From the Guidelines
Rosacea treatment should prioritize topical metronidazole (0.75% or 1% cream applied twice daily) as a first-line treatment, given its efficacy in reducing inflammatory lesions and perilesional erythema, as demonstrated in a 6-month double-blind placebo-controlled study 1.
Treatment Overview
Rosacea treatment typically involves a combination of skincare practices, medications, and lifestyle changes. For mild rosacea, starting with gentle skincare using a mild cleanser, avoiding irritants, and applying daily broad-spectrum sunscreen is recommended.
First-Line Treatments
Topical medications like metronidazole (0.75% or 1% cream applied twice daily) 1, azelaic acid (15-20% applied twice daily) 1, or ivermectin 1% cream (applied once daily) are considered first-line treatments.
Moderate to Severe Cases
For moderate to severe cases, oral antibiotics such as doxycycline (40-100mg daily for 8-12 weeks) may be prescribed, with once-daily doxycycline 40 mg being as effective as once-daily doxycycline 100 mg for moderate-to-severe rosacea 1.
Additional Treatments
Persistent facial redness can be treated with brimonidine gel 0.33% or oxymetazoline cream 1% applied once daily. For ocular rosacea, artificial tears and eyelid hygiene are recommended, with possible antibiotic treatment. Laser or intense pulsed light therapy can help reduce visible blood vessels.
Lifestyle Modifications
Lifestyle modifications are crucial—avoiding triggers like spicy foods, alcohol, extreme temperatures, and stress. Treatment success varies by individual, and combining approaches often yields the best results. Rosacea is chronic, so ongoing management is necessary to control symptoms and prevent worsening. Some key points to consider:
- Metronidazole 0.75% and 1.0% strengths are equally effective when used once daily 1.
- Azelaic acid 15% gel was FDA-approved for rosacea in 2002 and has been shown to improve rosacea by exerting anti-inflammatory activity on the cathelicidin pathway 1.
- Doxycycline 40 mg utilizes the drug’s anti-inflammatory properties at a dose below that which can typically kill bacteria and is as effective as once-daily doxycycline 100 mg for moderate-to-severe rosacea 1.
From the FDA Drug Label
To use AZELEX® Cream for the full prescribed treatment period. AZELEX Cream is a topical cream indicated for the treatment of rosacea. There is no direct information in the provided drug labels that mentions the treatment of rosacea for Benzoyl Peroxide. However, for Azelaic Acid, it can be used for the treatment of rosacea.
- The treatment should be used for the full prescribed treatment period.
- Azelaic Acid is the key ingredient in the treatment of rosacea, as per the given information 2.
- If sensitivity or severe irritation develops with the use of AZELEX Cream, treatment should be discontinued and appropriate therapy instituted.
From the Research
Treatment Options for Rosacea
- Topical medications: metronidazole, azelaic acid, sodium sulfacetamide-sulfur, benzoyl peroxide, clindamycin, calcineurin inhibitors, and permethrin 3, 4, 5, 6
- Oral medications: tetracyclines, metronidazole, macrolides, and isotretinoin 3, 5, 6
- Laser and light-based therapies: intense pulsed light and pulsed dye laser 5
- Surgical procedures: for phymatous rosacea 4
- Skin care and cosmetic treatments: gentle skin care, sun protection, and makeup 7
Specific Treatment Approaches
- For papulopustular rosacea: oral metronidazole or oral tetracycline, and topical crotamiton 10% or metronidazole for Demodex folliculorum infestation 3
- For erythematotelangiectatic rosacea: topical brimonidine, oxymetazoline, and laser and light-based therapies 5
- For ocular rosacea: topical and oral medications, and eyelid hygiene 7