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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. The type of medications used depend on the subtype of rosacea you have and the severity of symptoms.

Prescription Medications

  • Metronidazole
  • Clindamycin
  • Clindamycin and benzoyl peroxide
  • Sulfur and sodium sulfacetamide
  • Tetracycline
  • Minocycline
  • Erythromycin
  • Doxycycline
  • Metronidazole
  • Tretinoin
  • Benzoyl peroxide
  • Isotretinoin
  • Brimonidine
  • Xylometazoline
  • Oxymetazoline
  • Propanolol
  • Carvedilol
  • Cyclosporine
  • Corticosteroids

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
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. 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
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 increase turnover of skin cells. It is used to treat papulopustular or phymatous rosacea.
Possible side effects include:
  • Burning
  • Tingling
  • Stinging
  • Redness
  • Peeling
  • Skin irritation
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. 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. 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
Invermectin
Invermectin is an antiparasitic medication that helps with papulopustular 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
Ocular Medications
Common medications include:
  • Cyclosporine
  • Corticosteroids
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 are used to reduce inflammation. 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.
  • Plan ahead for refills if you need them.
  • Do not share your prescription medication with anyone.
  • Medications can be dangerous when mixed. Talk to your doctor if you are taking more than one medication, including over-the-counter products and supplements.

References

Corticosteroid (ophthalmic route) side effects. Mayo Clinic website. Available at: http://www.mayoclinic.org/drugs-supplements/corticosteroid-ophthalmic-route/side-effects/drg-20070461. Updated September 1, 2015. Accessed December 30, 2015.
Ocular rosacea. DermNet NZ website. Available at: http://www.dermnetnz.org/acne/ocular-rosacea.html. Updated January 10, 2015. Accessed December 30, 2015.
Questions and answers about rosacea. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) website. Available at: http://www.niams.nih.gov/Health%5FInfo/Rosacea/default.asp. Updated September 2013. Accessed December 28, 2015.
Rosacea. DermNet NZ website. Available at: http://www.dermnetnz.org/acne/rosacea.html. Updated June 15, 2015. Accessed December 30, 2015.
Rosacea. EBSCO DynaMed website. Available at: EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. December 10, 2015. Accessed December 30, 2015.
Rosacea: Diagnosis and treatment. American Academy of Dermatology website. Available at: https://www.aad.org/public/diseases/acne-and-rosacea/rosacea. Accessed December 30, 2015.
Shanler SD, Ondo AL. Successful treatment of the erythema and flushing of rosacea using a topically applied selective alpha1-adrenergic receptor agonist, oxymetazoline. Arch Dermatol. 2007;143(11):1369-1371.

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