Prescription Creams for Rosacea
Topical treatments are generally the first line treatment for rosacea, however some patients with more severe rosacea may decide to go for a combination of topical and oral medication to gain control as quickly as possible.
How do metronidazole, azelaic acid, ivermectin work?
- Ivermectin (Soolantra): Has a dual mechanism. It is a potent anti-inflammatory and also targets Demodex mites, which are often found in higher numbers on rosacea-affected skin and are thought to contribute to the inflammatory response. In my experience, it is the most effective topical for inflammatory lesions.
- Azelaic Acid: This reduces inflammation, helps normalise skin cell turnover to prevent clogged pores, and reduces redness.
- Metronidazole: Primarily acts as an anti-inflammatory. It can be effective for papules and pustules but in my experience is less effective than topical ivermectin.
Expected timelines and side effects
Most topical treatments take time to work. You should expect to see initial improvements within 4-8 weeks, with full effects often taking 12 weeks of consistent daily use. Common initial side effects for all can include mild stinging, itching, or dryness, which usually subsides as the skin adapts. It is best to introduce them gradually, perhaps every other night, alongside a good moisturiser.
How can I help
I see patients in person in central London. An in person consultation allows me to examine the skin directly including features that are difficult to capture in a photograph such as 3-dimensional changes and textural change. This is the better option where the diagnosis is uncertain, where previous treatment has not been effective, or where a procedure is being considered. For more straightforward conditions such as acne and rosacea a remote consultation with clear photographs can be a good option.
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