A 38-year-old female presents with facial redness, visible blood vessels, and occasional burning. What is the most appropriate treatment?

• A. Topical metronidazole
• B. Oral doxycycline
• C. Oral isotretinoin
• D. Tea tree oil

Answer: (A)

Rosacea presenting with facial redness, visible blood vessels (telangiectasia), and burning is commonly treated first with topical anti-inflammatory therapy. Topical metronidazole is a first-line option for mild-to-moderate rosacea because it dampens inflammation in the skin and helps reduce erythema and burning while staying largely localized to the treated area. It has a favorable safety profile and avoids systemic antibiotic exposure.

Oral doxycycline can be effective for more pronounced inflammation or persistent symptoms, but it involves systemic treatment and broader antibiotic exposure, so it’s usually reserved for more extensive disease. Oral isotretinoin is typically reserved for severe, refractory cases due to potential serious adverse effects. Tea tree oil is not a standard, evidence-based treatment for rosacea and can irritate sensitive facial skin.

So starting with topical metronidazole aligns with best practice for this presentation, addressing the inflammatory component with a localized, well-tolerated option.