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13.6.2 Rosacea-topical and oral treatment

Topical agents (mild to moderate papulopustular rosacea)

1st choiceAzelaic acid (15%) gel (Finacea®)
Metronidazole 0.75% topical cream (or gel)
Ivermectin (Soolantra®) 10mg/g cream

Oral agents (moderate to severe papulopustular rosacea)

1st choiceDoxycycline 100mg capsules [off-label indication]


100mg once daily for 3 months

capsules 408mg [off-label indication]


408mg daily for 2-3 months

Prescribing Notes

  • Mild rosacea is best treated with a topical agent
  • Pustular rosacea is best treated with systemic antibiotics
  • Courses of antibiotics usually last 6-12 weeks and are repeated intermittently
  • Brimonidine gel (Mirvaso®) can be considered for the treatment of moderate to severe persistent erythema. It may not reduce erythema in all cases and will not have any effect on papules, pustules or phymatous changes. Telangiectasia may be accentuated as general redness is reduced
  • Doxycycline 40mg controlled release (Efracea®) can be considered if doxycycline 100mg is not tolerated
  • Cosmetics can often cover up rosacea effectively, and some patients may benefit from the use of skin camouflage (see section 13.8.2).


  • Brimonidine gel (Mirvaso®): Systemic cardiovascular effects including bradycardia, hypotension and dizziness have been reported after application. It is important to avoid application to irritated or damaged skin, including after laser therapy. See Drug Safety Update June 2017

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