Rosacea
Dermatology Pathways: Rosacea NICE CKS: Rosacea BAD Patient Information: Rosacea
Topical treatment
Metronidazole
Metronidazole 0.75% cream
Metronidazole 0.75% gel
Azelaic acid
Azelaic acid 15% gel
Ivermectin
Ivermectin 10mg/g cream
For facial erythema associated with rosacea.
Brimonidine
Brimonidine 3mg/g gel
Prescribing Notes:
- Rosacea has four clinical variants (erythematotelangectasic, papulopustular, rynophymatous and ocular) and treatment should be targeted. Pustular rosacea is best treated with systemic antibiotics (see separate pathway).
- Camouflage creams may be required for redness of the skin due to rosacea (see Cosmetic camouflage section).
History Notes
27/05/2026
Regional formulary chapter launched.
Systemic treatment
Doxycycline
Doxycycline 100mg capsules
Lymecycline
Lymecycline 408mg capsules
Erythromycin is a less cost-effective choice than lymecycline or doxycycline. Preferred choice in pregnancy.
Erythromycin
Erythromycin 250mg gastro-resistant tablets
Prescribing Notes:
- Camouflage creams may be required for redness of the skin due to rosacea (see Cosmetic camouflage section).
- Pustular rosacea is best treated with systemic antibiotics. If no improvement after 3 months, the patient should be switched to an alternative antibiotic.
History Notes
27/05/2026
Regional formulary chapter launched.
Topical treatment
Rosacea is rare in children, consider seeking specialist advice.
Metronidazole
Metronidazole 0.75% cream
Metronidazole 0.75% gel
Prescribing Notes:
- Camouflage creams may be required for redness of the skin due to rosacea (see Cosmetic camouflage section).
History Notes
27/05/2026
Regional formulary chapter launched.
Systemic treatment
Prescribing Notes:
- Consider diagnosis and seek specialist advice prior to initiating systemic therapy for a child.
History Notes
27/05/2026
Regional formulary chapter launched.