What are the treatment options for managing rosacea?

From the Guidelines

Rosacea treatment should involve a combination of lifestyle changes, topical medications, oral medications, and procedural interventions tailored to the specific subtype and severity, with metronidazole, azelaic acid, and doxycycline being key treatment options. Lifestyle modifications include avoiding triggers like sun exposure, spicy foods, alcohol, and extreme temperatures, while using gentle skincare products and daily broad-spectrum sunscreen. For mild to moderate cases, topical treatments are the first line of defense, including:

• Metronidazole (0.75% or 1% applied once or twice daily) 1
• Azelaic acid (15-20% applied twice daily) 1
• Ivermectin 1% cream (applied once daily)
• Brimonidine 0.33% gel for temporary redness relief When topical treatments are insufficient, oral antibiotics like doxycycline (40-100mg daily for 8-12 weeks) 1 or isotretinoin (0.3-1mg/kg/day for severe cases) may be prescribed. For ocular rosacea, artificial tears, lid hygiene, and sometimes oral antibiotics are recommended. Persistent redness and visible blood vessels can be addressed with laser or intense pulsed light therapy, while rhinophyma may require surgical intervention. Treatment success often requires a consistent, long-term approach combining multiple strategies, as rosacea is a chronic condition that can be managed but not cured, with regular follow-ups with a dermatologist important to adjust treatment as needed based on response and tolerance 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Treatment Options for Managing Rosacea

The treatment options for managing rosacea include:

• Topical metronidazole, which has been well studied as a rosacea therapy 2
• Topical azelaic acid, which is also effective in treating rosacea 2, 3, 4
• Oral antibiotics, such as doxycycline, which can be used in combination with topical metronidazole 2, 3, 5
• Other topical treatments, including sulfur, retinoids, and sodium sulfacetamide-sulfur 5, 6
• Systemic therapies, such as isotretinoin, which can be used in resistant cases of rosacea 5
• Laser and light-based therapies, and surgical procedures, which can also be used to treat rosacea 6

Topical Treatments

Topical treatments are often the first line of treatment for rosacea, and include:

• Metronidazole 1.0% cream or gel, which is as effective as 250 mg tetracycline twice daily 2
• Azelaic acid 15% gel, which is as effective as metronidazole 1.0% gel 4
• Sodium sulfacetamide-sulfur, which is a standard topical treatment agent for rosacea 6

Systemic Treatments

Systemic treatments, such as oral antibiotics, can be used in combination with topical treatments to manage rosacea, and include:

• Doxycycline, which is effective in decreasing inflammatory lesions and erythema associated with rosacea 2, 3, 5
• Isotretinoin, which can be used in resistant cases of rosacea 5
• Minocycline, which may be a useful alternative to doxycycline, but more research is needed to confirm its effectiveness 3