Dawaa Reference

chronic

Acne rosacea (papulopustular rosacea)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources4 sources

Egyptian National Drug Formulary - Antimicrobial 2023 (doxycycline monograph) · Rozex 0.75% w/w Gel SmPC sections 4.2 and 4.4 (eMC product 925) · UK eMC Skinoren 15% Gel / Finacea 15% Gel SmPC (LEO Pharma), product id 10926 · Rosacea - disease-level clinical article (acne-rosacea-full.txt)

Verified against6 documents
  • Egyptian National Drug Formulary - Antimicrobial 2023 (doxycycline monograph)
  • Rozex 0.75% w/w Gel SmPC sections 4.2 and 4.4 (eMC product 925)
  • UK eMC Skinoren 15% Gel / Finacea 15% Gel SmPC (LEO Pharma), product id 10926
  • Rosacea - disease-level clinical article (acne-rosacea-clinical.txt)
  • Acne rosacea (papulopustular rosacea) - disease-level clinical article (acne-rosacea-full.txt)
  • Rosacea - disease-level clinical article (acne-rosacea-full.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (5)

  • Persistent facial redness with episodes of flushing across the nose and cheeks is usually the first sign [redness]
  • Watery, dry, or gritty-feeling eyes with itching can occur when the eyes are affected [itching]
  • Between half and three quarters of patients have eye involvement, so ocular symptoms are the rule rather than the exception
  • The affected eye can burn or tingle, water, feel as though something is in it, and dislike light
  • Vision can blur once the eyes are involved, which is the point to send them to an ophthalmologist

Signs — what you find (7)

  • Crops of papules and pustules on the face resemble adult acne but without blackheads or whiteheads [acne · papules · pustules]
  • Thickened, enlarged sebaceous glands cause tissue overgrowth, classically on the nose in men
  • Diagnosis can be made from fixed central facial redness that periodically flares, or from phyma changes alone [redness]
  • Two of flushing, papules and pustules, or visible small blood vessels also support the diagnosis [papules · pustules]
  • Eye involvement can include lid-margin telangiectasia, conjunctival injection, a spade-shaped corneal infiltrate, or scleritis [eye redness · telangiectasia]
  • The flushing, redness, visible vessels and spots settle on the nose, chin, cheeks and forehead [redness]
  • Features of more than one subtype are often present together, and which one dominates can change over the years

Tests (1)

  • No lab testing is needed since diagnosis is clinical, though patients with eye symptoms need an ophthalmology evaluation

If not this — what else fits (6)

  • True acne is distinguished by comedones, which rosacea does not have
  • Seborrheic dermatitis produces greasy scaling that concentrates around the nasolabial folds and hair-bearing regions, and often overlaps with rosacea
  • Keratosis pilaris rubra causes tiny follicular bumps on red patches of the cheeks and neck, mainly in teenagers
  • Flushing confined to the face fits rosacea; flushing elsewhere needs further workup
  • Lupus's malar rash looks similar but typically spares the nasolabial fold and has no pustules
  • A drug-induced acneiform eruption starts suddenly after a new medication, with uniform lesions on the trunk

SourceStatPearls "Rosacea" - disease-level clinical article

Presentation findings are traced to the source above.

1

METRONIDAZOLE

1st line

Formtopical

Adult dose and duration

Apply 0.75% gel or cream thin layer to affected facial areas twice daily - The average period of treatment is three to four months.

Paediatric dose

Paediatric population : Not recommended. Safety and efficacy have not been established.

Choice

Alternatives. Both are topical anti-inflammatories for papulopustular rosacea; metronidazole is the better tolerated of the two and the cheaper (12-62 EGP against 22-87).

Dose source

Rozex 0.75% w/w Gel SmPC sections 4.2 and 4.4 (eMC product 925)

Why

Topical anti-inflammatory antibiotic that calms the papules and pustules of rosacea, most likely by damping local reactive oxygen species and inflammatory activity rather than by killing bacteria outright; well tolerated on facial skin, which is why it is used first-line.

