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A new JAMA Dermatology study compares topical rosacea treatments. Learn how ivermectin, encapsulated benzoyl peroxide, and metronidazole perform for reducing redness, lesions, and improving treatment outcomes.
Rosacea is a common chronic skin condition that affects millions of people worldwide. It can cause persistent facial redness, bumps, pimples, burning sensations, and visible skin inflammation. Because rosacea often fluctuates over time, finding an effective long-term treatment approach can be challenging.
A recent study published in JAMA Dermatology has provided new insights into how different topical medications compare for people with moderate to severe rosacea. The research examined multiple prescription creams and gels to determine which treatments offered the best balance of effectiveness and tolerability.
The findings suggest that topical ivermectin and encapsulated benzoyl peroxide may provide stronger short-term improvements than traditional metronidazole therapy, although some differences in side effects were observed.
Rosacea is a chronic inflammatory skin disorder that commonly affects the face. Symptoms may include:
According to researchers, rosacea affects approximately 5% to 10% of the global population. The condition can significantly affect confidence, emotional well-being, and quality of life.
Topical treatments are often the first choice for managing inflammatory rosacea. Commonly prescribed options include:
However, doctors and patients have often lacked clear evidence comparing these treatments directly.
The study was a systematic review and network meta-analysis published online in JAMA Dermatology on July 1, 2026.
Researchers reviewed randomized clinical trials involving adults with moderate to severe rosacea. The analysis included:
The researchers compared medications based on several important outcomes:
The goal was to understand which topical therapies offered the greatest benefits.
One of the key findings was that topical ivermectin performed better than metronidazole for reducing inflammatory lesions.
Compared with metronidazole, ivermectin showed:
Ivermectin is believed to help rosacea patients by reducing inflammation and targeting factors associated with the condition, including immune responses and microscopic organisms such as Demodex mites, which have been linked with rosacea symptoms.
The study findings support the continued use of ivermectin as an important first-line topical option for inflammatory rosacea.
Another important finding involved encapsulated benzoyl peroxide.
Traditional benzoyl peroxide can sometimes irritate sensitive skin. The newer encapsulated formulation uses delivery technology designed to release the ingredient gradually, potentially improving effectiveness while reducing irritation.
The study found that encapsulated benzoyl peroxide:
However, researchers also found that more patients stopped treatment because of side effects compared with metronidazole.
Reported concerns included application site reactions such as:
This means benzoyl peroxide may be highly effective for some patients but may require careful consideration, especially for people with very sensitive skin.
Metronidazole has been a commonly used topical rosacea treatment for many years. It remains an established option because it can reduce inflammation and is generally well tolerated.
However, this analysis suggested that ivermectin and encapsulated benzoyl peroxide may provide greater short-term improvement in inflammatory lesions and overall disease severity.
This does not mean metronidazole is ineffective. Many patients continue to benefit from it, and treatment decisions depend on individual symptoms, skin sensitivity, previous treatment response, and medical history.
Rosacea is not only about bumps and pimples. Many patients struggle with facial redness, which requires different treatment approaches.
The study also reviewed treatments targeting erythema, including:
These medications work differently from anti-inflammatory treatments because they target facial blood vessel dilation.
The researchers found that these therapies improved clinician-rated redness compared with placebo treatments.
However, more research is needed to understand long-term effectiveness and patient experiences.
Although the study provides valuable information, researchers highlighted several limitations.
Most clinical trials lasted only 8 to 16 weeks. Rosacea is a lifelong condition, meaning patients often need treatments that remain effective and comfortable over months or years.
Future studies should focus on:
Researchers also noted that many studies compared treatments against placebo rather than directly comparing one active medication against another.
The latest evidence suggests that topical ivermectin and encapsulated benzoyl peroxide may offer strong short-term benefits for moderate to severe inflammatory rosacea.
However, the best treatment depends on individual factors, including:
Anyone experiencing persistent facial redness, bumps, or irritation should consult a qualified healthcare professional before starting or changing treatment.
This article is for informational and educational purposes only and does not replace professional medical advice, diagnosis, or treatment. Rosacea treatment should be discussed with a dermatologist or qualified healthcare provider who can consider your individual symptoms, medical history, and treatment goals.
Amstutz AV, Sánchez-Feliciano A, Dewey E, et al. Topical Preparations for Moderate to Severe Rosacea Treatment: A Systematic Review and Network Meta-Analysis. JAMA Dermatology. Published online July 1, 2026. doi:10.1001/jamadermatol.2026.2062.