From the Guidelines
The most effective treatment for rosacea involves a combination of lifestyle changes and medical treatments, with metronidazole 0.75% or 1% gel/cream being the first-line topical treatment, as evidenced by a recent study published in 2024 1. The management of rosacea can be broken down into several key components:
- Lifestyle modifications:
- Avoid triggers: Identify and avoid factors that worsen symptoms (e.g., sun exposure, spicy foods, alcohol, hot beverages)
- Use gentle skincare: Non-irritating cleansers and moisturizers
- Sun protection: Daily use of broad-spectrum SPF 30+ sunscreen
- Topical treatments:
- First-line: Metronidazole 0.75% or 1% gel/cream, applied twice daily
- Alternative: Azelaic acid 15% gel, applied twice daily
- For persistent erythema: Brimonidine 0.33% gel, applied once daily
- Oral medications:
- For moderate to severe cases: Doxycycline 40-100 mg daily for 6-12 weeks, as supported by a study published in 2024 1
- For severe cases: Isotretinoin 0.3-1 mg/kg/day for 4-6 months (under specialist supervision)
- Additional treatments:
- For telangiectasia: Laser or intense pulsed light therapy
- For rhinophyma: Surgical or laser treatments It's essential to start with lifestyle changes and topical treatments, and if symptoms persist, add oral medications. Severe cases may require combination therapy or referral to a dermatologist. This approach targets the inflammatory and vascular components of rosacea, with topical agents reducing inflammation and killing bacteria, while oral antibiotics have anti-inflammatory effects. Brimonidine constricts blood vessels to reduce redness, and long-term management often requires ongoing treatment and regular follow-ups to adjust therapy as needed, as recommended by the global rosacea consensus panel in 2017 1.
From the Research
Treatment Options for Rosacea
The treatment options for rosacea can be divided into several categories, including:
- Patient education
- Skin care
- Pharmacological/procedural interventions 2 Some of the specific treatment options for rosacea include:
- Topical medications such as azelaic acid, metronidazole, and sulfacetamide/sulfur 3
- Oral antibiotics such as tetracyclines, and oral retinoids alone or in combination 3
- Light therapies such as intense pulsed light and pulsed dye laser, which are best used for the erythemato-telangiectatic type 3
- Topical brimonidine, oxymetazoline, ivermectin, tacrolimus, pimecrolimus, low-dose modified-release tetracyclines and botulinum toxin, which are new additions to the therapeutic armamentarium 3
Topical Treatments
Topical treatments for rosacea include:
- Brimonidine for erythema 2, 4
- Ivermectin, metronidazole, or azelaic acid for inflammatory lesions 2, 4
- Metronidazole 1% and azelaic acid 15% cream to reduce the severity of erythema 2
- Sodium sulfacetamide, ivermectin 1%, permethrin 5%, and retinoid for papulopustules 2
Systemic Treatments
Systemic treatments for rosacea include:
- Metronidazole, doxycycline, minocycline, clarithromycin, and isotretinoin for papulopustules 2
- Oral antibacterial for ocular involvement 2
- Omega-3 fatty acids and cyclosporine ophthalmic emulsion for ocular rosacea 5
Procedural Interventions
Procedural interventions for rosacea include:
- Flashlamp-pumped dye, potassium-titanyl-phosphate and pulsed-dye laser, and intense pulsed light for telangiectasias 2
- Dermatosurgical procedures, decortication, and various types of lasers for rhinophyma 2
- Vascular lasers and light devices for telangiectases 5
- Surgical or laser therapy for clinically noninflamed phyma 5
Skin Care
Skin care for rosacea includes: