What are the first-line topical treatments for managing acne rosacea in adults?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025Updated: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

The first-line topical treatments for managing acne rosacea in adults include topical ivermectin, applied once daily for 8–12 weeks, especially for mild-to-moderate papules and/or pustules .

Alternative topical treatments are metronidazole 0.75%, applied twice daily, or azelaic acid 15%, applied twice daily, if ivermectin is not suitable or available .

For persistent erythema, topical brimonidine 0.5% gel may be prescribed for temporary relief, applied once daily as needed .

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