than through their antibacterial capabilities. Using alpha-hydroxy acid peels may help relieve redness caused by irritation, and reduce papules and pustules associated with rosacea. Oral antibiotics may help to relieve symptoms of ocular rosacea. If papules and pustules persist, then sometimes isotretinoin can be prescribed. The flushing and blushing that typically accompany rosacea are typically treated with the topical application of alpha agonists such as brimonidine and less commonly oxymetazoline or xylometazoline. A review found that ivermectin was more effective than alternatives for treatment of papulopustular acne rosacea. An ivermectin cream has been approved by the FDA, as well as in Europe, for the treatment of inflammatory lesions of rosacea. The treatment is based upon the hypothesis that parasitic mites of the genus Demodex play a role in rosacea. In a clinical study, ivermectin reduced lesions by 83% over 4 months, as compared to 74% under a metronidazole standard therapy. Quassia amara extract at 4% demonstrated to have clinical efficacy for rosacea. When compared to metronidazole 0.75% as usual care in a randomized, double-blinded clinical trial, Quassia amara extract at 4% demonstrated earlier onset of action, including improvement in telangiectasia, flushing, and papules. Quassia amara showed a sustained reduction of global assessment score at day 42 (reduced to 4.68 from baseline 7.65) compared to metronidazole at day 42 (reduced to 6.32 from baseline 7.2), p<0.001. Laser Evidence for the use of laser and intense pulsed-light therapy in rosacea is poor. Outcomes The highly visible nature of rosacea symptoms are often psychologically challenging for those affected. People with rosacea can experience issues with self-esteem, socializing, and changes to their thoughts, feelings, and coping mechanisms. Epidemiology Rosaceae affects around 5% of people worldwide. Incidence varies by ethnicity, and is particularly prevalent in those with Celtic heritage. Men and women are equally like to develop rosacea. See also Seborrheic dermatitis Keratosis pilaris References External links Rosacea photo library at Dermnet Questions and Answers about Rosacea, from the US National Institute of Arthritis and Musculoskeletal and Skin Diseases Acneiform eruptions Erythemas Cutaneous conditions