# Acne rosacea (papulopustular rosacea) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - 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) ## Treatment metadata - Metronidazole — topical - Azelaic acid — topical - Referral & safety-netting (no drug therapy) - Doxycycline — 50 mg — oral.solid ## Complete treatment card ```text ACNE ROSACEA (PAPULOPUSTULAR ROSACEA) 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) Review status: REVIEWED against 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) (2026-08) 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 Source StatPearls "Rosacea" - disease-level clinical article Status traced to the source above 1. METRONIDAZOLE [1st line] Adult Apply 0.75% gel or cream thin layer to affected facial areas twice daily - The average period of treatment is three to four months. Peds 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). 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. Caution 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. Egypt ROSAGEL 0.75% GEL 20 GM EVA PHARMA 11.50 EGP FIPCODAZOLE 10 MG GEL D B K > BOSTO... 62.00 EGP 2. AZELAIC ACID [1st line] Adult Apply a thin layer of 15% gel or 20% cream twice daily (morning and evening) to affected areas of the face Peds 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. 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. Caution 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. Egypt AZECLEAR 20% CREAM 30 GM BIOPHARM EGYP... 21.60 EGP EZALIC 20% CREAM 30 GM MULTI-APEX 26.40 EGP SKINOREN 20% CREAM 30 GM INTENDIS MANU... 35.50 EGP AZADERM 20% CREAM 30 GM MUP 87.00 EGP 3. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult 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. Caution RED FLAG - Ocular symptoms need ophthalmic evaluation or referral. 4. DOXYCYCLINE [2nd line] Adult 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 Peds 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. 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. Caution 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. Egypt DOXYCOST 50MG 30 TABS. PENTA PHARMA 51.00 EGP (1.70/unit) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)