TherapyFormulation and dosageEffectivenessAdverse effectsMechanism of actionEvidenceCost*
Metronidazole† (Metrogel, Metrocream, Metrolotion)

  • 0.75% gel, cream, or lotion: twice per day

  • 1% gel: once per day

Papules, pustules, erythemaPruritus, stinging, irritation, drynessAntioxidant, anti-inflammatoryRCTs

  • $$$ ($$$$)

  • 45- to 60-g tubes of cream or gel; 59-mL bottle of lotion

Azelaic acid† (Finacea)15% gel once or twice per dayPapules, pustules, erythemaStinging, irritation, burningAntioxidant; decreases KLK5 and cathelicidinRCTs

  • NA ($$$$)

  • 50-g tube

Sulfacetamide/sulfur† (several brands)10%/5% cream and other formulations; once or twice per dayPapules, pustules, erythemaIrritation, malodorous, avoid in persons with sulfa allergyAntibacterialSmall studies and historical precedent

  • $$ to $$$$

  • 28- to 57-g tube

Brimonidine† (Mirvaso)0.33% gel once per dayErythemaPruritus, burning, irritation, dryness, erythema; use with caution in patients with CAD or CVDVasoconstrictionRCTs

  • NA ($$$$)

  • 30-g tube

Ivermectin† (Soolantra)1% cream once per dayPapules, pustulesBurning, skin irritationAntiparastic/anti-inflammatoryRCTs

  • NA ($$$$)

  • 30-g tube

Permethrin (Elimite)5% cream once per dayPapules, erythemaIrritation, burningAntiparasiticLimited studies

  • $$ ($$)

  • 60-g tube

Benzoyl peroxide5% gel once or twice per dayPapules, pustules, erythemaErythema, burningAntibacterialLimited studies

  • $ ($$)

  • 90-g tube

Clindamycin1% gel twice per dayPapules, pustulesPruritus, burning, irritation, drynessAntibioticLimited studies

  • $$ ($$$)

  • 60-g tube

Erythromycin2% gel twice per dayPapules, pustulesPruritus, erythema, irritation, drynessAntibioticLimited studies

  • $ (NA)

  • 60-g tube

Pimecrolimus (Elidel)1% cream twice per dayErythemaBurningAnti-inflammatoryLimited studies

  • NA ($$$$)

  • 60-g tube

Tretinoin

  • Cream: 0.025%, 0.05%, 0.1%

  • Gel: 0.01%, 0.025%

  • Once per night at bedtime

Papules, pustules, erythema, possibly telangiectasiaPeeling, erythema, pruritus, dryness, irritation, may exacerbate rosacea photosensitivityStimulates epithelial cell turnoverLimited studies

  • $ ($$$)

  • 20-g tube of cream

  • 15-g tube of gel

Oxymetazoline (Afrin)0.05% nasal solution every six hoursErythemaIrritation, burningVasoconstrictionCase studies

  • $ ($)

  • Available OTC

Cyclosporine (Restasis)0.5% ophthalmic emulsion every 12 hoursOcularHyperemia, burning, blurred vision, tearingImmunomodulationRCTs

  • NA ($$$)

  • 30 vials of 0.4 mL