From the Guidelines
Treatment for rosacea should prioritize topical metronidazole, azelaic acid, or ivermectin as first-line options, with oral doxycycline or minocycline considered for moderate to severe cases, as these treatments have demonstrated efficacy in reducing inflammatory lesions and improving quality of life, as shown in studies such as 1, 1, and 1. The choice of treatment depends on the severity and phenotype of rosacea, with lifestyle modifications, including avoiding triggers and using gentle skincare products, also playing a crucial role in managing the condition. Some key points to consider in the treatment of rosacea include:
- Topical metronidazole (0.75% or 1% gel or cream) applied once or twice daily, as it has been shown to reduce inflammatory lesions and perilesional erythema, with a 65% decrease in inflammatory lesion counts compared to vehicle in a 9-week split-face study 1.
- Azelaic acid (15-20% applied twice daily) is another effective topical treatment, with a 51% achievement of marked improvement or complete remission in a 12-week double-blind, randomized, parallel-group, vehicle-controlled study 1.
- Ivermectin (1% cream applied once daily) has also demonstrated efficacy, with a 38.4% and 40.1% achievement of treatment success in two 12-week, double-blind, randomized controlled trials 1.
- Oral doxycycline (40-100mg daily for 8-12 weeks) or minocycline (50-100mg daily) may be considered for moderate to severe rosacea, with doxycycline 40mg showing superiority to placebo and non-inferiority to doxycycline 100mg in a phase 3 trial 1.
- Lifestyle modifications, such as avoiding triggers, using gentle skincare products, and protecting the skin from the sun, are essential in managing rosacea, as they can help reduce symptoms and improve quality of life, as recommended by the global Rosacea Consensus (ROSCO) panel 1.
From the Research
Treatment Options for Rosacea
The treatment options for rosacea include a range of topical and oral medications, as well as other therapies. Some of the available treatment options are:
- Topical medications such as metronidazole, azelaic acid, and sodium sulfacetamide-sulfur 2, 3, 4, 5
- Oral medications such as tetracyclines, metronidazole, and macrolides 2, 3
- Systemic therapy for patients with sensitive skin or in cases where topical medications are irritant 2, 3
- Isotretinoin for resistant cases of rosacea 2, 3
- Topical crotamiton 10% or metronidazole for Demodex folliculorum infestation 2, 3
- Brimonidine for erythema and ivermectin, metronidazole or azelaic acid for inflammatory lesions 6
- Laser and light-based therapies, and surgical procedures 4, 5
Topical Therapies
Topical therapies play a critical role in the treatment of patients with papulopustular rosacea and erythematotelangiectatic rosacea. The primary agents for the topical treatment of rosacea are:
- Metronidazole 2, 3, 6, 4, 5
- Azelaic acid 2, 3, 6, 4, 5
- Sodium sulfacetamide-sulfur 4, 5 Additional topical therapies include benzoyl peroxide, clindamycin, retinoids, topical steroids, calcineurin inhibitors, and permethrin 4, 5
Oral Therapies
Oral therapies are often used in combination with topical therapies to treat rosacea. Some of the available oral therapies include: