Rosacea is a common skin condition causing flushing, redness, red pimples, and pustules on the face, which should not be confused with acne. It can also cause inflammation of the eyes or eyelids, or both. Some people can develop a thickening of the skin, especially of the nose, which is called rhinophyma. Because rosacea is a chronic disease the effect of treatment on quality of life is very important to the individual. A range of treatment options are available which include several topical and oral antibiotics, azelaic cream, topical and systemic retinoids, and light-based therapies, e.g. laser therapy.
This review found that in 3 clinical trials with 334 participants, topical metronidazole was more effective than placebo. Although most of the studies did not specifically address participants' satisfaction with treatment, they did nevertheless confirm the effectiveness of some of the treatments, expressed as a reduction in lesion counts, but these evaluations were largely physician-assessed. Three clinical trials involving 778 participants provided some evidence that topical azelaic acid cream was more effective than placebo. Two studies reported that the anti-inflammatory dose of doxycycline (40 mg) was more effective than placebo, confirmed by another study which also reported a lower risk of side-effects with the 40 mg dose rather than the 100 mg dose. Cyclosporine 0.05% ophthalmic emulsion appears to be more effective than artificial tears for rosacea of the eyes.
Future research should aim to provide reliable evidence for people to make informed decisions about whether other widely-available treatments are effective in managing rosacea, i.e. other oral tetracyclines, isotretinoin, and treatments used for rosacea of the eyes, in addition to investigating the potential role of sunscreens and dietary change.