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Which rosacea medications are proven to be effective?

Last Update: August 14, 2014; Next update: 2017.

Skin creams containing metronidazole or azelaic acid can help relieve the symptoms of rosacea like skin redness. The same is probably true for medications containing the antibiotic doxycycline.

Rosacea is a common inflammation of the skin on the face. It can cause flushing and redness, papules (red pimples) and pustules (pus pimples), as well as enlarged blood vessels. In its more severe forms it can cause swelling and bumps, and it often affects the eyes and eyelids also.

A wide variety of creams, lotions and gels are available for treating rosacea. For more severe forms, stronger oral medications are also used, some of which can have serious side effects.

In order to find the most effective treatments for rosacea, researchers from the Cochrane Collaboration – an international network of researchers – systematically analyzed the available trials. Nearly all the trials they found involved drug treatments for rosacea.

Azelaic acid and metronidazole can relieve symptoms

The researchers analyzed 58 studies on the treatment of rosacea. Many of the studies were not very conclusive. But overall they found evidence that some of the drugs tested can relieve rosacea symptoms. These medications include creams containing azelaic acid or the antibiotic metronidazole.

Azelaic acid is the best-studied treatment. Evaluations of studies on this substance showed the following:

  • Symptoms improved in 64 out of 100 participants who used azelaic acid.
  • Compare: Symptoms improved in only 40 out of 100 people who used a cream without azelaic acid.

In other words, azelaic acid can help relieve symptoms in 24 of 100 people.

Creams containing azelaic acid and metronidazole also proved to be rather well tolerated: There were not many side effects, or they were not especially severe. When using creams, however, it can sometimes take a few weeks to to see noticeable improvement.

The antibiotic drug doxycycline is the oral medication that seems to be able to reduce skin redness. Research suggests that lower doses (40 mg) are not less effective than higher doses, but cause fewer side effects.

There is not enough good research on the other commonly used treatments. This is also true of several oral medications used for serious skin changes caused by rosacea that affect larger areas of skin. Those medications can also have side effects including diarrhea, nausea and – in some cases – sensitivity to light.


  • Van Zuuren EJ, Kramer S, Carter B, Graber MA, Fedorowicz Z. Interventions for rosacea. Cochrane Database Sys Rev: Version 2011, Issue 3. CD003262.
  • IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

    Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. We do not offer individual consultations.

    Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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