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Skin concern

Rosacea

Primary source

Rosacea: a chronic inflammatory condition of the face with flushing, persistent redness, and sometimes papules, pustules or visible vessels. It is identified from a combination of features. The strongest evidence comes from a 2015 human trial: In moderate-to-severe papulopustular rosacea, once-daily ivermectin 1% cream reduced inflammatory lesion counts by 83.0% from baseline at 16 weeks versus 73.7% for twice-daily metronidazole 0.75% cream (P<0.001, 962 participants), and more subjects reached 'clear' or 'almost clear' on the investigator's global assessment (84.9% vs 75.4%, P<0.001). 2 ingredients have evidence for Rosacea: Centella asiatica, Niacinamide.

Rosacea is identified by a clinician from defined features; redness has many other causes. Skin care in this condition is adjunctive, the consensus sets complete clearance as its treatment target.

Where the definition comes from

Source wording

“A transition from a subtyping to a phenotyping approach in rosacea is underway, allowing individual patient management according to presenting features instead of categorization by predefined subtypes.” … “Cutaneous and ocular features are defined.” — from the ROSCO 2019 consensus update. The panel is dermatologists and ophthalmologists, so the features it defines are diagnostic features, not consumer descriptions.

Recommendations for rosacea diagnosis, classification and management: update from the global ROSacea COnsensus 2019 panel British Journal of Dermatology (Schaller et al.)

Ingredients at a glance

2015 · 962 people · adults with moderate-to-severe papulopustular rosacea · PMID 25228137

Ingredient Measured outcome Based on Certainty Year
— Skin effect Human trial High 2015
Centella asiatica Skin effect Human trial Moderate 2026
— Skin effect Review article Moderate 2010
Niacinamide Skin effect Human trial Low 2005

Studies and results

  1. 1 Centella asiatica Skin effect
    Moisturizer Containing Centella Asiatica Extract, Ceramide NP, and Panthenol for Erythema and Skin Barrier in Erythematotelangiectatic Rosacea: A Randomized Controlled Trial

    In a randomized controlled trial of 75 patients with erythematotelangiectatic rosacea, a moisturizer containing Centella asiatica extract, ceramide NP and panthenol produced greater improvements in facial redness and barrier measures than the control group at day 28.

    Human trial · 2026 · 75 people · patients with erythematotelangiectatic rosasma · Adults with erythematotelangiectatic rosacea using the combination moisturizer twice daily for 28 days, alongside oral minocycline. · Centella asiatica was one of three actives in the moisturizer; all adverse events were mild and self-limiting.

    PMID 42876425

    Read the full finding →
    Source:Moisturizer Containing Centella Asiatica Extract, Ceramide NP, and Panthenol for Erythema and Skin Barrier in Erythematotelangiectatic Rosacea: A Randomized Controlled Trial
  2. 2 Niacinamide Skin effect
    Niacinamide-containing facial moisturizer improves skin barrier and benefits subjects with rosacea

    A facial moisturiser containing niacinamide improved stratum corneum barrier function and skin hydration, measured instrumentally, in people with rosacea over four weeks of twice-daily use.

    Human trial · 2005 · 50 people · Adults with rosacea · A leave-on facial moisturiser, applied twice daily for four weeks, in adults with rosacea. · The tested article was a finished moisturiser. Fifty participants, one centre, four weeks. The study measured barrier function and hydration.

    PMID 16209160

    Read the full finding →
    Source:Niacinamide-containing facial moisturizer improves skin barrier and benefits subjects with rosacea

Study limits

Study conditions and measured outcomes.

  • ev-ivermectin-rosacea-trial Human trial · 2015

    A randomized trial of a marketed drug against another prescription drug. It supports ivermectin as a rosacea treatment. Funding came from the drug's developer (Ivermectin Phase III study group).

  • Centella asiatica Human trial · 2026

    Centella asiatica was one of three actives in the moisturizer; all adverse events were mild and self-limiting.

  • ev-doxycycline-rosacea-review Review article · 2010

    The cited source is a published drug evaluation that summarizes two pivotal trials. Like the ivermectin evidence here. Low-dose doxycycline is anti-inflammatory and sub-antimicrobial, oral antibiotics carry their own considerations.