Cautions
  • Avoid contact with eyes and mucous membranes.
  • Local skin irritation, erythema, and dryness may occur.
  • Avoid exposure to strong UV light during treatment.
  • Rosacea takes time - the label puts the average course at three to four months, and it may be continued beyond that if it is clearly working. Keep treated skin out of the sun.
Egyptian brands
Egyptian brandManufacturerIndicative price
ROSAGEL 0.75% GEL 20 GMEVA PHARMA11.50 EGP
FIPCODAZOLE 10 MG GELD B K > BOSTON HEALTH62.00 EGP
2

AZELAIC ACID

1st line

Formtopical

Adult dose and duration

Apply a thin layer of 15% gel or 20% cream twice daily (morning and evening) to affected areas of the face

Paediatric dose

The safety and efficacy of Finacea Gel for the treatment of papulopustular rosacea in children below the age of 18 years have not been established.

Dose source

UK eMC Skinoren 15% Gel / Finacea 15% Gel SmPC (LEO Pharma), product id 10926

Why

Topical dicarboxylic acid with anti-inflammatory, antimicrobial, and mild comedolytic action that reduces the papules and pustules of rosacea; a first-line topical alternative to metronidazole.

Cautions
  • Initial transient skin burning, stinging, or pruritus is common in first 1-2 weeks.
  • There is a hypopigmentation risk in dark-skinned individuals; monitor closely.
Egyptian brands
Egyptian brandManufacturerIndicative price
AZECLEAR 20% CREAM 30 GMBIOPHARM EGYPT > SAJA PHARMA21.60 EGP
EZALIC 20% CREAM 30 GMMULTI-APEX26.40 EGP
SKINOREN 20% CREAM 30 GMINTENDIS MANUFACTURING SPA-ITALY > BAYER HEALTHCARE35.50 EGP
AZADERM 20% CREAM 30 GMMUP87.00 EGP
3

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Rosacea - disease-level clinical article (acne-rosacea-clinical.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions
  • RED FLAG - Ocular symptoms need ophthalmic evaluation or referral.
4

DOXYCYCLINE

2nd line

Strength50 mg

Formoral.solid

Adult dose and duration

By what the rosacea is doing, and for 8 to 12 weeks in each case. Papules and pustules: sub-antimicrobial modified-release doxycycline 40 mg daily (30 mg immediate-release plus 10 mg delayed-release beads). Inflamed phyma: 100 mg once or twice daily. Ocular rosacea: sub-antimicrobial modified-release 40 to 100 mg daily. x 6-12 weeks

Paediatric dose

Use under 8 years only for a severe or potentially life-threatening infection, or where no better alternative exists - the risk is permanent tooth discoloration and enamel hypoplasia during tooth development. Where it is justified: 2.2 mg/kg every 12 hours, maximum 100 mg per dose.

Dose source

Rosacea - disease-level clinical article (acne-rosacea-full.txt)

Why

At the low, sub-antimicrobial dose used here, doxycycline works through its anti-inflammatory action, inhibiting the enzymes and neutrophil activity that drive rosacea's inflammation, rather than acting as an antibiotic; added orally when topical treatment alone is not enough.

Cautions
  • Contraindicated in pregnancy and children <8 years (permanent dental staining and bone growth inhibition). Doxycycline 100 mg Capsules SmPC says, in section 4.2, "Doxycycline should not be used in children aged younger than 8 years due to the risk of teeth discolouration", in section 4.3, "Doxycycline is contraindicated in pregnancy", and in section 4.4 that tetracyclines used during tooth development "may cause permanent discolouration of the teeth (yellow-grey-brown)" and that "Enamel hypoplasia has also been reported".
  • Photosensitivity reaction; instruct patient to use broad-spectrum sun protection.
  • Take with full glass of water while standing to avoid esophageal ulceration.
Egyptian brands
Egyptian brandManufacturerIndicative price
DOXYCOST 50MG 30 TABS.PENTA PHARMA51.00 EGP (1.70/unit)

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.