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As with other types or rosacea, patients with granulomatous rosacea are advised to avoid known exacerbating factors such as hot drinks, alcohol, and extremes of temperature. In addition, they should be encouraged to use a noncomedogenic high-factor sunscreen when exposed to sunlight and wind. Treatment of granulomatous rosacea is not different from classical rosacea and tetracycline, doxycycline, erythromycin or minocycline are usually effective. In addition, topical metronidazole may be helpful for mild disease and in addition to systemic therapy. Topical keratolytics such as benzoyl peroxide and azelaic acid offer limited symptomatic control of inflammatory pustules. Isotretinoin (Accutane) may be helpful for recalcitrant (hard to treat) disease, but recurrence is common. Long-term, low-dose isotretinoin therapy may be suitable for some patients. Dapsone has a pharmacological double function as both an antibiotic and an anti-inflammatory drug. The value of dapsone in granulomatous rosacea, however, has not yet been established by controlled studies. Permanent telangiectasia may be treated by electrosurgery or by pulsed dye laser.
More in-depth information about the treatment of rosacea, including granulomatous rosacea, can be found on the eMedicine web page.
Accutane (isotretinoin) may be helpful for granulomatous rosacea that is resistant to treatment, but recurrence is common. Long-term, low-dose isotretinoin therapy may be suitable for a small selection of patients. One recount of treatment of granulomatous rosacea with isotretinoin can be accessed by clicking here.
For more information about the use of Accutane for rosacea, in general, click here.