Because the signs and symptoms of rosacea vary from one patient to another, treatment must be tailored for each individual. You may be prescribed oral medications, sometimes to be used with topical gels and creams to be applied to the skin.
1,2
The main treatments for rosacea (mentioned by generic and brand names) that are available in the UK are listed below.
Azelaic acid is a naturally occurring agent found in wheat, rye and barley. Azelaic acid 15% gel (Finacea
®; Intendis GmbH) was introduced in the UK in 2006. This non-antibiotic gel has been proven to effectively reduce the bumps, pimples and redness of papulopustular rosacea or can be used after a course of oral antibiotics on an ongoing basis to maintain the skin’s condition.
3,4
Metronidazole gel or cream Antibiotic skin formulations that were first introduced in 1991 for mild-to-moderate rosacea. The 0.75% metronidazole gel and creams Rozex
® (Galderma)
and Metrogel
® (Galderma) are the most commonly prescribed topical treatments for rosacea.
Other 0.75% metronidazole formulations include Zyomet
® (Goldshield), Metrosa
® (Linderma) and Acea™ (Ferndale). Treatment with metronidazole gel or creams should be continued to maintain remission and prevent recurrence of symptoms.
5
Antibiotic tablets or capsules (tetracycline, oxytetracycline or erythromycin) These antibiotics are given orally, usually in combination with a gel or cream such as azelaic acid 15% gel or 0.75% metronidazole gel or cream to control the initial symptoms of rosacea.
Courses last 6–12 weeks, after which progress is reviewed, and are repeated when required. These agents are thought to act by reducing inflammation rather than via an antibacterial action.
5
Concerns about antibiotic ‘superbug’ resistance have made some experts question the use of this treatment for a non-bacterial condition; however, a limited number of alternatives are available.
Surgery and laser resurfacing have a role in reducing advanced rhinophyma (nose enlargement) caused by skin thickening (phymatous) rosacea.
2 Lasers and pulsed light therapy may be used to reduce skin redness in rosacea.
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1. Van Zuuren EJ et al. Interventions for rosacea. Cochrane Database of Systematic Reviews 2005;3:article CD003262.
2. Blount W, Pelletier, AL. Rosacea: a common, yet commonly overlooked condition. Am Family Phys 2002;66:435–40.
3. Thiboutot D et al. Efficacy and safety of azelaic acid (15%) gel as a new treatment for papulopostular rosacea: results from 2 vehicle-controlled, randomized phase III studies. J Am Acad Dermatol 2003;48:8:36–45.
4. Elewski BE et al. A comparison of 15% azelaic acid gel and 0.75% metronidazole gel in the topical treatment of papulopustular rosacea. Arch Dermatol 2003;139:1444–50.
5. Gupta AK, Chaudhry MM. Rosacea and its management: an overview. JEADV 2005;273-285.