What are the first-line topical treatments recommended for managing mild to moderate rosacea in adults?

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

Posted: 14 August 2025Updated: 14 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

For mild to moderate rosacea, the first-line topical treatments include topical ivermectin applied once daily for 8–12 weeks, depending on local guidelines .

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

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