Characterized by papules and pustules often on a blush of erythema primarily affecting the nose, cheeks, and forehead. Predilection of lesions on the central aspect of the face, sometimes with central facial edema. Associated with flushing.
- This subtype is best treated with topical or systemic antibiotics, topical sulfur or sulfacetamide based lotions, or azelaic acid. A newly available agent with superior demonstrated efficacy over topical metronidazole for reduction of inflammatory lesions of rosacea is topical ivermectin 1% cream (such as Soolantra), applied once daily. This medication is indicated for the treatment of papulo-pustular rosacea with dual mechanism of action as an anti-parasitic agent (through action on Demodex mites that may trigger inflammatory pathways that lead to rosacea) and as an anti-inflammatory treatment (through cytokine modulation and reduction of inflammatory cell activation).