Topical treatments for rosacea target papules/pustules and include metronidazole 0.75% cream, ivermectin 1% cream, azelaic acid 15% gel and foam, and sodium sulfacetamide 10% with or without sulfur 5%. Topical treatments for erythema include brimonidine 0.33% gel and oxymetazoline 1% cream. These treatments can be combined for best results, and the recent MOSAIC study showed that initiation of therapy with a combination regimen of ivermectin 1% cream plus brimonidine 0.33% gel was associated with superior efficacy and good patient acceptance.33 In addition, medical and physical therapies may be used together for good results.34,35 Commonly used oral therapies for rosacea include tetracycline-type agents in an antibiotic dose and in a sub-antimicrobial dose. Clinician-directed skin care (cleanser, moisturizer, sun protection) should be a part of the rosacea regimen to improve therapeutic outcomes and decrease the likelihood of skin irritation.11 Treatment can now be individualized to the patient’s presentation, taking into account the specific signs and symptoms present, trigger factors, and patient preferences.
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