From the Guidelines
Rosacea treatment should prioritize a combination of topical and oral medications, along with lifestyle changes, with doxycycline 40mg being a first-line oral treatment option, as it has been shown to be effective in reducing inflammatory lesions and improving symptoms, as demonstrated in a study published in 2024 1.
Treatment Options
- Topical treatments: metronidazole (0.75% or 1% gel or cream), azelaic acid (15-20% gel or cream), or ivermectin 1% cream, applied once or twice daily for several months
- Oral antibiotics: doxycycline (40-100mg daily) or minocycline (50-100mg daily) for 8-12 weeks
- Laser therapy or intense pulsed light treatments to reduce persistent redness and visible blood vessels
Pricing and Insurance
- Topical medications: $30-$300 per tube, depending on generic or brand-name versions
- Oral antibiotics: $30-$150 per month
- Laser treatments: $300-$600 per session, with multiple sessions needed
- Insurance coverage varies, so checking with the provider is important
Lifestyle Changes
- Avoiding triggers like spicy foods, alcohol, extreme temperatures, and sun exposure
- Using gentle cleansers, moisturizers, and sun protection factor 30+ to manage symptoms The most recent and highest quality study, published in 2024 1, supports the use of doxycycline 40mg as a first-line oral treatment option, due to its effectiveness in reducing inflammatory lesions and improving symptoms. Additionally, a study published in 2017 1 provides a phenotype-led treatment algorithm, which can be used to guide treatment decisions. Another study published in 2024 1 reviews the current treatment landscape for rosacea, including the use of metronidazole and other topical treatments.
From the Research
Rosacea Treatment Options
- Topical medications: azelaic acid, metronidazole, sulfacetamide/sulfur, brimonidine, ivermectin, tacrolimus, pimecrolimus 2, 3, 4
- Oral antibiotics: tetracyclines, doxycycline, minocycline, isotretinoin 5, 6, 3, 4
- Laser and light-based therapies: intense pulsed light, pulsed dye laser, yttrium-aluminium-garnet (Nd:YAG) laser 2, 4
Effectiveness of Treatments
- Topical metronidazole and azelaic acid have moderate to high quality evidence for effectiveness in papulopustular rosacea 4
- Topical ivermectin has high quality evidence for effectiveness in papulopustular rosacea 4
- Oral doxycycline has high quality evidence for effectiveness in papulopustular rosacea 4
- Low dose isotretinoin has high quality evidence for effectiveness in rosacea 4
Prices
- No information is available on the prices of rosacea treatments in the provided studies 5, 2, 6, 3, 4
Treatment Considerations
- Treatment choices may depend on the severity and subtype of rosacea, as well as the presence of triggers such as Helicobacter pylori infection and small intestinal bacterial overgrowth 5
- Combination therapy may be effective for some patients, such as the use of oral metronidazole and topical metronidazole 5