From the Guidelines
Rosacea treatment should prioritize topical metronidazole (0.75% or 1% gel or cream applied twice daily) as a first-line option for mild to moderate cases, due to its efficacy in reducing inflammatory lesions and perilesional erythema, as demonstrated in a 9-week split-face study 1.
Treatment Options
- Topical treatments: metronidazole (0.75% or 1% gel or cream applied twice daily), azelaic acid (15-20% applied twice daily), or ivermectin 1% cream (applied once daily) are effective first-line options for mild to moderate rosacea.
- Oral antibiotics: doxycycline (40-100mg daily for 8-12 weeks) may be prescribed for more severe cases or those with significant inflammatory lesions, as shown in a 16-week study 2.
- Persistent facial redness: brimonidine 0.33% gel or oxymetazoline 1% cream applied once daily can be used.
- Ocular rosacea: artificial tears and eyelid hygiene are recommended, with oral doxycycline if needed.
Skincare Practices
- Gentle, fragrance-free cleansers
- Broad-spectrum sunscreen daily
- Avoid known triggers (like spicy foods, alcohol, extreme temperatures)
- Consider laser or light therapy for persistent redness or visible blood vessels ### Key Considerations
- Treatment should be tailored to the specific symptoms and severity of rosacea.
- A phenotype-led treatment algorithm can be used to guide treatment decisions, as recommended by the global rosacea consensus (ROSco) panel 3.
- Combination therapy may be necessary to address multiple symptoms and features of rosacea.
- Patient education and trigger factor avoidance are important aspects of rosacea management, as emphasized by the ROSco panel 4.
From the Research
Rosacea Treatment Options
- Topical metronidazole and azelaic acid are commonly used to treat rosacea, with studies showing similar efficacy in reducing inflammatory lesion counts and erythema 5, 6
- Metronidazole has been used for over 30 years to treat rosacea, with several placebo-controlled trials demonstrating its effectiveness in moderate-to-severe cases 7
- Combination therapy with topical metronidazole and other agents, such as sulfacetamide and sulfur, may provide additive benefits in managing rosacea 8
- Oral antibiotics, such as doxycycline, can be used in combination with topical metronidazole to treat rosacea, with subantimicrobial doses showing efficacy in reducing inflammatory lesions and erythema 6
- Low-dose isotretinoin has been shown to be effective in treating papulopustular rosacea, including severe cases, with once-weekly administration being a potential treatment option 9
Treatment Efficacy
- Metronidazole 1% gel and azelaic acid 15% gel have been shown to have similar efficacy in reducing inflammatory lesion counts and erythema, with success rates of 53.7% and 56.4%, respectively 5
- Topical metronidazole has been shown to be effective in preventing relapses of rosacea and allowing for longer intervals between flares 6, 7
- Low-dose isotretinoin has been shown to be effective in achieving complete or partial response in patients with severe rosacea, with 62.5% of patients achieving complete response and 29.2% achieving partial response 9