From the Guidelines
Treatment for rosacea should be individualized based on the subtype and severity of the condition, with first-line options including topical metronidazole, azelaic acid, and oral doxycycline, as well as lifestyle modifications to avoid triggers and reduce symptoms. When considering treatment options, it's essential to prioritize the most recent and highest quality studies. According to the most recent study 1, metronidazole is an effective treatment for reducing inflammatory lesions and perilesional erythema associated with rosacea. Some key points to consider when treating rosacea include:
- Topical treatments, such as metronidazole (0.75% or 1% gel or cream applied once or twice daily) and azelaic acid (15-20% applied twice daily), are typically first-line options 1
- Oral antibiotics, such as doxycycline (40mg daily as anti-inflammatory dose) for 8-12 weeks, may be prescribed for moderate to severe cases 1
- Lifestyle modifications, including avoiding triggers such as spicy foods, alcohol, extreme temperatures, sun exposure, and stress, are crucial for managing rosacea symptoms 1
- Daily use of gentle cleansers, fragrance-free moisturizers, and broad-spectrum sunscreen (SPF 30+) is essential for maintaining healthy skin and reducing symptoms 1 It's also important to note that rosacea is a chronic inflammatory condition, and maintenance therapy is often needed after initial improvement to control symptoms and prevent relapse 1.
From the FDA Drug Label
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 mentioned in the drug label is the use of azelaic acid cream, which should be applied twice daily to the affected areas.
- The application involves washing and drying the skin, then massaging a thin film of the cream into the affected areas.
- The hands should be washed following application. 2
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 3 Some of the key treatment options include:
- Topical medications such as metronidazole, azelaic acid, and sulfacetamide/sulfur
- Oral antibiotics such as tetracyclines
- Oral retinoids
- Light therapies such as intense pulsed light and pulsed dye laser 4
Topical Metronidazole
Topical metronidazole has been shown to be effective in the treatment of moderate to severe rosacea, with significant reductions in papules and pustules 5, 6 The exact mechanism of action of topical metronidazole is not fully understood, but it is thought to have anti-inflammatory or immunosuppressive effects 7 Topical metronidazole is available in various formulations, including 0.75% and 1% cream, 0.75% gel, and 0.75% lotion 5, 6
Other Treatment Options
Other treatment options for rosacea include:
- Nonselective β-blockers and α2-adrenergic agonists to decrease erythema and flushing 3
- Topical α-adrenergic receptor agonist brimonidine tartrate 0.5% to reduce persistent facial erythema 3
- Intradermal botulinum toxin injection to reduce erythema and flushing 3
- Flashlamp-pumped dye, potassium-titanyl-phosphate and pulsed-dye laser, and intense pulsed light to treat telangiectasias 3
- Dermatosurgical procedures, decortication, and various types of lasers to correct rhinophyma 3