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by Scholten A

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 several 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.

Prescription Medications

  • Metronidazole
  • Clindamycin
  • Clindamycin and benzoyl peroxide
  • Sulfur and sodium sulfacetamide
  • Tetracycline
  • Minocycline
  • Erythromycin
  • Doxycycline
  • Metronidazole
  • Tretinoin
  • Benzoyl peroxide
  • Isotretinoin

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 rosacea. You may have to use this medication for at least nine weeks before seeing improvement. The long-term use of metronidazole helps maintain remission in most people with rosacea. 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
If you have a more severe case of 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
  • Light-headedness
Topical Anti-acne Agents
  • Tretinoin
  • Benzoyl peroxide
Tretinoin helps to treat acne by keeping skin pores clear. Tretinoin should not be used during pregnancy. Benzoyl peroxide increases turnover of skin cells. By doing so, it helps keep pores cleaner which helps reduce the chance of infection. It should also not be used with some other types of medication and skin products. Ask your doctor for a list of products that should not be used with tretinoin.
Possible side effects include:
  • Burning feeling or stinging skin
  • Lightening of the treated skin
  • Peeling of skin
  • Redness of skin
  • Unusual dryness of skin
Systemic Anti-acne Agents
Common name: isotretinoin
Isotretinoin is used to treat severe or therapy-resistant 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
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
This is an acid compound that works to kill bacteria on the skin and helps the skin turnover to newer, healthier skin.
Possible side effects include:
  • Burning
  • Tingling
  • Stinging
  • Redness
  • Peeling
  • Skin irritation

Special Considerations

If you are taking medications, follow these general guidelines:
  • Take your medications as directed. Do not change the amount or the schedule.
  • Know what side effects could occur. Discuss them with your doctor.
  • Talk to your doctor before you stop taking prescription medication.
  • Plan ahead for refills if you need them.
  • Do not share your prescription medication with anyone.
  • Drugs can be dangerous when mixed. Talk to your doctor if you are taking more than one drug, including over-the-counter products and supplements.

References

Fast facts about rosacea. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health%5FInfo/Rosacea/rosacea%5Fff.asp. Updated September 2009. Accessed November 14, 2013.
Odom R, Dahl M, et al. Standard management options for rosacea, part 1: overview and broad spectrum of care. Cutis. 2009;84(1):43-47.
Odom R, Dahl M, et al. Standard management options for rosacea, part 2: options according to subtype. Cutis. 2009;84(2):97-104.
Rosacea. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated August 22, 2011. Accessed November 14, 2013.

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