Topical Rosacea Therapy

Metronidazole — Direct Anti-inflammatory Action in Rosacea

Reduces oxidative and inflammatory follicular damage.

• ROS scavenger: Mechanism (Short placeholder note)
• 0.75–1%: Typical dose (Topical gel/cream)
• ~3–4 wk: Onset (Short placeholder note)
• Mild: Demodex effect (Short placeholder note)

Neutrophil and ROS suppression

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Clinical response pattern

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Azelaic Acid — Antimicrobial and Anti-inflammatory Dual Action

Targets keratinocytes and inflammatory cytokine pathways.

• KLK5/cathelicidin: Mechanism (Short placeholder note)
• 15–20%: Typical dose (Topical gel/foam)
• ~4 wk: Onset (Short placeholder note)
• Mild-moderate: Demodex effect (Short placeholder note)

Keratinocyte normalization

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Cytokine pathway modulation

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Ivermectin — Anti-parasitic Clearance of Demodex Mites

Paralyzes mites via glutamate-gated chloride channels.

• GluCl agonist: Mechanism (Short placeholder note)
• 1% cream: Typical dose (Once daily)
• ~2–4 wk: Onset (Short placeholder note)
• Strong: Demodex effect (Short placeholder note)

Mite paralysis and death

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Secondary anti-inflammatory gain

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Demodex Mite Density Returns Toward Normal Skin Levels

Weekly mite counts decline with sustained topical therapy.

• ~6/cm²: Baseline density (Rosacea skin average)
• <1/cm²: Normal skin (Reference threshold)
• 8–12 wk: Time to normalize (Short placeholder note)
• Ivermectin: Best agent (Short placeholder note)

Density decline kinetics

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Agent comparison

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Inflammatory Papule and Pustule Clearance Over Treatment Course

Papule and pustule counts fall as inflammation and mites resolve.

• ~14: Baseline lesions (Short placeholder note)
• ~70–90%: Clear at 12 wk (Short placeholder note)
• Moderate: Relapse risk (Short placeholder note)
• Recommended: Maintenance (Short placeholder note)

Lesion count trajectory

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Long-term maintenance

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