Once you have been diagnosed with rosacea, everyone naturally wants to know What is the best treatment for rosacea?
Wouldn’t it be great if there was a simple answer to this question that satisfied everyone who has rosacea!
Hopefully it doesn’t come as a surprise to find out that there is no known panacea for rosacea.
This high level paper from The Journal of Family Practice seeks to summarise the available published research into rosacea treatments. Thus the treatments being labelled `best’ by this study are only ever going to be the ones that have been proven by years of research and development and real life testing.
What I’m trying to warm you up to is the idea that you should only ever expect to see the well known prescription topical and systemic treatments emerge from these sorts of studies.
Clinical Inquiries: What is the most effective treatment for acne rosacea?
J Fam Pract. 2011 Feb;60(2):108a-c., May D, Kelsberg G, Safranek S.
Topical metronidazole and azelaic acid are equally effective for the papulopustular lesions of acne rosacea, although metronidazole is better tolerated. Oral doxycycline, tetracycline, and metronidazole are also effective, but not enough evidence exists to determine whether one is more effective than another or more effective than topical therapy (strength of recommendation [SOR]: A, systematic review and individual randomized controlled trials [RCTs]).
Some evidence supports a benefit for topical sodium sulfacetamide with sulfur, and benzoyl peroxide (SOR: B, small single RCTs).
Pulsed-light and laser therapy may improve the erythema and telangiectasias associated with acne rosacea (SOR: C, case series).
All patients with acne rosacea should use sunscreen and emollients, and avoid skin irritants (SOR: C, expert opinion)
The American Acne and Rosacea Society guidelines state that good evidence supports topical treatments—metronidazole,
azelaic acid, and sulfacetamide/sulfur—as well as anti-inflammatory doses of oral doxycycline.
The guidelines also list other topical and oral antibiotic treatments, but cite low-quality evidence for their efficacy and concerns about the emergence of antibiotic resistance. They advise appropriate skin care, including gentle cleansers, moisturizers, and sun protection.
Full Article PDF: What is the most effective treatment for acne rosacea?
Best Topical Therapy
Topical Metronidazole (Metrogel) and Azelaic Acid (Finacea) are indicated as being better than placebo, but “the studies
were generally weak because of poor methodology and reporting, small sample sizes, and lack of quality-of-life measures.”
Overall Metrogel is better tolerated than Finacea.
Best Systemic Therapy
Oral Metronidazole (Flagyl) and Oral Tetracycline as well as anti-inflammatory dose oral doxycycline (Periostat/Oracea) have been found to be effective.
Best Therapy for Redness
The best therapy for redness and broken blood vessels was found to be pulsed light therapy, laser therapy and photodynamic therapy with red light. No great surprises there.
“They advise appropriate skin care, including gentle cleansers, moisturizers and sun protection”. That is good advice we should all heed.
Can YOU Answer This Question?
Perhaps this paper won’t happily satisfy everyone’s quest for rosacea relief, but maybe you can.
You meet a newly diagnosed rosacea sufferer who is distressed. You have memories of being there yourself. What advice will you give them – what do you think is the best treatment for rosacea?