Medications for Rosacea

The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included. Ask your doctor if you need to take any special precautions. Use each of these medications only as recommended by your doctor, and according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.

There are many prescription medications available to treat rosacea. They are used to control the redness and clear up bumps and pustules on your face. You may be given medication to apply to your skin (topical) and medication to take by mouth (oral). It may take a few weeks to see results. Once your symptoms have cleared, you may need to continue taking medication to keep rosacea under control. The type of medications used depend on the subtype of rosacea you have and the severity of symptoms.

Prescription Medications

Topical antibiotics

  • Metronidazole
  • Clindamycin
  • Clindamycin and benzoyl peroxide
  • Sulfur and sodium sulfacetamide

Oral antibiotics

  • Tetracycline
  • Minocycline
  • Erythromycin
  • Doxycycline
  • Metronidazole
  • Azithromycin

Topical anti-acne agents

  • Tretinoin
  • Benzoyl peroxide

Systemic anti-acne agents

  • Isotretinoin

Anti-inflammatories

Topical

  • Cortisone creams
  • Azelaic acid
  • Ivermectin
  • Calcineurin inhibitors
    • Tacrolimus
    • Pimecrolimus

Systemic non-steroidal anti-inflammatory agents

  • Diclofenac

Topical Alpha-adrenergic Agents

  • Brimonidine
  • Xylometazoline
  • Oxymetazoline

Systemic Beta-blockers and Alpha-adrenergic Agents

  • Clonidine
  • Propanolol
  • Carvedilol

Ocular Medications

  • Ibuprofen
  • Cyclosporine
  • Corticosteroids
  • Antibiotic ointment

Prescription Medications

Topical Antibiotics

Common names include:

  • Metronidazole
  • Clindamycin
  • Clindamycin and benzoyl peroxide
  • Sulfur and sodium sulfacetamide

Topical antibiotics are applied to your skin to help reduce the redness and pimples of papulopustular, phymatous, or ocular rosacea. You may have to use this medication for at several weeks before seeing improvement. Use cosmetics sparingly and make sure they are oil-free (noncomedogenic) to reduce irritation.

Possible side effects include:

  • Dry skin
  • Redness, stinging, and burning of the skin
  • Watering of the eyes

Oral Antibiotics

Common names include:

  • Tetracycline
  • Minocycline
  • Erythromycin
  • Doxycycline
  • Metronidazole
  • Azithromycin

If you have a more severe case of papulopustular, phymatous, or ocular rosacea, your doctor may prescribe an oral antibiotic. Doxycycline, minocycline, and less commonly tetracycline, and erythromycin are often used to treat rosacea. Some people respond quickly, while others require long-term therapy.

Possible side effects include:

  • Increased skin sensitivity to sunlight
  • Stomach cramps or burning sensation
  • Diarrhea
  • Lightheadedness

Topical Anti-acne Agents

Common names include:

  • Tretinoin
  • Benzoyl peroxide

Tretinoin helps to treat papulopustular rosaeca by keeping skin pores clear. May be used for phymatous rosacea. Benzoyl peroxide increases turnover of skin cells. By doing so, it helps keep pores cleaner which helps reduce the chance of infection. These medications should not be used with some other types of medication and skin products. Tretinoin should not be used during pregnancy. Discuss the risks and benefits with your doctor before using benzoyl peroxide if you are pregnant.

Possible side effects include:

  • Burning feeling or stinging skin
  • Lightening of the treated skin
  • Peeling of skin
  • Redness of skin
  • Unusual dryness of skin
  • Sensitivity to sunlight

Systemic Anti-acne Agents

Common name: Isotretinoin

Isotretinoin is used to treat severe or therapy-resistant papulopustular or phymatous rosacea if other medications have failed to help. However, isotretinoin is linked to a number of adverse effects, some of which can be severe. The most serious potential adverse effect is that it can cause birth defects in pregnant women who take it. Therefore, you should not be pregnant or get pregnant while taking isotretinoin. If you are a woman of childbearing age, you must use an appropriate birth control method one month before the initiation of therapy, during the entire course of therapy, and until two months after stopping taking the drug. Your doctor will order a pregnancy test before therapy is started and every month during therapy. Also, you should not donate blood while taking this medication or for 30 days after you stop taking it, in the event that it could be donated to a pregnant woman.

Possible side effects include:

  • Dryness of the mouth, nose, eyes, and skin
  • Headache
  • Sensitivity to sunlight
  • Upset stomach
  • Fatigue
  • Thinning of hair
  • Depression

Anti-inflammatories

Cortisone cream

  • Cortisone creams can decrease inflammation in the skin. However, they can also cause the skin to become too thin, so they should be used for only brief periods of time (1-2 weeks). Furthermore, although cortisone will produce fast improvement in rosacea, the disease will flare very soon after discontinuation. Therefore, cortisone should not be used for long-term treatment of rosacea.
  • Possible side effects include:
    • Thinning of the skin
    • Increased skin fragility
    • Acne-like breakout
    • Worsening of rosacea upon discontinuation

