From the Guidelines
Topical metronidazole and azelaic acid are the most effective treatments for rosacea, while topical corticosteroids and non-steroidal options like tacrolimus and pimecrolimus are commonly used for eczema. For rosacea, metronidazole 0.75% and 1.0% formulations have been well studied in more than 500 patients, demonstrating superiority over vehicle in reducing inflammatory lesions and perilesional erythema 1. Azelaic acid 15% gel has also been shown to be effective in reducing inflammatory lesions and improving rosacea symptoms 1. In contrast, eczema treatment typically involves topical corticosteroids like hydrocortisone (1-2.5%) for mild cases or stronger options like triamcinolone (0.1%) for moderate cases, applied 1-2 times daily during flares. Non-steroidal options like tacrolimus (Protopic) and pimecrolimus (Elidel) can be used on sensitive areas like the face.
Some key points to consider when treating rosacea and eczema include:
- Identifying and avoiding triggers that can exacerbate symptoms
- Moisturizing regularly with fragrance-free products to reduce inflammation and dryness
- Using sunscreen with a sun protection factor of 30+ to prevent further skin damage
- Considering oral antibiotics like doxycycline (40-100mg daily) for moderate to severe rosacea cases
- Using physical modalities like electrodessication or intense pulsed light for telangiectasia
- Referring patients with ocular rosacea to an ophthalmologist for further treatment.
It's essential to note that treatment duration varies based on severity, with some patients requiring ongoing maintenance therapy 1. By prioritizing the most effective treatments and considering individual patient needs, healthcare providers can help improve morbidity, mortality, and quality of life outcomes for patients with rosacea and eczema.
From the FDA Drug Label
The exact mechanism of action of azelaic acid is not known. Azelaic acid has been shown to possess antimicrobial activity against Propionibacterium acnes and Staphylococcus epidermidis. A normalization of keratinization leading to an anticomedonal effect of azelaic acid may also contribute to its clinical activity.
The medication that treats rosacea is azelaic acid (TOP) 2. However, there is no information in the provided drug labels that directly supports the use of azelaic acid or tacrolimus for the treatment of eczema.
From the Research
Medications for Rosacea
- Topical metronidazole, azelaic acid, and oral doxycycline (40 mg) have some evidence to support their effectiveness in moderate to severe rosacea 3, 4
- Oral metronidazole or oral tetracycline can be used to treat papulopustolar rosacea 3, 4
- Isotretinoin can be used in resistant cases of rosacea 3, 4
- Topical crotamiton 10% or metronidazole can be used when Demodex folliculorum infestation is present 3, 4
Medications for Eczema
- Unfortunately, there are no research papers provided to assist in answering this question about eczema treatment
Common Treatments for Rosacea
- Topical metronidazole, sulfacetamide/sulfur, and azelaic acid are generally effective for patients with mild rosacea 5
- Combination therapy with oral tetracyclines and topical agents is the first-line choice for moderate papulopustular rosacea 5
- Treatment with a topical agent, such as metronidazole, may help maintain remission 5
- Azelaic acid 20% cream provides an effective and safe alternative to metronidazole 0.75% cream or permethrin 5% cream with the added benefit of increased patient satisfaction 6
Treatment Approaches for Rosacea
- Treatment starts with avoidance of triggers and use of mild cleansing agents and moisturizing regimens, as well as photoprotection with wide-brimmed hats and broad-spectrum sunscreens (minimum sun protection factor of 30) 7
- For inflammatory lesions and erythema, the recommended initial treatments are topical metronidazole or azelaic acid 7
- Once-daily brimonidine, a topical alpha-adrenergic receptor agonist, is effective in reducing erythema 7
- Papulopustular rosacea can be treated with systemic therapy including tetracyclines, most commonly subantimicrobial-dose doxycycline 7