What alternative antibiotics or other therapies do you recommend for patients with papulopustular rosacea and a tetracycline allergy?  

 PO Ivermectin and PO Niacinamide can be helpful. However, for antibiotics, anything works/is anti-inflammatory, but usually, I’ll do azithromycin.

0.2mg/kg weekly x 4-12 weeks for p.o. ivermectin dosing. You can also use topical soolantra which generally works well in my hands. Coverage can be an issue as well as cost, so if all else fails, horse dewormer on amazon (ivermectin 1.87%) can be used topically and/or mixed with topical sulfur cream...

More than ever, it is exceedingly helpful to develop a relationship with a compounding pharmacist (or if your state allows, compound in office) to make topicals like ivermectin or 5-FU/calcipotriene or others affordable for patients. It seems more legitimate than a vet supply and doesn’t have ...

Always used erythromycin but costly now; a short course of amoxicillin or azithromycin.

Skin Medicinals compounds a topical Ivermectin/Metronidazole/Azelaic acid cream which many patients have found quite helpful. Sulfur has a long history of use that goes beyond our modern civilization. We offer a sulfur bar soap with a buff puff to patients, and also sometimes prescribe sulfacetamid...