From the Guidelines
Erythematous rosacea should be treated with azelaic acid 15% gel, as it has been shown to be effective in reducing inflammatory lesions and improving symptoms, according to the most recent and highest quality study 1.
Treatment Options
The treatment of erythematous rosacea typically involves a combination of topical medications, oral antibiotics, and lifestyle modifications.
- Topical medications such as metronidazole 0.75% or 1% gel, azelaic acid 15-20% gel, and ivermectin 1% cream have been shown to be effective in reducing inflammatory lesions and improving symptoms 1.
- Oral antibiotics like doxycycline (40-100mg daily for 4-12 weeks) or minocycline (50-100mg daily) may be prescribed for moderate to severe cases 1.
- Lifestyle modifications, such as adopting gentle skincare routines, applying broad-spectrum sunscreen (SPF 30+) daily, and identifying and avoiding personal triggers, are also important in managing symptoms.
Lifestyle Modifications
In addition to medical treatment, lifestyle modifications can help manage symptoms and prevent progression to more severe forms of rosacea.
- Gentle skincare routines using mild, non-abrasive cleansers and alcohol-free products can help reduce irritation and inflammation.
- Applying broad-spectrum sunscreen (SPF 30+) daily can help protect the skin from further damage and reduce the risk of skin cancer.
- Identifying and avoiding personal triggers, such as spicy foods, alcohol, extreme temperatures, and stress, can help reduce symptoms and prevent flare-ups.
Alternative Treatments
For persistent redness, laser therapy or intense pulsed light treatments may be recommended 1.
- These treatments can help reduce the appearance of blood vessels and improve skin texture.
- However, they may not be suitable for all patients and should be discussed with a healthcare professional to determine the best course of treatment.
From the FDA Drug Label
If sensitivity or severe irritation develop with the use of AZELEX® Cream, treatment should be discontinued and appropriate therapy instituted. Due in part to the low pH of azelaic acid, temporary skin irritation (pruritus, burning, or stinging) may occur when AZELEX® Cream is applied to broken or inflamed skin, usually at the start of treatment.
The azelaic acid cream is used to treat inflammatory lesions, but the provided drug labels do not directly address erythematous rosacea.
- The labels mention skin irritation and sensitivity, but do not provide information on the treatment of erythematous rosacea specifically.
- There is no direct information on the use of azelaic acid for erythematous rosacea in the provided drug labels 2, 2.
From the Research
Definition and Classification of Rosacea
- Rosacea is an inflammatory dermatologic disorder characterized by the presence of facial erythema, visible blood vessels, papules, and pustules 3.
- The National Rosacea Society has established a classification system that identifies 4 distinct rosacea subtypes based on clinical presentation: erythematotelangiectatic, papulopustular, phymatous, and ocular 3, 4.
Treatment Options for Erythematous Rosacea
- The goal of topical therapy for rosacea is to reduce inflammatory lesion counts, decrease intensity of erythema, and reduce symptoms such as stinging, burning, and pruritus 3.
- Metronidazole and azelaic acid are thought to reduce the inflammation associated with rosacea by inhibiting the production of reactive oxygen species produced by neutrophils 3.
- Topical brimonidine tartrate gel, oral medication such as beta blockers, or vascular laser and light-based therapy can be used to treat erythema 5, 4.
- Oral doxycycline 40 mg modified release can be used as monotherapy or in combination with other treatments for recalcitrant disease 5.
Treatment Efficacy
- Both metronidazole 1% gel and azelaic acid 15% gel have been shown to be effective in reducing inflammatory lesion counts and erythema in patients with moderate rosacea 3.
- The efficacy of once-daily application of metronidazole 1% gel and twice-daily applications of azelaic acid 15% gel were similar in reducing erythema and inflammatory lesion counts 3.
- Topical ivermectin and sulfacetamide/sulfur are also used as treatment options for rosacea, with variable results 6.