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Rosacea Recap: Comparing Treatment Options


James Q. Del Rosso, DO, highlights different rosacea treatment options in his session at the 2022 Fall Clinical Dermatology Conference for PAs & NPs.

Along with traditional rosacea treatments, dermatologists have a growing choice of new options for treating this widespread skin disorder. James Q. Del Rosso, DO, research director of JDR Dermatology Research in Las Vegas, Nevada and senior vice president of clinical research and strategic development at Advanced Dermatology & Cosmetic Surgery in Maitland, Florida, detailed the different therapy options for rosacea in a presentation at the 2022 Fall Clinical Dermatology Conference for PAs & NPs, held June 3-5 in Scottsdale, Arizona.1

Treatments for rosacea include topical azelaic acid as it shows efficacy in the downregulation of cathelicidin pathway. Additionally, topical azelaic acid has reported favorable skin tolerability characteristics. Another treatment is ivermectin 1% cream (Sklice, Arbor Pharmaceuticals), which suppresses the innate immune response, reduces angiogenesis, and reduces inhibition of the cathelicidin pathway. Del Rosso cited a study which reported ivermectin 1% cream reducing papulopustular lesions, reduction in relevant biomarkers, and reduction of Demodex mites in vivo.2,3

New topical therapies for papulopustular include minocycline 1.5% foam once daily, and microencapsulated benzoyl peroxide 5% cream once daily. In randomized controlled trials, minocycline 1.5% foam saw efficacy equivalent to its 3% concentration, favorable tolerability, and no systemic safety signals.4 Microencapsulated benzoyl peroxide 5% cream was associated with a 5.9% adverse events rating in its active group and statistically significant efficacy in patients aged 65 and over.5

Using subantimicrobial, sub-antibiotic dosing of doxycycline at 40 mg in a modified release capsules once daily, or immediate-release 20 mg twice daily is an alternative therapy option, Del Rosso explained. The treatments modes of action include the inhibition of matrix metalloproteinases and an indirect inhibition of the cathelicidin pathway. He said that in addition to multiple studies supporting efficacy and safety, subantimicrobial doxycycline has shown to have comparable efficacy to doxycycline 100 mg daily.6-9

Del Rosso concluded by highlighting the role of aesthetic devices in the treatment of rosacea, including pulse dye laser and intense pulse light.


Del Rosso reported being a research investigator (*), consultant/advisor (^), and/or speaker (#) for AbbVie^, Aclaris Therapeutics*^#, Amgen Inc*^#, Almirall SA*^#, AnaptysBio*, Arcutis Biotherapeutics*^, ASLAN Pharmaceuticals*, Athenex*, Ortho Dermatologics*^#, Beiersdorf AG#, Biofrontera^#, BioPharmX Corporation*^, Biorasi*, BlueCreek Dermatologics, Inc^, Boehringer Ingelheim^, Botanix Pharmaceuticals*, Brickell Biotech, Inc*, Bristol Myers Squibb^#, Cara Therapeutics*, Cassiopea SpA*^, Dermata Therapeutics^, Dermavant Sciences, Inc*^, Encore Dermatology Inc^#, EPI Health*^#, Evommune, Inc^, Ferndale Pharma Group, Inc^#, Galderma*^#, Genentech, Inc*#, Incyte*^#, Janssen Pharmaceuticals*, Jem Health^#, LEO Pharma*^#, La Roche-Posay^, Eli Lilly and Company*^#, MC2^, Mindera Health^, Novan*^, Pfizer Inc*^#, Ralexar Therapeutics, Inc*, Regeneron Pharmaceuticals, Inc*^#, Sanofi-Genzyme^#, Sente, Inc^, Sol–Gel*^, Sonoma Pharmaceuticals^, Sun Pharmaceutical Industries Ltd*^#, UCB*^#, Verrica Pharmaceuticals^#, Vyne Therapeutics Inc*^#


  1. Del Rosso JQ. What you need to know about rosacea. Presented at: 2022 Fall Clinical Dermatology Conference for PAs & NPs. June 3-5, 2022. Scottsdale, Arizona and virtual.
  2. Del Rosso JQ. Azelaic acid topical formulations: differentiation of 15% gel and 15% foam. J Clin Aesthet Dermatol. 2017;10(3):37-40.
  3. Schaller M, Gonser L, Belge K, et al. Dual anti-inflammatory and anti-parasitic action of topical ivermectin 1% in papulopustular rosacea. J Eur Acad Dermatol Venereol. 2017;31(11):1907-1911.
  4. Del Rosso JQ, Webster G, Weiss JS, Bhatia ND, Gold LS, Kircik L. Nonantibiotic properties of tetracyclines in rosacea and their clinical implications. J Clin Aesthet Dermatol. 2021;14(8):14-21.
  5. Bhatia N, submitted for publication, 2020; presented at Virtual Fall Clinical Fall 2020.
  6. Kim S, Michaels B, Kim G, et al. In: Wolverton SE, Ed. 3rd Edition. Comprehensive Dermatologic Drug Therapy, Elsevier-Saunders, 2013. pp 61-97.
  7. Del Rosso JQ, Zeichner JA. The clinical relevance of antibiotic resistance. Dermatologic Clinics. 2016;34(2):167-173.
  8. Simonart T, Dramaix M, De Maertelaer V. Efficacy of tetracyclines in the treatment of acne vulgaris: a review. Br J Dermatol. 2007;0(0):071106220718013
  9. Garner SE, Eady A, Bennett C, Newton JN, Thomas K, Popescu CM. Minocycline for acne vulgaris: efficacy and safety. Cochrane Skin Group, ed. Cochrane Database of Systematic Reviews. Published online August 15, 2012.
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