From the Guidelines
Rosacea treatment should prioritize topical metronidazole (0.75% or 1% gel or cream applied twice daily) as a first-line treatment, given its efficacy in reducing inflammatory lesions and perilesional erythema, as demonstrated in multiple studies, including a 6-month double-blind placebo-controlled study 1. The treatment of rosacea typically involves a combination of skincare practices, medications, and lifestyle changes tailored to the specific subtype and severity.
- For mild to moderate rosacea, topical medications like metronidazole (0.75% or 1% gel or cream applied twice daily) are effective in reducing inflammatory lesions, with a 65% decrease in inflammatory lesion counts compared to a 15% reduction for vehicle 1.
- Azelaic acid (15-20% applied twice daily) is also a viable option, with studies showing a 51% improvement in inflammatory lesions compared to 43% with vehicle 1.
- For more severe or inflammatory rosacea, oral antibiotics such as doxycycline (40-100mg daily for 8-12 weeks) may be prescribed, with a study demonstrating a mean reduction in lesions of 11.8 in one study and 9.5 in another, compared to reductions of 5.9 and 4.3, respectively, in placebo-treated subjects 1.
- Persistent facial redness can be treated with brimonidine 0.33% gel or oxymetazoline 1% cream applied once daily.
- For ocular rosacea, artificial tears and eyelid hygiene are recommended, sometimes with oral antibiotics.
- Laser or intense pulsed light therapy can help reduce visible blood vessels. Patients should adopt gentle skincare using mild, fragrance-free cleansers, apply broad-spectrum sunscreen daily, identify and avoid personal triggers (such as spicy foods, alcohol, extreme temperatures), and use moisturizers to maintain skin barrier function.
- Minocycline 1.5% foam is also an option, with studies showing a statistically significant greater reduction in inflammatory lesion counts compared to vehicle, and a low incidence of treatment-related adverse effects 1. These treatments work by reducing inflammation, controlling bacterial overgrowth, constricting blood vessels, or physically removing visible vessels. While rosacea cannot be cured, consistent treatment can effectively manage symptoms and prevent progression, with the goal of improving morbidity, mortality, and quality of life.
From the Research
Treatment Options for Rosacea
- A range of treatment options are available for rosacea, including topical and oral drugs, as well as laser and light-based therapies 2, 3, 4, 5.
- Topical treatments include metronidazole, azelaic acid, ivermectin, and brimonidine, which have been shown to be effective in reducing symptoms of rosacea 3, 5.
- Oral treatments, such as doxycycline and isotretinoin, may also be effective in reducing symptoms of rosacea, particularly in cases of papulopustular rosacea 3, 5.
- Laser and light-based therapies, such as pulsed dye laser and intense pulsed light therapy, may be effective in reducing erythema and telangiectasias associated with rosacea 3, 4, 5.
Specific Treatments for Different Subtypes of Rosacea
- For erythematotelangiectatic rosacea, topical brimonidine and oxymetazoline may be effective in reducing erythema 3.
- For papulopustular rosacea, topical azelaic acid, ivermectin, and metronidazole, as well as oral doxycycline and isotretinoin, may be effective in reducing symptoms 3, 5.
- For ocular rosacea, oral omega-3 fatty acids and ciclosporin ophthalmic emulsion may be effective in reducing symptoms 3, 5.
Considerations for Treatment
- The majority of studies on rosacea treatments are at high or unclear risk of bias, and further well-designed, adequately-powered randomised controlled trials are required to fully assess the effectiveness of different treatments 2, 5.
- Treatment options should be tailored to the individual patient, taking into account the severity and subtype of rosacea, as well as any underlying triggers or comorbidities 2, 6.