What over-the-counter (OTC) medications are available for rosacea treatment?

From the Guidelines

Over-the-counter treatments for rosacea should prioritize gentle, fragrance-free cleansers, broad-spectrum sunscreen with SPF 30+, and products containing azelaic acid, sulfur, or niacinamide, as these ingredients have been shown to reduce inflammation and improve symptoms. When selecting over-the-counter treatments, consider the following options:

• Azelaic acid products, such as Azelex, at a concentration of 15-20%, which can reduce inflammation and kill bacteria that may worsen symptoms 1
• Sulfur-based products, like sulfacetamide sodium 10%, to help reduce redness and inflammation; use as directed on the product, typically once or twice daily
• Niacinamide (vitamin B3) serums at a concentration of 4-5% to strengthen the skin barrier and reduce redness when applied twice daily
• Green-tinted moisturizers and primers to neutralize visible redness
• Gentle, fragrance-free cleansers like Cetaphil or CeraVe for cleansing These treatments work by reducing inflammation, strengthening the skin barrier, or addressing specific triggers of rosacea. While these OTC options can help manage mild symptoms, persistent or severe rosacea may require prescription treatments from a dermatologist for more effective control, such as metronidazole or doxycycline, as recommended by the global rosacea consensus panel 1. Additionally, recent studies have shown that microencapsulated benzoyl peroxide 5% (E-BPO 5%) is a promising treatment option for managing inflammatory lesions of rosacea, with rapid onset of action, excellent tolerability, and sustained long-term results for up to 52 weeks of treatment 1.

From the FDA Drug Label

The exact mechanism of action of azelaic acid is not known. Azelaic acid has been shown to possess antimicrobial activity against Propionibacterium acnes and Staphylococcus epidermidis. A normalization of keratinization leading to an anticomedonal effect of azelaic acid may also contribute to its clinical activity.

Over-the-counter (OTC) medications for rosacea are not explicitly mentioned in the provided drug label. However, azelaic acid is a topical medication that has been shown to have antimicrobial and anticomedonal effects, which may be beneficial in the treatment of rosacea.

• Azelaic acid is available by prescription only, not over-the-counter 2.

From the Research

Over-the-Counter Medications for Rosacea

• There are several over-the-counter (OTC) medications available for the treatment of rosacea, including:
  • Topical metronidazole 3, 4, 5, 6
  • Azelaic acid 3, 4, 5, 6, 7
  • Sulfacetamide/sulfur 4, 7
• These medications can be used to reduce the severity of erythema, papules, and pustules associated with rosacea 3, 4, 5, 6, 7
• It is essential to note that while OTC medications can be effective, they may not be suitable for all types of rosacea, and consultation with a healthcare professional is recommended for proper diagnosis and treatment 3, 4, 5, 6, 7

Combination Therapies

• Combination of topical medications, such as azelaic acid or metronidazole, with oral antibiotics like doxycycline, may have a synergistic effect in treating rosacea 3, 4
• Light-based therapies, including intense pulsed light and pulsed dye laser, can be effective in treating erythema and telangiectasias associated with rosacea 3, 4, 7

New Additions to Therapeutic Armamentarium

• Topical brimonidine, oxymetazoline, ivermectin, tacrolimus, pimecrolimus, and low-dose modified-release tetracyclines are new additions to the therapeutic options for rosacea 7
• Botulinum toxin has also been used to treat erythema and flushing associated with rosacea 4, 7