From the Guidelines
Alternative treatments for rosacea should prioritize metronidazole 0.75% or 1.0% formulations, which have been well-studied and proven effective in reducing inflammatory lesions and perilesional erythema associated with rosacea, as demonstrated in a study published in 2024 1. When considering alternative treatments for rosacea, it's essential to focus on options that have a strong evidence base for reducing symptoms and improving quality of life.
- Metronidazole, available in 0.75% and 1.0% formulations, has been a mainstay of topical rosacea therapy for several decades, with studies showing its superiority over vehicle in reducing inflammatory lesions and erythema 1.
- The use of metronidazole has been supported by multiple studies, including a 9-week split-face study that demonstrated a 65% decrease in inflammatory lesion counts compared to a 15% reduction for vehicle 1.
- Other alternative treatments, such as microencapsulated benzoyl peroxide 5% (E-BPO 5%), have also shown promise in enhancing therapeutic response and minimizing skin irritation, with a review of the current treatment landscape highlighting its potential as a valuable treatment option for managing inflammatory lesions of rosacea 1. However, metronidazole remains a recommended first-line treatment due to its established efficacy and safety profile, with both 0.75% and 1.0% strengths being equally effective when used once daily 1.
- Gentle skincare practices, dietary modifications, and supplements like omega-3 fatty acids and probiotics may also be beneficial as complementary treatments, but their effectiveness may vary depending on individual patient needs and responses.
- It's crucial to prioritize treatments that have been proven to reduce morbidity, mortality, and improve quality of life, and to consider the most recent and highest-quality evidence when making treatment decisions, such as the studies published in 2024 1.
From the Research
Alternative Treatments for Rosacea
- Herbal ingredients such as licorice, feverfew, green tea, oatmeal, lavender, chamomile, tea tree oil, and camphor oil have been used by patients to relieve persistent facial redness 2
- These herbal compounds are often chosen for their anti-inflammatory properties, although some may have potential benefits or aggravate rosacea 2
Conventional Treatment Options
- Topical medications such as azelaic acid, metronidazole, and sulfacetamide/sulfur are commonly used to manage rosacea 3, 4
- Oral antibiotics like tetracyclines and oral retinoids are also used, often in combination with topical treatments 3, 4
- Light-based therapies like intense pulsed light and pulsed dye laser are effective for the erythemato-telangiectatic type of rosacea 3
Emerging Treatment Options
- New additions to the therapeutic armamentarium include topical brimonidine, oxymetazoline, ivermectin, tacrolimus, pimecrolimus, low-dose modified-release tetracyclines, and botulinum toxin 3
- Laser or light-based therapies are primarily used to treat phymatous rosacea 4
- Combination therapies, including skin care and cosmetic treatments, topical therapies, oral therapies, and injection therapies, are being explored for their potential in treating rosacea 5