This review addresses the topical treatment of the rosacea phenotype of papules and pustules (RPPP) in adults, with a focus on topical ivermectin 1% cream. A patient-centred approach to management is recommended, helping patients understand rosacea as a manageable, long-term condition. First-line topical treatments include ivermectin 1% cream (Soolantra®), recently approved by Medsafe, as well as metronidazole 0.75% cream and azelaic acid 20% cream. Ivermectin 1% is more effective than metronidazole 0.75% in reducing inflammatory lesions, particularly in severe cases, and provides a longer period of remission after treatment withdrawal. Topical ivermectin’s once-daily dosing is also generally preferred over twice-daily regimens.
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