Treatment of rosacea during pregnancy

Dermatol Online J. 2021 Jul 15;27(7). doi: 10.5070/D327754360.


Background: Exacerbation of rosacea may occur during pregnancy and there are multiple associated cases of rosacea fulminans (RF). Treatment during pregnancy poses a significant challenge as many rosacea treatments are contraindicated or have limited evidence regarding potential adverse fetal effects.

Objective: Review the pregnancy categories of various treatments and develop algorithms for treating pregnant patients with rosacea and RF.

Methods: Rosacea treatments showing efficacy in randomized controlled trials were searched through DailyMed to review pregnancy labelling. Searching the PubMed/MEDLINE database for English articles using keywords "rosacea fulminans AND pregnancy" without publishing-time restrictions yielded 8 articles. We summarized treatments used in cases of RF during pregnancy.

Results: Topical ivermectin was more effective than metronidazole, but has a more concerning pregnancy category. Three pregnant women with RF were treated successfully with topical metronidazole in combination with other therapies. Azithromycin is the only oral rosacea therapy that is considered safe for pregnant patients and it has been used to treat RF.

Conclusions: This review highlights the challenging aspects of treating pregnant patients with rosacea, as there is limited pregnancy-related treatment efficacy and safety data. The pregnancy categories of therapeutic options are summarized. Further studies are needed to learn which therapies are effective and safe for use during pregnancy.

Publication types

  • Review

MeSH terms

  • Adult
  • Algorithms*
  • Animals
  • Anti-Bacterial Agents / adverse effects
  • Anti-Bacterial Agents / therapeutic use
  • Azithromycin / adverse effects
  • Azithromycin / therapeutic use
  • Brimonidine Tartrate / therapeutic use
  • Dermatologic Agents / therapeutic use
  • Dicarboxylic Acids / therapeutic use
  • Doxycycline / adverse effects
  • Doxycycline / therapeutic use
  • Female
  • Humans
  • Isotretinoin / adverse effects
  • Isotretinoin / therapeutic use
  • Ivermectin / adverse effects
  • Ivermectin / therapeutic use
  • Metronidazole / therapeutic use
  • Mice
  • Minocycline / adverse effects
  • Minocycline / therapeutic use
  • Phototherapy / adverse effects
  • Phototherapy / methods
  • Pregnancy
  • Pregnancy Complications / therapy*
  • Randomized Controlled Trials as Topic
  • Rosacea / therapy*
  • Tetracyclines / adverse effects
  • Tetracyclines / therapeutic use
  • Treatment Outcome


  • Anti-Bacterial Agents
  • Dermatologic Agents
  • Dicarboxylic Acids
  • Tetracyclines
  • Metronidazole
  • Brimonidine Tartrate
  • Ivermectin
  • Azithromycin
  • Isotretinoin
  • azelaic acid
  • Minocycline
  • Doxycycline