From the Guidelines
Rosacea treatment should prioritize topical metronidazole 0.75% gel or cream applied twice daily, as it has been shown to be effective in reducing inflammatory lesions and perilesional erythema associated with rosacea 1.
Treatment Options
When considering treatment for rosacea, it's essential to individualize the approach based on the subtype and severity of the condition. The following options can be considered:
- Topical treatments: metronidazole 0.75% gel or cream applied twice daily, azelaic acid 15-20% applied twice daily, or ivermectin 1% cream applied once daily
- Oral antibiotics: doxycycline (40mg daily as anti-inflammatory dose or 100mg twice daily for more severe cases) for 8-12 weeks
- Lifestyle modifications: avoid triggers like spicy foods, alcohol, extreme temperatures, and sun exposure, use gentle skincare products, and broad-spectrum sunscreen (SPF 30+) daily
Severity-Based Treatment
For mild to moderate rosacea, topical treatments are often sufficient. However, for more severe cases or those with significant inflammatory lesions, oral antibiotics like doxycycline may be necessary 1.
Additional Considerations
In addition to these treatments, laser or light therapy can help reduce visible blood vessels and redness in persistent cases. It's also important to note that treatment should be individualized based on the specific subtype and severity of rosacea, with regular follow-up to adjust therapy as needed 1.
Key Takeaways
- Topical metronidazole 0.75% gel or cream is a effective treatment for reducing inflammatory lesions and perilesional erythema associated with rosacea
- Doxycycline (40mg daily or 100mg twice daily) can be used for more severe cases or those with significant inflammatory lesions
- Lifestyle modifications, such as avoiding triggers and using gentle skincare products, are essential for managing rosacea.
From the Research
Treatment Options for Rosacea
- Topical medications such as azelaic acid, metronidazole, and sulfacetamide/sulfur are commonly used to treat rosacea 2, 3, 4, 5
- Oral antibiotics like tetracyclines and oral retinoids can be used alone or in combination to manage rosacea 2, 3, 4, 5
- Light-based therapies, including intense pulsed light and pulsed dye laser, are effective for the erythemato-telangiectatic type of rosacea 2, 3
- Newer treatment options include topical brimonidine, oxymetazoline, ivermectin, tacrolimus, pimecrolimus, and botulinum toxin 2, 5
Subtypes of Rosacea and Their Treatment
- Erythematotelangiectatic rosacea can be treated with topical brimonidine and oxymetazoline for persistent erythema, and vascular lasers and light devices for telangiectases 3, 5
- Papulopustular rosacea can be treated with topical azelaic acid, ivermectin, metronidazole, and oral doxycycline, tetracycline, and isotretinoin 3, 4, 5
- Phymatous rosacea is treated primarily with laser or light-based therapies 3, 5
- Ocular rosacea can be managed with lid hygiene, topical cyclosporine, and topical or systemic antibiotics 3, 5