What is Papulopustular rosacea?

Papulopustular rosacea is a subtype of rosacea that is mistaken for acne. It begins with pus-filled blemishes or swollen bumps that form together on your skin. They appear mainly on the cheeks, forehead, and chin.

  • Sunlight
  • Smoking
  • Spicy food, hot drinks, and chocolate
  • High temperatures.
  • Alcohol
  • High stress
  • Exercise
  • Some medications and supplements.

What are the symptoms of Papulopustular rosacea?

  • flushing
  • Swelling, and
  • breakouts that resemble acne.

What is the treatment for Papulopustular rosacea?

Combining topical treatments with oral antibiotics is the treatment for papulopustular rosacea.

Topical treatments:

Topical treatments include metronidazole, ivermectin, azelaic acid, and dapsone.


Metronidazole works as an anti-inflammatory drug by changing neutrophil chemotaxis and inactivating reactive oxygen species. Metronidazole 0.75% has been shown to reduce erythema, papules, and pustules in patients with moderate to severe rosacea.


Ivermectin can be used to treat mild to moderate rosacea, and also Demodex mites(which may activate the local immune response to produce the pustules). It also has anti-inflammatory properties that can calm the redness and irritation. It can be applied once daily for four months.

Azelaic acid:

Topical azelaic acid is an over-the-counter product that has anti-inflammatory, and antibacterial effects. A 15% gel and 20% lotion are available for use and can be applied once or twice daily.


Dapsone is an antibacterial with anti-inflammatory action. Dapsone 7.5% gel is applied once daily for 12 weeks. You should avoid dapsone if you have glucose-6-phosphate dehydrogenase deficiency.

Oral antibiotics:

Oral antibiotics used in papulopustular rosacea include erythromycin, clarithromycin, minocycline, doxycycline, and clindamycin.

Doxycycline and minocycline:

Doxycycline at 40 mg per day is commonly given in the USA as a sub-antimicrobial dose. In Australia, 50 mg daily is used. Photosensitivity is the main side effect, and sunscreens may be required, especially during the summer months. Minocycline is probably more effective but using it long-term can lead to pigmentation, liver disorders, and lupus-like syndrome.

Erythromycin and clarithromycin:

Erythromycin and clarithromycin are generally used in patients who are intolerant to doxycycline, and minocycline). Topical or oral erythromycin is used in pregnant women with papulopustular rosacea.


Low-dose isotretinoin at 10mg daily should be effective and have fewer side effects. It is usually reserved for patients who are intolerant to oral or systemic therapies.