Prescription Creams for Rosacea

By Dr Magnus Lynch
MA(Cantab) DPhil(Oxon) MRCS FRCP
Consultant Dermatologist & Dermatological Surgeon

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.

Related articles

• Ivermectin (Soolantra) for rosacea
• Azelaic Acid for Rosacea
• Topical metronidazole for rosacea

About Dr Magnus Lynch

I am a London-based Consultant Dermatologist and Dermatological Surgeon. I am highly experienced in skin cancer diagnosis and treatment, Mohs micrographic surgery, facial reconstructive surgery, laser treatments, regenerative dermatology, acne, rosacea and acne scarring. Since 2019, I have been passionate about sharing information online about dermatology and skin care. I studied at the Universities of Cambridge and Oxford, and completed my dermatology training and Mohs fellowship at the prestigious St John’s Institute of Dermatology. I graduated from medical school in 2003 and have worked exclusively in Dermatology since 2012.

I lead a research team at King’s College London investigating the molecular biology of skin cancer and skin cancer diagnostics, and I constantly aim to translate the latest findings into better patient care. You can learn more about my Research.

In recent years I have been involved in Media Appearances, including the Channel 5 series 'Skin A&E', where I perform skin surgeries and treat various skin conditions. Filming for the next series has recently completed and the series will be released later in 2025.

How I can help

My NHS practice is at Guy's Hospital. I consult with private patients at several well-appointed and conveniently located sites across central London:

• London Bridge Hospital: Conveniently situated within The Shard, next to London Bridge station.
• Skin55 Ltd: Located at 55 Harley Street, this beautiful Edwardian building houses one of the largest private dermatology facilities in the UK with a comprehensive laser suite.
• OneWelbeck: Located close to Bond Street underground station. Mohs surgery, lasers, and other skin surgeries are performed in the state-of-the-art surgical suite here.

A new consultation is £250, a follow up consultation is £220. For more information on fees, please visit Prices.