A Side-by-Side Look at the Most Common Rosacea Treatments

Side Effects, Effectiveness, Dosage, and Costs

Elizabeth Szaluta, MPH


May 17, 2017

Table 3. Other Topicals

Agent Azelaic acid (gel or cream) (Generic) Brimonidine (gel or cream)
Ivermectin (gel or cream) (Soolantra®) Oxymetazoline topical (Rhofade™) Sodium sulfacetamide (Generic)
Dosage 1 g/day 1 g/day 1 g/day 1% (varies based on area needing treatment) 1 g/day As needed, pea-size dab per area, 1-3 x per day
*Sample Cost $394.50 / 30 g 20% $462 / 30 g .33% $348.09 / 30 g $494.28 / 30 g 1% $10 / oz, 10%
**Side Effects Burning, stinging, tingling, dryness, tightness, scaling, itching, redness, irritation, swelling, acne;; dizziness, headache, diarrhea, nausea, stomach pain, loss of appetite, constipation, changes in taste, furry tongue, dry mouth.[3,4] Redness, flushing; burning sensation of the skin, skin irritation, warm feeling of the skin, tingling sensation, acne, skin pain, exacerbation of rosacea; blurred vision, headache; runny nose, nasal congestion.[3,4] Mild burning or stinging when the medicine is applied; rare: numbness or tingly feeling in hands or feet; cough, stuffy nose, sore throat, cold symptoms; dry, scaly, or itchy skin; diarrhea.[3,4] Redness, itching pain, worsening of rosacea Redness, irritation, scaling, warmth, swelling, itching, stinging, or burning of the treated skin.[3,4]
Effectiveness Azelaic acid is a newer therapeutic option that became commercially available in 2010. Most effective topical non-antibiotic medication. Generally well tolerated.[3,4] Vaso-constricting/alpha-adrenergic topical agent. Very effective for the redness of rosacea. Generally well tolerated.[3,4] Antiparasitic; thought to improve rosacea via suppression of the mite Demodex folliculorum or via anti-inflammatory mechanisms (or a combination of both). Generally well tolerated. Most effective topical.[3,4] Vaso-constricting/alpha-adrenergic topical agent. Newly approved, effective. Used in combination with sulfur for a synergistic effect. Generally well tolerated.[3,4]

Self-care Recommendations for Patients

There is no cure for rosacea, but you can help your patients devise a treatment plan that will keep it under control—reduce the acne-like breakouts, redness, and the number of flare-ups—and prevent the condition from getting worse. Rosacea can be exacerbated by various factors.[6] "It's important for patients to be aware of triggers—such as sun, alcohol, and stress—to minimize flare-ups," adds Dr Gribetz. Following a skincare plan is also helpful. Dr Gribetz recommends the following:

Sunscreen: Protects from the effects of ultraviolet radiation, which can damage the skin over time.

Moisturizer: Hydrates and protects the skin. Needs to be oil-free, fragrance-free, and hypoallergenic.

Cleansers and makeup: Use gentle, oil-free cleanser; makeup should also be oil-free. Your doctor may prescribe cleansers and lotions that contain sodium sulfacetamide or sulfur.

Artificial tears: Helpful for ocular rosacea.

Avoiding triggers: Paying attention to food intake (especially spicy foods), skincare, and lifestyle choices, such as limiting alcohol, can go a long way toward keeping skin clear.


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