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Your doctor may prescribe a topical antibiotic preparation, such as metronidazole, to make your skin look less puffy and red and to reduce the number of blemishes. Certain antibiotics have an anti-inflammatory effect, which is why they can be effective at reducing redness and blemishes. 

Our doctors typically prescribe topical antibiotics for six to eight weeks. Together, you and your doctor assess their effectiveness and determine whether treatment should continue. You may see results in as few as two weeks, but it’s not unusual for this to take longer.

Topical retinoids may be recommended if you have blemishes associated with rosacea. These blemishes are caused by clogged or inflamed pores, which are the tiny openings in the skin where hair follicles open to the surface. Topical retinoids help to clear the pores by reducing the clogging of the openings and may provide an anti-inflammatory effect as well.

Topical retinoids are generally applied every day, but some people build up slowly to daily use, so that the skin can acclimate. Common side effects of retinoids include dry and flaky skin, but this usually resolves or diminishes with continued use. It can take four weeks before you see results with this medication.

Azelaic acid is a naturally derived medication. It has been demonstrated to improve the appearance of redness and to reduce blemishes and whiteheads caused by rosacea. Azelaic acid is available over the counter as well as by prescription. Your doctor recommends the appropriate formula based on your symptoms.

This medication is available as a cream that is typically applied twice a day—once in the morning and once at night. Its effects are seen in one to two months. After six to eight weeks, your dermatologist assesses how well the medication is working before making a recommendation about further treatment. Azelaic acid can cause side effects, including dry, itchy skin, which can be managed and may diminish with continued use.

Brimonidine is a prescription gel that reduces chronic facial redness, one of the most common and persistent symptoms of rosacea. It does so by temporarily shrinking the blood vessels beneath the skin. A topical gel applied once daily, this medication can be effective for up to 12 hours. Side effects may include irritation or worsening redness.

If your skin has improved after several months on a topical medication regimen, your doctor may try stopping treatment to see if your symptoms reappear. For some people, topical medication is no longer needed to manage rosacea. For others, continued treatment may be necessary to prevent symptoms from returning.