Azelaic acid

  • Topical azelaic acid kills bacteria on the skin and increases turnover of skin cells. It is also anti-inflammatory. It is used to treat papulopustular or phymatous rosacea.
  • Possible side effects include:
    • Burning
    • Tingling
    • Stinging
    • Redness
    • Peeling
    • Skin irritation

Invermectin

  • Invermectin is an antiparasitic medication that helps with papulopustular or phymatous rosacea. It is used as a topical medication to reduce inflammation and help clear the skin. Talk to your doctor if you think you are or plan on becoming pregnant. Invermectin is associated with birth defects. If you are of childbearing age, you may need to use birth control before starting treatment.
  • Common side effects include:
    • Hives
    • Itching
    • Flushing
    • Lightheadedness

Calcineurin inhibitors

  • Tacrolimus ointment and pimecrolimus cream are anti-inflammatory medications. May help some people with rosacea.
  • Common side effects include:
    • Warm or burning sensation in treated areas
    • Headache
    • Cough, fever, flu-like symptoms
    • Muscle aches
    • Acne in treated areas
    • Increased susceptibility to skin infections

Diclofenac

  • Non-steroidal anti-inflammatory medication that may reduce redness and discomfort in erythematotelangiectatic or phymatous rosacea.
  • Common side-effects include:
    • Constipation
    • Diarrhea
    • Nausea
    • Liver damage
    • Headache
    • Urinary tract infectious disease
    • Nasopharyngitis, sinusitis, and upper respiratory infection

Alpha-adrenergic Agents

Common names include:

  • Brimonidine
  • Xylometazoline
  • Oxymetazoline

The redness that is seen with erythematotelangiectatic rosacea may be controlled with these topical medications that restrict blood flow to the face. May be used for phymatous rosacea. Brimonidine is a gel that is applied directly to the face. Xylometazoline and oxymetazoline are nasal decongestant solutions that are also appied to the face.

Possible side effects include:

  • Burning or stinging
  • Flushing
  • Redness
  • Headache

Beta-blockers

Common names include:

  • Propanolol
  • Carvedilol

Low-dose oral beta-blockers may be helpful in managing erythematotelangiectatic rosacea. May be used for phymatous rosacea. Traditionally, they are used as blood pressure medications. Their effect on the nerves that control blood vessels and pressure may also reduce facial redness. People with heart-related diseases may not be able to use beta blockers for rosacea. Talk to your doctor about the risks and benefits of this treatment.

Possible side effects include:

  • Nausea
  • Low blood pressure
  • Fatigue
  • Lightheadedness
  • Cold hands

Ocular Medications

Common medications include:

  • Ibuprofen
  • Cyclosporine
  • Corticosteroids
  • Antibiotic ointment

For rosacea that affects the eyes, your doctor may recommend eye drops (most common), gels, or emulsions. Cyclosporine helps to increase tear production to soothe dry, rirritated eyes. Corticosteroids and ibuprofen are used to reduce inflammation. Antibiotic ointment is used if an eye infection develops. The type of medication prescribed depends on the symptoms or condition affecting the eye.

Possible side effects of cyclosporine include a burning sensation in the eye.

Possible side effects of corticosteroids include:

  • Eye pain
  • Eye infection
  • Blurred or a decrease in vision
  • Nausea or vomiting

Special Considerations

If you are taking medications, follow these general guidelines:

  • Take the medication as directed. Do not change the amount or the schedule.
  • Ask what side effects could occur. Report them to your doctor.
  • Talk to your doctor before you stop taking any prescription medication.
  • Do not share your prescription medication.
  • Medications can be dangerous when mixed. Talk to your doctor or pharmacist if you are taking more than one medication, including over-the-counter products and supplements.
  • Plan ahead for refills as needed.

References:

Corticosteroid (ophthalmic route) side effects. Mayo Clinic website. Available at: https://www.mayoclinic.org/drugs-supplements/corticosteroid-ophthalmic-route/side-effects/drg-20070461. Updated March 01, 2017. Accessed December 27, 2017.
Management options for rosacea. National Rosacea Society website. Available at: https://www.rosacea.org/patients/managementoptions/index.php. Accessed December 27, 2017.
Ocular rosacea. DermNet NZ website. Available at: https://www.dermnetnz.org/topics/ocular-rosacea. Updated 2014. Accessed December 27, 2017.
Rosacea. DermNet New Zealand website. Available at: https://www.dermnetnz.org/topics/rosacea. Updated June 2014. Accessed December 22, 2017.
Rosacea. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116224/Rosacea . June 8, 2017. Accessed December 22, 2017.
Rosacea: Diagnosis and treatment. American Academy of Dermatology website. Available at: https://www.aad.org/public/diseases/acne-and-rosacea/rosacea#treatment. Accessed December 22, 2017.
Rosacea: How is it treated? National Institute of Arthritis and Musculoskeletal and Skin Disorders website. Available at: https://www.niams.nih.gov/health-topics/rosacea#tab-treatment. Accessed December 22, 2017.
Last reviewed November 2018 by EBSCO Medical Review Board Michael Woods, MD, FAAP
Last Updated: 12/27/2017

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