From the Guidelines
Ivermectin 1% cream is the most effective topical treatment for rosacea, particularly for papulopustular rosacea, due to its ability to target Demodex mites and reduce inflammation, as shown in a recent study 1.
Key Points
- Topical treatments for rosacea include metronidazole, azelaic acid, ivermectin 1% cream, and sodium sulfacetamide-sulfur preparations.
- Ivermectin 1% cream has been shown to be superior to metronidazole 0.75% cream in reducing lesion counts and improving IGA ratings 1.
- Azelaic acid 15% gel is also an effective treatment for rosacea, with anti-inflammatory, antimicrobial, and antioxidant properties 1.
- A phenotype-led treatment algorithm can be used to guide treatment decisions, with ivermectin 1% cream considered a first-line option for moderate to severe papulopustular rosacea 1.
Treatment Recommendations
- For mild cases of rosacea, brimonidine 0.33% gel or oxymetazoline 1% cream can be used to temporarily reduce facial redness.
- For moderate to severe papulopustular rosacea, ivermectin 1% cream is recommended as a first-line treatment.
- Patients should also use gentle cleansers, apply moisturizers, and use broad-spectrum sunscreen daily as part of their skincare routine.
- Avoiding triggers like spicy foods, alcohol, extreme temperatures, and harsh skincare products is essential for managing rosacea alongside topical treatments.
From the Research
Topical Treatments for Rosacea
- Metronidazole and azelaic acid are two commonly used topical treatments for rosacea, which work by reducing inflammation and inhibiting the production of reactive oxygen species produced by neutrophils 2.
- Studies have shown that metronidazole 1% gel and azelaic acid 15% gel are effective in reducing inflammatory lesion counts and decreasing the intensity of erythema in patients with moderate rosacea 2, 3.
- Topical metronidazole has been well studied as a rosacea therapy, and has been shown to be as effective as oral antibiotics such as tetracycline and doxycycline in reducing inflammatory lesions and erythema associated with rosacea 3.
- Other topical agents used to treat rosacea include sulfacetamide-sulfur, clindamycin, and erythromycin, which can be used alone or in combination with systemic antibiotic therapy 4, 5.
Efficacy and Safety of Topical Treatments
- The efficacy of topical therapy for rosacea relates primarily to reduction in inflammatory lesions, decreased intensity of erythema, and amelioration of symptoms such as stinging, pruritus, and burning 4.
- Topical metronidazole has been shown to be well tolerated by most patients, and is effective in preventing relapses of disease 6.
- Newer therapeutic choices, such as improved vehicle formulations, have demonstrated favorable skin tolerability and cosmetic elegance 4.
- Combination treatment with oral antibiotics at both antimicrobial and subantimicrobial doses is an efficacious means of treating rosacea, and maintenance treatment with topical metronidazole can decrease relapses and allow for longer intervals between flares 3.