What's on this rung
- Azelaic acid (Evidence A; OTC 10%, Rx 15%) — for redness and papules
- Niacinamide 5% — barrier support, reduces reactivity
- Introduce one active at a time, every other day, building to daily
What to expect
Visible reduction in redness and bumps over 8–12 weeks. Azelaic acid is the single most useful OTC active for rosacea.
When to climb
If you see little change after 12 weeks, or have moderate-to-severe bumps, a clinician can prescribe topicals (Rung 3).