Treatment of rosacea: medications, topical creams, ointments and more

Treatment of rosacea is local (applied to the affected areas) or systemic, anti-inflammatory or antibacterial.

Preparations used to treat rosacea

Azelaic acid

This active substance is applied to the skin in the form of a gel and cream. It has an antibacterial and anti-inflammatory effect. It induces a balance of keratinisation in the skin and also has an antioxidant effect. With regular use, redness is reduced and inflamed rashes heal.

The duration of use is a minimum of 12 weeks.

Brimonidine

It belongs to a group of drugs called alpha-2 adrenergic receptor agonists. It has a selective vasoconstrictor effect on small blood vessels, i.e. it constricts dilated blood vessels in the skin.

It is available in the form of a gel which is applied once a day in a thin layer to the face and affected areas. After about half an hour, the effect of the gel is visible. The blood vessels constrict, blood flow is reduced and redness of the skin is reduced.

This effect persists for 12 hours. The use of the gel can prevent the appearance of telangiectasia, but no longer affects the appearance of existing ones.

It cannot be used in patients who are also taking antidepressants, namely MAO (monoamine oxidase) inhibitors, tricyclic or tetracyclic antidepressants. It is also prohibited in pregnant and lactating women.

Ivermectin

This drug, made 'famous' during the COVID-19 pandemic, belongs to the group of 'avermectins'. It has mainly an antiparasitic and anti-inflammatory effect.

It effectively intervenes against the colonization of demodex mites, which, when overgrowing in the skin of rosacea, promote inflammation, transmit other bacterial pathogens and are responsible for the appearance of purulent and painful rashes.

It is administered in the evening for 4 months. The treatment needs to be repeated regularly in many cases.

Topical retinoids (tretinoin and adapalene)

These are applied in the form of gel, cream, oils or various tinctures. They are effective in combating inflamed rashes. However, they have no effect on the vascular dysregulation in the skin and therefore do not reduce either inflammation or dilated blood vessels on the face.

Tetracycline antibiotics

Antibiotics that are taken systemically, most commonly in tablet form. They have antibacterial and anti-inflammatory effects. They block angiogenesis (the formation of new blood vessels) and also inhibit the production of pro-inflammatory cytokines and vascular endothelial factor.

Small to micro doses of antibiotics are sufficient to have this effect. If the patient is allergic to tetracycline antibiotics, treatment with macrolides with a similar effect may be considered.

Treatment of the different subtypes of rosacea

Erythematotelangiectatic rosacea

• Brimonidine
• azelaic acid
• metronidazole
• UVA and UVB protective agents
• lasers, IPL

Papulopustular rosacea

• Metronidazole
• azelaic acid
• ivermectin
• retinoids
• tetracycline ATBs or macrolides
• isotretinoin
• photoprotection
• IPL, lasers

Fymatous rosacea

• retinoids - isotretinoin
• metronidazole
• tetracycline ATBs
• lasers
• Surgical treatment - removal of fibrous parts of the skin

Ocular rosacea

• artificial tears
• cyclosporine
• topical ATBs in the form of drops and ointments
• tetracycline systemic ATB