From the Guidelines
Rosacea treatment should start with topical metronidazole (0.75% or 1% gel or cream) or azelaic acid (15-20% gel or cream) applied twice daily to affected areas, as these have been shown to be effective in reducing inflammatory lesions and perilesional erythema associated with rosacea 1.
Treatment Options
- For mild to moderate rosacea, topical metronidazole or azelaic acid can be used as first-line treatment, with a decrease in inflammatory lesion counts of up to 65% compared to vehicle 1.
- For more severe cases or those with significant inflammatory lesions, oral antibiotics like doxycycline (40-100mg daily) for 8-12 weeks can be effective, with a mean reduction in inflammatory lesions of 11.8 in one study 1.
- For persistent redness, brimonidine 0.33% gel can provide temporary relief when applied once daily.
Lifestyle Modifications
- Avoid triggers like spicy foods, alcohol, extreme temperatures, and sun exposure.
- Use gentle cleansers and non-comedogenic moisturizers.
- Always apply broad-spectrum sunscreen (SPF 30+) daily.
Treatment Algorithm
A phenotype-led treatment algorithm can be used to guide treatment decisions, taking into account the individual's rosacea subtype and severity, as recommended by the global rosacea consensus (ROSco) panel 1.
Key Considerations
- Treatment should be individualized based on rosacea subtype and severity, with regular follow-up to adjust therapy as needed.
- The most recent and highest quality studies support the use of topical metronidazole and azelaic acid as first-line treatments for mild to moderate rosacea 1.
From the Research
Treatment Options for Rosacea
- A range of treatment options are available for rosacea, including topical and oral medications, as well as laser and light-based therapies 2, 3, 4, 5, 6
- Topical treatments include metronidazole, azelaic acid, ivermectin, brimonidine, and other antibiotics, while oral treatments include tetracyclines, metronidazole, and isotretinoin 2, 3, 5, 6
- The choice of treatment depends on the severity and subtype of rosacea, as well as the presence of triggers such as Helicobacter pylori infection and small intestinal bacterial overgrowth 2
Efficacy of Treatments
- There is high-quality evidence to support the effectiveness of topical azelaic acid, topical ivermectin, brimonidine, doxycycline, and isotretinoin for rosacea 3, 4
- Moderate-quality evidence is available for topical metronidazole and oral tetracycline 3
- Low-quality evidence is available for low-dose minocycline, laser and intense pulsed light therapy, and ciclosporin ophthalmic emulsion for ocular rosacea 3
Adverse Events
- Most treatments for rosacea are not associated with higher adverse event rates than placebo 3, 4
- However, some treatments such as oral isotretinoin may have more significant adverse effects, and the risk of adverse events should be carefully considered when selecting a treatment 2, 3
Management of Rosacea
- Identification of subtypes can help guide treatment strategies, and conservative management such as nonpharmacologic routine skin care is an essential part of overall care 5
- Daily use of sunscreen, moisturizers, and mild skin cleansers, as well as avoidance of triggers, are essential aspects of maintenance treatment 6
- Referral for care is recommended for fixed phymatous changes and ocular rosacea 6