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Refer to section 13.6, National Patient Pathways and British Association of Dermatology patient information leaflet (

Reduce triggering factors such as:

  • hot drinks like tea and coffee, alcohol etc.
  • hot and spicy food
  • excessive heat, direct sunshine, hot showers etc.
  • topical steroids.   

Topical treatment (refer to section 13.6): 

For mild papular/pustular rosacea:

  • metronidazole (Rozex®) 0·75% cream or gel
  • azelaic acid 15% cream.

For moderate to severe persistent redness/erythema:

  •  brimonidine gel 0·33% can be used (note MHRA advice below).

Oral treatment:

For moderate rosacea or not responding to topical treatment:

  • a tetracycline, eg oxytetracycline or doxycyline
  • erythromycin is an alternative
  • review treatment in 6 to 8 weeks and if improvement the dose of antibiotics can be reduced, or change to topical.

For severe rosacea or not responding to oral antibiotics refer to Dermatology Department at Raigmore Hospital.

MHRA: Brimonidine gel: advice for health professionals:

  • Exacerbation of rosacea symptoms occurred in up to 16% of patients treated with brimonidine gel in clinical studies; in most cases, erythema and flushing resolve after stopping treatment.
  • Initiate treatment with a small amount of gel (less than the maximum dose) for at least 1 week and increase the dose gradually, based on tolerability and response to treatment.
  • Advise patients carefully on how to apply the gel and on the importance of not exceeding the maximum daily dose (which is 1 gram of gel in total weight, approximately 5 pea-sized amounts).
  • Advise patients to stop treatment and consult a doctor if their symptoms worsen during treatment (increased redness or burning).
  • For further information see
Editorial Information

Last reviewed: 31 December 2016

Next review: 31 December 2018

Author(s): Skin Review Group

Version: 8

Approved By: TAM Subgroup of ADTC