Rosacea: Which medications have been well studied?

Skin creams containing metronidazole or azelaic acid can help reduce the symptoms of rosacea. Medications containing the antibiotic drug doxycycline might also help to relieve skin redness.

Rosacea is a common chronic skin condition that affects the face. About 1 in 10 people (10%) have it. It can cause flushing and redness, papules (red pimples) and pustules (pus pimples), as well as enlarged blood vessels. In its more severe forms it can cause swelling and bumps, and it often affects the eyes and eyelids, too.

A wide variety of creams, lotions and gels are available for the relief of rosacea symptoms. For more severe forms, stronger oral medications are also used, some of which can have serious adverse effects. You can learn more about rosacea, including the non-drug treatment options, in our fact sheet.

In order to try to find out what the most effective treatments for rosacea are, researchers from the Cochrane Collaboration (an international network of researchers) systematically analyzed the available trials. Practically all of the trials found tested medications for rosacea, and hardly any of the trials looked at non-drug treatments.

Creams containing azelaic acid and metronidazole can reduce symptoms

The researchers analyzed 58 trials on the treatment of rosacea. Many of the trials were not very reliable. But overall, they found evidence for some drugs that they can relieve the symptoms of rosacea. These drugs include one cream with the substance azelaic acid, and creams with the antibiotic called metronidazole.

Azelaic acid was the substance that was studied best. Here are some figures on the treatment success:

• Symptoms got better in 64 out of 100 people who used the drug (64%).
• In comparison: In people who used a cream without azelaic acid, symptoms improved only for 40 out of 100 people (40%).

In other words, 24 out of 100 people had a benefit from using azelaic acid (24%). Creams containing azelaic acid and metronidazole also proved to be rather well tolerated: There were not many adverse effects, or they were not especially severe. When using creams, however, it can sometimes take a few weeks before a clear improvement is seen.

Of the oral medications, the antibiotic drug doxycycline seems to be able to reduce skin redness. Research results indicate that lower doses (40 mg) are not less effective than higher doses, but that they lead less commonly to adverse effects.

Other frequently used treatments have not been adequately tested. This is also true of several oral medications that are used for serious widespread skin changes caused by rosacea. Those medications can also cause adverse effects, including diarrhea, nausea and – in some cases – sensitivity to light.

You can find more information on how to use medications safely in our section Choosing between treatment options. You can read more about things that should generally be kept in mind when taking antibiotics here.

Author: German Institute for Quality and Efficiency in Health Care (IQWiG)

Next planned update: March, 2014. You can find out more about how our health information is updated here.

© IQWiG (Institute for Quality and Efficiency in Health Care)