What are the treatment options for rosacea in men?

From the Guidelines

Rosacea treatment in men 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. Topical treatments are typically the initial approach and may also include azelaic acid (15-20% applied twice daily), ivermectin (1% cream applied once daily), and brimonidine (0.33% gel for temporary reduction of redness). For moderate to severe cases, oral antibiotics like doxycycline (40-100mg daily for 8-12 weeks) or minocycline (50-100mg daily) are effective, especially for inflammatory lesions, with doxycycline showing significant improvement in lesion reduction as seen in 1. Isotretinoin may be considered for severe, resistant cases at 0.3-0.5mg/kg daily for 12-16 weeks. Lifestyle modifications are crucial, including avoiding triggers such as spicy foods, alcohol, extreme temperatures, and sun exposure, and using gentle cleansers and broad-spectrum sunscreen daily. Laser and light therapies can also effectively treat persistent redness and visible blood vessels. Treatment should be tailored to the specific subtype of rosacea (erythematotelangiectatic, papulopustular, phymatous, or ocular) and severity of symptoms, as suggested by 1.

Some key points to consider in the treatment of rosacea in men include:

• The importance of individualizing treatment based on the severity and subtype of rosacea.
• The use of topical treatments as the first line of therapy, with oral antibiotics reserved for more severe cases.
• The role of lifestyle modifications in managing symptoms and preventing flare-ups.
• The potential benefits of laser and light therapies for persistent symptoms.
• The need for ongoing assessment and adjustment of treatment as necessary to achieve optimal outcomes, considering the latest evidence from studies like 1 and 1.

Given the variability in patient response and the potential for side effects, close monitoring and follow-up are essential components of rosacea management in men.

From the FDA Drug Label

CLINICAL STUDIES A controlled clinical study was conducted in 144 patients with moderate to severe rosacea, in which MetroLotion® Topical Lotion was compared with its vehicle. MetroLotion® Topical Lotion was significantly more effective than its vehicle in mean percent reduction of inflammatory lesions associated with rosacea and in the investigators’ global assessment of improvement

The treatment options for rosacea in men include topical metronidazole, as evidenced by the clinical study showing its effectiveness in reducing inflammatory lesions and improving global assessment of improvement 2.

• MetroLotion Topical Lotion has been shown to be effective in treating moderate to severe rosacea.
• The exact mechanisms of metronidazole in treating rosacea are unknown, but it is believed to have an anti-inflammatory effect 2.

From the Research

Treatment Options for Rosacea in Men

• Topical metronidazole is a commonly used treatment for rosacea, and it has been shown to be effective in reducing inflammatory lesions and erythema 3, 4, 5
• Oral antibiotics, such as tetracycline and doxycycline, can also be used to treat rosacea, especially in cases where topical treatments are not effective 3, 6
• Combination therapy, using both topical and oral treatments, can be an effective way to manage rosacea 3, 6
• Other treatment options, such as azelaic acid, sulfacetamide/sulfur, and retinoids, can also be used to treat rosacea 6, 7
• Light-based therapies, such as intense pulsed light and pulsed dye laser, can be used to treat the erythemato-telangiectatic type of rosacea 7

Topical Metronidazole

• Topical metronidazole has been shown to be effective in maintaining remissions of rosacea and reducing the risk of relapse 4, 5
• It can be used as a monotherapy or in combination with oral antibiotics 3, 4, 5
• Different formulations of topical metronidazole, such as cream, gel, and lotion, are available and can be effective in treating rosacea 3, 4

Oral Antibiotics

• Oral antibiotics, such as tetracycline and doxycycline, can be used to treat rosacea, especially in cases where topical treatments are not effective 3, 6
• They can be used at antimicrobial or subantimicrobial doses, and have been shown to be effective in reducing inflammatory lesions and erythema 3, 6

Other Treatments

• Azelaic acid, sulfacetamide/sulfur, and retinoids can be used to treat rosacea, especially in cases where topical metronidazole is not effective 6, 7
• Light-based therapies, such as intense pulsed light and pulsed dye laser, can be used to treat the erythemato-telangiectatic type of rosacea 7
• Newer treatments, such as topical brimonidine, oxymetazoline, ivermectin, tacrolimus, pimecrolimus, and botulinum toxin, are also being used to treat rosacea 7