Standard Management Options

for Rosacea
The National Rosacea Society Expert Committee has published updated standard management options for rosacea to reflect
the dramatic increase in scientific knowledge about rosacea and broader range of medical therapies.1 The chart below provides
an overview of the committee’s assessment of available treatments to address the disease’s signs and symptoms, also known
as phenotypes.
Although there is no cure, these options, including topical and oral therapies as well as lasers and light devices, may help
reduce or control rosacea’s phenotypes. Because each case is unique and what works for one patient may not be effective or
suitable for another, treatment must be tailored by a physician on an individual basis.
In addition, because rosacea is characterized by flare-ups and remissions, comprehensive treatment for rosacea should
include lifestyle changes to avoid personal triggers, as well as gentle skin care to maintain the skin barrier.

TREATMENT OPTIONS FOR DIAGNOSTIC FEATURES

Persistent Erythema Phymas (Skin thickening)
(Facial redness)
Active (Inflamed) Fixed (Not inflamed)

Topical Therapies
Brimonidine ●●
Oxymetazoline ●●
Retinoids ○/C
Light Devices & Surgical Interventions
Intense pulsed light (IPL) ○○
Pulsed dye laser ○○
KTP laser ○○
CO2 laser C
○○○○
Erbium laser* C
○○○○
Traditional surgery* C
○○○○
Electrosurgery* C
○○○○
Radiofrequency ablation* C
○○○○
Oral Therapies
Carvedilol ○
Doxycycline (subantimicrobial) ○ ○/C
Doxycycline ○ ○/C
Minocycline ○ ○/C
Tetracycline ○/C
Isotretinoin ○○/C
Azithromycin ○/C
Trimethoprim/sulfamethoxazole ○/C
The number of circles indicates the committee’s expert opinion on relative efficacy up to 4, with 4 indicating the most effective. Filled
vs. open circles indicate strength of clinical trial evidence, with solid circles as strong and open circles as weak.
C indicates treatments used in combination therapy only.
* Skill dependent; post-inflammatory hyperpigmentation risk.

- over -
 TREATMENT OPTIONS FOR MAJOR FEATURES
Papules/Pustules Telangiectasia Flushing Ocular Symptoms
(Bumps/Pimples) (Visible Blood Vessels) (Eye Irritation)

Topical Therapies
Ivermectin ●●● ○
Azelaic acid ●●
Metronidazole ●●
Clindamycin ○
Retinoids ○ ○
Sulfacetamide sodium/sulfa ○
Brimonidine C ○
Oxymetazoline ○
Azithromycin† ○○○
Cyclosporin‡ ○○○
Tacrolimus† ○○○
Oral Therapies
Doxycycline (subantimicrobial) ●●● ○○
Azithromycin ○○○ ○○
Doxycycline ○○○ ○○
Minocycline ○○○ ○○
Isotretinoin ○○○
Trimethoprim/sulfamethoxazole ○○○ ○
Tetracycline ○○ ○
Clindamycin ○
Carvedilol ○
Clonidine ○
Propranolol ○
Cyclosporin‡ ○○○
Light Devices
Intense pulsed light (IPL) ○○○○ ○○
Pulsed dye laser ○○○○
KTP laser ○○○○ ○
The number of circles indicates the committee’s expert opinion on relative efficacy up to 4, with 4 indicating the most effective. Filled
vs. open circles indicate strength of clinical trial evidence, with solid circles as strong and open circles as weak.
C indicates treatments used in combination therapy only.
† On lashes, pulsed 1-2 weeks per month for 3-6 months.
‡ 2-3 months; long-term use causes topical steroid rosacea-like reaction.

1. Thiboutot D, Anderson R, Cook-Bolden F, et al. Standard management options for rosacea: the 2019 update by the National
Rosacea Society Expert Committee. J Am Acad Dermatol 2020;82(6):1501–1510. doi:10.1016/j.jaad.2020.01.077

© 2020 National Rosacea Society For more information visit rosacea.org