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Rosacea

NICE CKS Rosacea. Last revised: Dec 2024.

Guidelines

Avoid trigger factors if possible (e.g. smoking, alcohol, spicy food)
Sun protection with high-factor sunscreen

General skin care measures:

Regular use of non-oily emollients if skin is dry
Use gentle soap-free OTC cleansers
Cosmetics (yellow / green tinted) to camouflage skin erythema

Choice of drugs depends on the clinical phenotype and severity

1st line: topical brimonidine 0.5% gel once daily or PRN

Advise that it only offer temporary relief of symptoms (may reduce erythema within 30 min, reaching peak action at 3-6 hours, but after erythema will return to baseline)

Mild to moderate: topical ivermectin once daily for 8-12 weeks

Pregnancy: topical metronidazole / azelaic acid

Moderate to severe (of if topical ivermectin not effective alone): topical ivermectin + oral doxycycline 40mg once daily for 8-12 weeks

Pregnancy: topical metronidazole / azelaic acid + oral erythromycin

Consider oral doxycycline 40mg once daily for 6 weeks

References

NICE CKS Rosacea

Author: Adams Lau
Reviewer:
Last edited: 15/07/25

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