From the Guidelines
Treatment for rosacea should prioritize topical metronidazole (0.75% or 1% gel or cream applied once or twice daily) as the first-line option, given its efficacy in reducing inflammatory lesions and perilesional erythema, as demonstrated in studies such as 1.
Topical Treatments
- Metronidazole (0.75% or 1% gel or cream applied once or twice daily) is effective in reducing inflammatory lesions and perilesional erythema, with a 65% decrease in inflammatory lesion counts compared to a 15% reduction for vehicle 1.
- Azelaic acid (15-20% applied twice daily) has anti-inflammatory activity and can improve rosacea symptoms, with 51% of subjects achieving marked improvement or complete remission in a 12-week study 1.
- Ivermectin (1% cream applied once daily) has been shown to reduce inflammatory lesions and improve symptoms, with 38.4% and 40.1% of subjects achieving treatment success in two 12-week studies 1.
- Brimonidine (0.33% gel) can provide temporary reduction of redness.
Oral Treatments
- Doxycycline (40-100mg daily for 8-12 weeks) is an effective oral antibiotic for moderate to severe rosacea, with a mean inflammatory lesion reduction of 11.8 and 9.5 in two studies 1.
- Minocycline (50-100mg daily) is another oral antibiotic option for moderate to severe rosacea.
Lifestyle Modifications
- Avoiding triggers such as spicy foods, alcohol, extreme temperatures, sun exposure, and stress is crucial.
- Daily use of gentle cleansers, fragrance-free moisturizers, and broad-spectrum sunscreen (SPF 30+) is essential.
Other Options
- Laser and light therapies can effectively reduce persistent redness and visible blood vessels.
- Oral isotretinoin may be considered for severe cases or those with ocular involvement.
From the Research
Treatment Options for Rosacea
The treatment options for rosacea include:
- Topical agents such as metronidazole, azelaic acid, and sodium sulfacetamide-sulfur 2, 3, 4, 5
- Oral antibiotics like tetracycline, doxycycline, and metronidazole 2, 6, 4, 5
- Laser and light-based therapies for telangiectasias and rhinophyma 4
- Surgical procedures for severe cases 4
- Cosmetic camouflage to cover the signs of rosacea 4
Topical Treatments
Topical treatments are often used as the first line of treatment for mild rosacea, and include:
- Metronidazole 1.0% cream or gel, which has been shown to be effective in reducing inflammatory lesions and erythema 2, 3, 5
- Azelaic acid 15% gel, which has been shown to be effective in reducing papules and pustules 2, 3
- Sodium sulfacetamide-sulfur, which is often used in combination with other topical agents 3, 5
Oral Treatments
Oral treatments are often used for moderate to severe rosacea, and include:
- Tetracycline, which has been shown to be effective in reducing inflammatory lesions and erythema 2, 4, 5
- Doxycycline, which has been shown to be effective in reducing inflammatory lesions and erythema at subantimicrobial doses 2, 6
- Metronidazole, which has been shown to be effective in reducing inflammatory lesions and erythema 6, 4, 5
- Isotretinoin, which is often used for severe or recalcitrant cases of rosacea 6, 4