From the Guidelines
The best treatment for rosacea is a combination of topical and oral medications, along with lifestyle modifications, with ivermectin 1% cream being a highly effective first-line treatment for mild to moderate papulopustular rosacea, as shown in a 2024 study 1. For mild to moderate papulopustular rosacea, topical metronidazole (0.75% or 1% applied once or twice daily), azelaic acid (15-20% applied twice daily), or ivermectin 1% cream (applied once daily) are first-line treatments.
- Ivermectin 1% cream has been shown to be effective in reducing inflammatory lesions and improving symptoms of rosacea, with a study demonstrating a 83% reduction in lesion counts after 16 weeks of treatment 1.
- For more severe cases or those not responding to topicals, oral antibiotics such as doxycycline (40mg daily for anti-inflammatory effects) may be prescribed for 8-12 weeks, as recommended by the global rosacea consensus (ROSco) panel in 2017 1.
- Erythematotelangiectatic rosacea often responds to brimonidine 0.33% gel for temporary redness reduction, while severe or resistant cases might require isotretinoin.
- Ocular rosacea typically needs artificial tears and eyelid hygiene, sometimes with oral antibiotics. Alongside medications, patients should:
- Identify and avoid personal triggers (such as spicy foods, alcohol, extreme temperatures)
- Use gentle skincare products
- Apply broad-spectrum sunscreen daily
- Consider laser or intense pulsed light therapy for persistent redness or visible blood vessels. These treatments work by reducing inflammation, controlling skin microbes like Demodex mites, constricting blood vessels, or addressing immune system dysregulation that contributes to rosacea symptoms, as discussed in a 2024 review of the current treatment landscape for rosacea 1.
From the Research
Treatment Options for Rosacea
The treatment of rosacea can involve various approaches, including topical medications, oral antibiotics, and light-based therapies. Some of the key treatment options include:
- Topical metronidazole, which has been shown to be effective in reducing inflammatory lesion counts and erythema 2, 3
- Topical azelaic acid, which has also been demonstrated to be effective in treating rosacea 2, 4
- Oral doxycycline, which can be used at anti-inflammatory doses to treat moderate to severe rosacea 3, 4
- Combination therapy, which may involve the use of topical metronidazole and oral doxycycline, and has been suggested to have synergy effects 4
Topical Treatments
Topical treatments are often the first line of treatment for rosacea, and can include:
- Metronidazole 1% gel or cream, which can be applied once or twice daily 2, 3
- Azelaic acid 15% gel, which can be applied twice daily 2, 4
- Sulfacetamide/sulfur, which can be used as an alternative to metronidazole or azelaic acid 5
Oral Treatments
Oral treatments may be used in more severe cases of rosacea, or in cases where topical treatments are not effective. Some oral treatment options include:
- Doxycycline, which can be used at anti-inflammatory doses to treat moderate to severe rosacea 3, 4
- Tetracyclines, which can be used to treat papulopustular rosacea 6
- Isotretinoin, which can be used in resistant cases of rosacea 6
Light-Based Therapies
Light-based therapies, such as intense pulsed light and pulsed dye laser, can be used to treat the erythemato-telangiectatic type of rosacea 5. These therapies can help to reduce the appearance of redness and visible blood vessels.