Treatment of rosacea

Rosacea is characterised by recurrent episodes of facial flushing, persistent erythema, telangiectasia, papules and pustules, and eye symptoms. Rule out acne vulgaris before commencing treatment.

Mild papulopustular rosacea

Metronidazole gel/cream

Azelaic acid cream 20%

  • Apply twice daily (sensitive skin, once daily for first week)

Moderate or severe papulopustular rosacea

Metronidazole gel/cream

Ivermectin 1% cream

  • Apply once daily for 4 months; discontinue after 3 months if no improvement is seen
  • See section 13.6.3 Topical preparations for rosacea
  • May be used as an alternative to metronidazole in moderate disease


  • Capsules m/r 40mg
  • 40mg daily in the morning for 16 weeks; consider discontinuing treatment if no response after 6 weeks
  • See section 5.1.3 Tetracyclines

Lymecycline (unlicensed)

  • 408mg once daily. Review at 2 months and continue for a total of 3 months if responding well. Repeat 3 monthly course when rosacea flares
  • May be taken with food but avoid antacids, iron and zinc at the same time
  • See section 5.1.3 Tetracyclines


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