Azelaic acid hasn't helped my rosacea - what are the alternatives?
Azelaic acid helps many people with rosacea, but not everyone. Most notice an improvement after 6 to 8 weeks of regular use. If there has been no worthwhile change after that, there are effective alternatives, and the choice depends on whether the problem is spots, redness or irritation.
If the cream stung too much to use
A mild burning or itching is common when azelaic acid is first started and usually settles. If it does not settle you can try applying a gentle moisturiser 5 to 10 minutes beforehand - use a pea-sized amount for the whole face. However, if irritation persists it may be that your skin is too sensitive for this treatment and another treatment is a better choice.
If spots are still present
- Ivermectin (Soolantra): in my experience the most effective topical treatment for inflammatory rosacea.
- Metronidazole: gentle, well tolerated and suitable for long-term maintenance.
- Tablets: a few months of an oral tetracycline such as lymecycline can help where spots are widespread or persistent.
If redness is the main problem
Azelaic acid can help the spots but often not the background redness, because the redness comes from dilated blood vessels. Vascular laser is the most effective option here.
Azelaic acid not working?
I can assess which features of your rosacea are still active and recommend the treatments most likely to work for you. Consultations can be in person or remote.
Related Articles
- Azelaic acid for rosacea
- Prescription creams for rosacea
- Ivermectin (Soolantra) for rosacea
- Vascular laser
