What are the treatment options for Rosacea?

From the Guidelines

Rosacea treatment should prioritize a combination of topical and oral medications, along with lifestyle modifications, with a focus on reducing inflammation and addressing individual patient concerns, as recommended by the most recent and highest quality study 1. The treatment approach for rosacea can be tailored to the individual patient's needs, taking into account the severity of symptoms and the presence of specific features such as inflammatory papules, pustules, and persistent erythema.

• For mild to moderate rosacea, topical metronidazole (0.75% or 1% gel or cream) applied twice daily, azelaic acid (15-20% gel or cream) applied twice daily, or ivermectin 1% cream applied once daily can be effective in reducing inflammation and killing skin bacteria that may contribute to symptoms 1.
• For more severe cases or those with significant papules and pustules, oral antibiotics like doxycycline (40-100mg daily) for 8-12 weeks can be effective, with doxycycline 40 mg being a viable option for its anti-inflammatory properties and reduced gastrointestinal side-effects 1.
• Lifestyle modifications are crucial and include avoiding triggers like spicy foods, alcohol, extreme temperatures, sun exposure, and stress, as well as using gentle skincare products, applying broad-spectrum sunscreen daily, and avoiding scrubbing the face 1. The goal of treatment is to reduce symptoms, improve quality of life, and prevent long-term complications, with a focus on individualized care and ongoing management, as rosacea is a chronic condition 1.

From the FDA Drug Label

After the skin is thoroughly washed and patted dry, a thin film of AZELEX® Cream should be gently but thoroughly massaged into the affected areas twice daily, in the morning and evening. If sensitivity or severe irritation develop with the use of AZELEX® Cream, treatment should be discontinued and appropriate therapy instituted.

The treatment option for Rosacea is azelaic acid cream, which should be applied twice daily to the affected areas.

• The hands should be washed following application.
• If sensitivity or severe irritation develops, treatment should be discontinued and alternative therapy instituted 2 2.

From the Research

Treatment Options for Rosacea

The treatment options for rosacea can be divided into several categories, including:

• Patient education
• Skin care
• Pharmacological/procedural interventions 3 Some of the specific treatment options for rosacea include:
• Topical medications such as azelaic acid, metronidazole, and sulfacetamide/sulfur 4, 5
• Oral antibiotics such as tetracyclines 4, 6, 7
• Oral retinoids 4, 6
• Light-based therapies such as intense pulsed light and pulsed dye laser 4, 6
• Laser therapy for telangiectasias and phymatous rosacea 3, 6, 7
• Surgical procedures for rhinophyma 3

Topical Therapies

Topical therapies play a critical role in the treatment of patients with papulopustular rosacea and erythematotelangiectatic rosacea 5. Some of the primary agents for the topical treatment of rosacea are:

• Metronidazole 5, 7
• Azelaic acid 5, 7
• Sodium sulfacetamide-sulfur 5, 6 Additional topical therapies include:
• Benzoyl peroxide 5
• Clindamycin 5
• Retinoids 5
• Topical steroids 5
• Calcineurin inhibitors 5
• Permethrin 5

Systemic Therapies

Systemic therapies are used to treat papulopustular rosacea and include:

• Tetracyclines 4, 6, 7
• Doxycycline 6, 7
• Isotretinoin 6, 7
• Minocycline 3
• Clarithromycin 3

Light-Based Therapies

Light-based therapies are used to treat erythema and telangiectasias, and include:

• Intense pulsed light 4, 6
• Pulsed dye laser 4, 6
• Flashlamp-pumped dye laser 3
• Potassium-titanyl-phosphate laser 3