What is the most effective treatment for acne rosacea?

Abstract

Topical metronidazole and azelaic acid are equally effective for the papulopustular lesions of acne rosacea, although metronidazole is better tolerated. Oral doxycycline, tetracycline, and metronidazole are also effective, but not enough evidence exists to determine whether one is more effective than another or more effective than topical therapy (strength of recommendation [SOR]: A, systematic review and individual randomized controlled trials [RCTs]). Some evidence supports a benefit for topical sodium sulfacetamide with sulfur, and benzoyl peroxide (SOR: B, small single RCTs). Pulsed-light and laser therapy may improve the erythema and telangiectasias associated with acne rosacea (SOR: C, case series). All patients with acne rosacea should use sunscreen and emollients, and avoid skin irritants (SOR: C, expert opinion).