  • Niacinamide Human trial · 2005

    The tested article was a finished moisturiser. Fifty participants, one centre, four weeks. The study measured barrier function and hydration.

Products with a basis for this

23 products · 10% Niacinamide Booster · Acne Control Cleanser · 2015 · 962 people · adults with moderate-to-severe papulopustular rosacea · PMID 25228137

Research-backed approaches

These studies measured finished products and whole routines.

  1. 1 Skin effect
    Superiority of ivermectin 1% cream over metronidazole 0.75% cream in treating inflammatory lesions of rosacea: a randomized, investigator-blinded trial

    In moderate-to-severe papulopustular rosacea, once-daily ivermectin 1% cream reduced inflammatory lesion counts by 83.0% from baseline at 16 weeks versus 73.7% for twice-daily metronidazole 0.75% cream (P<0.001, 962 participants), and more subjects reached 'clear' or 'almost clear' on the investigator's global assessment (84.9% vs 75.4%, P<0.001).

    Human trial · 2015 · 962 people · adults with moderate-to-severe papulopustular rosacea · Prescription topical treatment for papulopustular rosacea. This is a medicine. · A randomized trial of a marketed drug against another prescription drug. It supports ivermectin as a rosacea treatment. Funding came from the drug's developer (Ivermectin Phase III study group).

    PMID 25228137

    Read the full finding →
    Source:Superiority of ivermectin 1% cream over metronidazole 0.75% cream in treating inflammatory lesions of rosacea: a randomized, investigator-blinded trial
  2. 2 Skin effect
    Doxycycline 40 mg capsules (30 mg immediate-release/10 mg delayed-release beads): anti-inflammatory dose in rosacea

    Low-dose (anti-inflammatory, sub-antimicrobial) oral doxycycline 40 mg once daily was significantly more effective than placebo at reducing inflammatory lesions in rosacea across two pivotal randomized, double-blind, placebo-controlled, multicenter trials (16 weeks). The 40 mg dose works as an anti-inflammatory.

    Review article · 2010 · Adults with rosacea in two pivotal multicenter trials · Oral prescription treatment for inflammatory rosacea. A medicine. · The cited source is a published drug evaluation that summarizes two pivotal trials. Like the ivermectin evidence here. Low-dose doxycycline is anti-inflammatory and sub-antimicrobial, oral antibiotics carry their own considerations.

    PMID 20369903

    Read the full finding →
    Source:Doxycycline 40 mg capsules (30 mg immediate-release/10 mg delayed-release beads): anti-inflammatory dose in rosacea

Common questions

Which ingredients have been studied for Rosacea?
Ingredients with evidence for Rosacea: Centella asiatica, Niacinamide.
How many people were studied?
4 findings · 2015 · 962 people · adults with moderate-to-severe papulopustular rosacea · PMID 25228137
What can I use for Rosacea?
Centella asiatica, Niacinamide · 2015 · 962 people · adults with moderate-to-severe papulopustular rosacea · PMID 25228137
Can I use these every day for Rosacea?
Adults with erythematotelangiectatic rosacea using the combination moisturizer twice daily for 28 days, alongside oral minocycline（2026 · 75 participants · 75 patients with erythematotelangiectatic rosasma · PMID 42876425） A leave-on facial moisturiser, applied twice daily for four weeks, in adults with rosacea（2005 · 50 participants · Adults with rosacea · PMID 16209160）
Can I use these alongside other products for Rosacea?
Adults with erythematotelangiectatic rosacea using the combination moisturizer twice daily for 28 days, alongside oral minocycline（2026 · 75 participants · 75 patients with erythematotelangiectatic rosasma · PMID 42876425）

Other concerns

Acne marks and scars Acne and breakouts Barrier damage Blackheads Bumps and rough texture Closed comedones Combination skin Dark circles Dark spots Skincare for deeper skin tones Dehydrated skin Dryness Dull skin Eczema and atopic dermatitis Hyperpigmentation Large pores Loss of firmness Melasma Skincare for men Oily skin Skincare while on acne medication Peeling and flaking Perioral dermatitis Skincare during pregnancy Psoriasis Facial redness Sebaceous filaments Sensitive skin Sun damage Sun protection Teenage skin Uneven skin tone Wrinkles and fine lines