From the Guidelines
Treatment for rosacea should prioritize topical metronidazole (0.75% or 1% gel or cream applied once or twice daily) as a first-line option, given its efficacy in reducing inflammatory lesions and perilesional erythema, as demonstrated in studies such as 1.
Key Treatment Options
- Topical treatments: metronidazole (0.75% or 1% gel or cream applied once or twice daily), azelaic acid (15-20% applied twice daily), ivermectin (1% cream applied once daily), and brimonidine (0.33% gel for temporary reduction of redness)
- Oral antibiotics: doxycycline (40-100mg daily for 8-12 weeks) or minocycline (50-100mg daily) for moderate to severe rosacea
- Lifestyle modifications: avoiding triggers like spicy foods, alcohol, extreme temperatures, sun exposure, and stress; daily use of gentle cleansers, fragrance-free moisturizers, and broad-spectrum sunscreen (SPF 30+)
Considerations for Treatment
- The choice of treatment should be guided by the severity and phenotype of rosacea, as well as the patient's individual concerns and preferences, as suggested by 1 and 1
- Combination therapy may be necessary for patients with multiple features of rosacea, and treatment should be allowed sufficient time to take effect before considering it a failure
- Oral doxycycline, particularly the 40-mg modified-release dose, is considered a viable treatment option for its anti-inflammatory effects, as noted in 1
Additional Therapies
- Laser and light therapies can be effective for reducing persistent redness and visible blood vessels
- Lifestyle modifications and general skincare are essential components of rosacea management, underlining the importance of patient education and trigger factor avoidance, as emphasized in 1 and 1
From the FDA Drug Label
Metronidazole gel USP (topical), 0.75%, is indicated for topical application in the treatment of inflammatory papules and pustules of rosacea. The treatment options for rosacea include topical metronidazole.
- Metronidazole gel USP (topical), 0.75% is specifically indicated for the treatment of inflammatory papules and pustules of rosacea 2. The exact mechanisms of action are unknown, but it is believed to have an anti-inflammatory effect 2.
From the Research
Treatment Options for Rosacea
The treatment options for rosacea include a range of topical and oral medications. Some of the commonly used topical treatments are:
- Metronidazole 3, 4, 5, 6
- Azelaic acid 3, 4, 6, 7
- Other antibiotics such as sulfur and retinoids 3
- Oral drugs like tetracyclines, metronidazole, and macrolides 3, 4
Topical Metronidazole
Topical metronidazole has been shown to be effective in treating rosacea, with studies demonstrating its efficacy in reducing inflammatory lesion counts and erythema 4, 5, 6. It can be used as a monotherapy or in combination with oral antibiotics 4. Maintenance treatment with topical metronidazole has also been shown to decrease relapses and allow for longer intervals between flares 5.
Combination Therapy
Combination therapy with oral antibiotics and topical treatments may be necessary for severe cases of rosacea 3, 4, 7. In some cases, the first choice is a systemic therapy because patients may have sensitive skin and topical medications can be irritant 3.
Other Treatments
Other treatments for rosacea include:
- Isotretinoin for resistant cases 3
- Adapted antibiotic protocols for patients with Helicobacter pylori infection or small intestinal bacterial overgrowth 3
- Topical crotamiton 10% or metronidazole for Demodex folliculorum infestation 3
- Brimonidine, an alpha-2-adrenoreceptor agonist, for the topical treatment of erythema in rosacea 7