, sauna, heat waves.

Melasma — the long game

Melasma needs strict photoprotection (mineral SPF, wide hat) plus a "Kligman-style" triple combination (hydroquinone + tretinoin + low-potency steroid) under dermatologist supervision, cycled to avoid rebound. Tranexamic acid orally or topically is increasingly used. Lasers and chemical peels help once the skin is calm — never as the first step.

Red flags & what to avoid

Over-the-counter "whitening" creams from unregistered sources often contain undisclosed steroids or mercury — both make pigmentation permanently worse. Always verify the product carries the Lebanese Ministry of Public Health registration.