From the Guidelines
Rosacea treatment should prioritize topical metronidazole (0.75% or 1% applied once or twice daily) for mild cases, and oral doxycycline (40-100mg daily for 8-12 weeks) for moderate to severe cases, as these treatments have shown significant reductions in inflammatory lesion counts and improvements in quality of life 1.
Treatment Options
- For mild rosacea, gentle cleansers, daily sunscreen (SPF 30+), and avoiding triggers like spicy foods, alcohol, extreme temperatures, and harsh skincare products are recommended.
- Topical treatments include metronidazole (0.75% or 1% applied once or twice daily), azelaic acid (15-20% applied twice daily), or ivermectin 1% cream (applied once daily).
- For moderate to severe cases, oral antibiotics such as doxycycline (40-100mg daily for 8-12 weeks) may be prescribed.
- Persistent facial redness can be treated with brimonidine gel 0.33% for temporary relief.
- Laser therapy or intense pulsed light treatments can help reduce visible blood vessels and redness.
Key Considerations
- Rosacea is a chronic inflammatory skin condition that primarily affects the face, causing redness, visible blood vessels, and sometimes small, red, pus-filled bumps.
- The condition involves inflammation, vascular instability, and sometimes microscopic skin mites (Demodex), which explains why anti-inflammatory medications and treatments targeting these factors are effective in controlling symptoms.
- Long-term avoidance of common triggers, use of gentle skin care, and adherence to pharmacologic treatment are fundamental strategies for rosacea control 1.
- Phenotype-based medical management of rosacea is recommended, where optimal therapy is tailored by the signs and symptoms the clinician observes and the patient finds most troubling 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Definition and Subtypes of Rosacea
- Rosacea is a chronic inflammatory skin condition associated with four distinct subtypes: erythematotelangiectatic, papulopustular, phymatous, and ocular 2.
- Each subtype has its own treatment, and patients may have multiple subtypes 2, 3, 4.
Treatment Options for Rosacea
- Treatment options for rosacea include topical and oral medications, as well as lifestyle changes such as avoiding triggers and proper skin care 2, 3, 4, 5, 6.
- Topical metronidazole, azelaic acid, and sulfacetamide/sulfur are generally effective for patients with mild rosacea 5.
- For moderate papulopustular rosacea, combination therapy with oral tetracyclines and topical agents is the first-line choice 5.
- Systemic treatment includes metronidazole, doxycycline, minocycline, clarithromycin, and isotretinoin, while topical treatment is based on metronidazole cream and gel 2, 3, 6.
Specific Treatments for Each Subtype
- Erythematotelangiectatic rosacea: brimonidine tartrate 0.5% reduces persistent facial erythema, and nonselective β-blockers and α2-adrenergic agonists decrease erythema and flushing 2.
- Papulopustular rosacea: metronidazole 1% and azelaic acid 15% cream reduce the severity of erythema, and oral metronidazole or oral tetracycline can be used to treat papulopustolar rosacea 2, 3.
- Ocular rosacea: oral or topical antibacterial can be used to treat ocular involvement 2, 5, 6.
- Phymatous rosacea: rhinophyma can be corrected by dermatosurgical procedures, decortication, and various types of lasers 2, 6.