From the Guidelines
Rosacea management options include topical and systemic treatments, as well as lifestyle modifications.
Treatment Options
- Topical treatments: metronidazole gel, azelaic acid gel and foam, ivermectin cream, minocycline foam, encapsulated benzoyl peroxide 5% (E-BPO 5%), brimonidine gel, and oxymetazoline HCl cream 1
- Systemic treatments: oral doxycycline, particularly the 40-mg modified-release dose, which has anti-inflammatory but not antibiotic activity 1
Lifestyle Modifications
- Long-term avoidance of common triggers
- Use of gentle skin care
- Adherence to pharmacologic treatment 1
Key Considerations
- Phenotype-based medical management of rosacea, where treatment is tailored to the individual patient's signs and symptoms 1
- Combination therapy may be necessary for optimal treatment outcomes, particularly for patients with multiple rosacea features 1
- Treatment should be allowed sufficient time to take effect before considering it a failure and choosing another option, with study duration typically ranging from 6 to 12 weeks 1
From the Research
Management Options for Rosacea
The management of rosacea involves a combination of topical and systemic therapies, laser and light-based therapies, and surgical procedures 2, 3, 4, 5, 6.
- Topical treatment agents include:
- Metronidazole
- Azelaic acid
- Sodium sulfacetamide-sulfur
- Brimonidine
- Ivermectin
- Oxymetazoline
- Systemic therapies include:
- Tetracyclines
- Oral retinoids
- Laser and light-based therapies are effective for:
- Erythemato-telangiectatic type
- Phymatous rosacea
- Surgical procedures may be necessary for:
- Phymatous rosacea
Treatment Approach
The treatment approach for rosacea is often tailored to the individual patient and may involve a combination of therapies 3, 5, 6.
- The National Rosacea Society Expert Committee recommends a phenotype-based classification for therapy 3, 4
- Treatment starts with avoidance of triggers and use of mild cleansing agents and moisturizing regimens, as well as photoprotection with wide-brimmed hats and broad-spectrum sunscreens (minimum sun protection factor of 30) 3
- Topical medications are often used as first-line treatment for erythematous and mild to severe papulopustular rosacea 5
Specific Therapies
Specific therapies are available for different subtypes of rosacea 2, 3, 6.
- Erythematotelangiectatic rosacea: topical metronidazole or azelaic acid, brimonidine
- Papulopustular rosacea: topical metronidazole or azelaic acid, systemic tetracyclines
- Phymatous rosacea: laser or light-based therapies
- Ocular rosacea: lid hygiene, topical cyclosporine, topical or systemic antibiotics 3