From the Guidelines
The preferred treatment for rosacea is a phenotype-led approach, with first-line treatments including topical medications such as metronidazole, azelaic acid, or ivermectin, and oral antibiotics like doxycycline for moderate to severe cases, as recommended by the global Rosacea Consensus (ROSCO) panel 1.
Treatment Options
- Topical medications:
- 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)
- Oral antibiotics:
- Doxycycline (40mg daily as anti-inflammatory dose) for 8-12 weeks
Lifestyle Modifications
- Avoiding triggers like spicy foods, alcohol, extreme temperatures, and sun exposure
- Using gentle, fragrance-free cleansers
- Applying broad-spectrum sunscreen daily
- Using moisturizers to repair skin barrier function
Additional Therapies
- Laser therapy (pulsed dye or intense pulsed light) to reduce persistent redness and visible blood vessels
- Artificial tears and eyelid hygiene for ocular rosacea, sometimes with oral antibiotics It is essential to note that treatment success depends on consistent application and patience, as results may take several weeks to become noticeable, and the newest topical agent, encapsulated benzoyl peroxide 5% (E-BPO 5%), shows promise in enhancing therapeutic response and minimizing skin irritation 1.
Recent Developments
- E-BPO 5% offers a promising addition to the treatment options due to its microencapsulation technology, which prolongs drug delivery time and aims to improve therapeutic response while minimizing skin irritation 1.
- The global Rosacea Consensus (ROSCO) panel recommends a phenotype-led treatment approach, considering each feature and its severity individually 1.
- Doxycycline 40mg daily has been shown to be effective in reducing inflammatory lesions and is as effective as doxycycline 100mg for moderate-to-severe rosacea 1.
From the Research
Treatment Options for Rosacea
The treatment for rosacea can vary depending on the severity and type of symptoms. Some of the preferred treatment options include:
- Topical medications such as azelaic acid, metronidazole, and sulfacetamide/sulfur 2, 3, 4
- Oral antibiotics such as tetracyclines, and oral retinoids alone or in combination 2, 3
- Light therapies such as intense pulsed light and pulsed dye laser for the erythemato-telangiectatic type 2
- Topical brimonidine, oxymetazoline, ivermectin, tacrolimus, pimecrolimus, low-dose modified-release tetracyclines and botulinum toxin as new additions to the therapeutic armamentarium 2, 5
Specific Treatment Recommendations
Some specific treatment recommendations include:
- Topical brimonidine and oxymetazoline for persistent erythema 5
- Topical azelaic acid, ivermectin, metronidazole, minocycline and oral doxycycline, tetracycline and isotretinoin for papules and pustules 5
- Vascular lasers and light devices for telangiectases 5
- Omega-3 fatty acids and cyclosporine ophthalmic emulsion for ocular rosacea 5
Combination Therapies
Combination therapies can also be effective in treating rosacea, including: