Several different topical medications (those applied directly to the skin) help reduce the redness and inflammation associated with rosacea. Used in conjunction with oral medications and laser or other light-based treatments, they can help you manage your symptoms over the long term and prevent future flare-ups.
The three most common—and most effective—topical medications prescribed for rosacea are metronidazole, azelaic acid, and sodium sulfacetamide/sulfur.
Metronidazole, a topical antibiotic, has both antimicrobial and anti-inflammatory properties. Studies have shown that it can reduce inflamed lesions caused by rosacea by up to 65 percent, and that it’s well tolerated by people of all skin types.
Originally, metronidazole was prescribed for rosacea because studies had found increased numbers of demodex mites on the skin of rosacea patients. (These tiny insects live in the hair follicles of mammals, including humans.) It was thought that the mites were playing some role in rosacea’s symptoms and that the metronidazole was helping to rid them from the skin. Although we now realize that demodex mites have nothing to do with rosacea, metronidazole proved to be an effective treatment for the condition anyway.
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Metronidazole is available in cream, lotion and gel, and at different strengths. You will be advised to use it either once or twice daily. It can produce mild side effects, including burning, itching, and stinging, but such reactions to the drug are usually temporary.
Approved for the treatment of rosacea in 2002, azelaic acid is a dicarboxylic acid that’s found naturally in whole grains. Like metronidazole, it appears to have antibacterial and anti-inflammatory properties, and can be quite effective in reducing rosacea-related skin lesions.
Some studies show that the incidence of side effects is greater with azelaic acid than with metronidazole, but most patients report that these effects (mild swelling, itching, burning) are acceptable. Discontinuation rates with this medication are low.
The combination of sodium sulfacetamide and sulfur has a long history as a treatment for acne. More recently, it’s also been found to be an effective treatment for rosacea. Until very recently, however, the treatment’s acceptability by patients was limited due to sulfur’s unpleasant odor. That problem has now been overcome, for drug companies have developed new products (gels, creams, lotions, and cleansers) that successfully disguise the odor.
Why sodium sulfacetamide/sulfur treatments work for rosacea is not fully understood, but studies have shown that this medication can be as effective as metronidazole in reducing inflammatory lesions and swelling. Side effects include redness, swelling, stinging and other skin reactions, but these are usually mild. You may not be able to use this treatment if you’re allergic to sulfur (you could have a life-threatening reaction), so be sure to alert your physician if you have such an allergy.
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