What are the treatment options for rosacea?

From the Guidelines

Rosacea treatment should prioritize a combination of topical medications, oral antibiotics, and lifestyle modifications to control symptoms and prevent progression, with doxycycline 40 mg daily being a highly effective oral antibiotic option, as demonstrated in recent studies 1. The treatment of rosacea typically involves a multi-faceted approach, including topical treatments, oral antibiotics, and lifestyle changes. For mild to moderate rosacea, topical treatments such as metronidazole 0.75% cream or gel, applied twice daily, or azelaic acid 15% gel, applied once or twice daily, can help reduce redness and inflammation, as shown in studies 2, 3. Some key points to consider when treating rosacea include:

• Topical metronidazole has been shown to be effective in reducing inflammatory lesions and perilesional erythema associated with rosacea, with a 65% decrease in inflammatory lesion counts compared to a 15% reduction for vehicle 2.
• Azelaic acid 15% gel has been FDA-approved for rosacea since 2002 and has been shown to improve rosacea by exerting anti-inflammatory activity on the cathelicidin pathway, with 51% of subjects achieving marked improvement or complete remission in one study 3.
• Oral antibiotics like doxycycline (40-100 mg daily) may be prescribed for 3-4 months for more severe cases or those not responding to topical treatments, with doxycycline 40 mg daily being a highly effective option, as demonstrated in recent studies 1. In addition to medications, lifestyle changes are crucial, including:
• Avoiding known triggers such as spicy foods, alcohol, hot beverages, and extreme temperatures
• Using gentle, fragrance-free skincare products
• Applying a broad-spectrum sunscreen (SPF 30 or higher) daily
• Considering laser therapy for visible blood vessels It's essential to note that rosacea is a chronic condition requiring ongoing management, and treatment plans should be personalized and may need adjustment over time, with the goal of controlling symptoms and preventing progression, as medications work by reducing inflammation and controlling the overgrowth of skin bacteria associated with rosacea, while lifestyle changes help minimize flare-ups by avoiding triggers that cause blood vessels to dilate.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION After the skin is thoroughly washed and patted dry, a thin film of AZELEX® Cream should be gently but thoroughly massaged into the affected areas twice daily, in the morning and evening. The treatment option for rosacea is applying a thin film of azelaic acid cream to the affected areas twice daily 4.

• The hands should be washed following application.
• The duration of use can vary from person to person and depends on the severity of the condition.
• Improvement of the condition occurs in the majority of patients with inflammatory lesions within four weeks 5.

From the Research

Treatment Options for Rosacea

The treatment options for rosacea include:

• Topical metronidazole, which has been shown to be effective in reducing inflammatory lesions and erythema associated with rosacea 6, 7, 8, 9, 10
• Topical azelaic acid, which has been approved for the treatment of rosacea and has been shown to be effective in reducing inflammatory lesion counts and erythema 7, 8, 9, 10
• Oral antibiotics, such as doxycycline, which can be used in combination with topical agents to treat moderate to severe papulopustular rosacea 6, 9, 10
• Combination therapy with topical and systemic agents, which can be effective in treating severe forms of rosacea 8, 9
• Maintenance treatment with topical metronidazole, which can help decrease relapses and allow for longer intervals between flares 6

Topical Therapies

Topical therapies for rosacea include:

• Metronidazole 1.0% cream or gel, which has been shown to be effective in reducing inflammatory lesions and erythema associated with rosacea 6, 7
• Azelaic acid 15% gel, which has been shown to be effective in reducing inflammatory lesion counts and erythema 7
• Sulfacetamide/sulfur, which can be used to treat mild rosacea 10
• Brimonidine, an alpha-2-adrenoreceptor agonist, which will be approved soon for the topical treatment of erythema in rosacea 8

Systemic Therapies

Systemic therapies for rosacea include:

• Oral doxycycline, which can be used in combination with topical agents to treat moderate to severe papulopustular rosacea 6, 9, 10
• Oral tetracyclines, which can be used in combination with topical agents to treat moderate papulopustular rosacea 10
• Low-dose minocycline and isotretinoin, which may be effective in treating rosacea, but more data is needed to draw final conclusions 9