Finacea

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Finacea on Prescriptsy

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Finacea is a prescription-only topical gel containing azelaic acid 15%, used to treat the papules (small red bumps) and pustules (pus-filled spots) of mild to moderate papulopustular rosacea in adults.

Rosacea is a chronic inflammatory skin condition affecting the central face, and papulopustular rosacea is one of its most common subtypes, characterised by persistent facial redness with superimposed inflammatory spots.

Finacea is manufactured by LEO Pharma and is applied to the affected areas of the face twice daily.

Rosacea is estimated to affect approximately 1 in 10 people in the United Kingdom, though many cases remain undiagnosed.

It most commonly affects fair-skinned individuals of northern European descent, typically developing between the ages of 30 and 50, and is more frequently diagnosed in women, though men tend to experience more severe forms.

The condition can have a profound impact on self-esteem, social confidence, and emotional wellbeing.

Despite being a common skin condition, rosacea is often misunderstood and may be confused with acne, eczema, or allergic reactions.

This page provides a comprehensive clinical overview of Finacea, including how azelaic acid works in rosacea, who should use it, application guidance, potential side effects, important safety information, and how to obtain a prescription in the United Kingdom.

Important safety information about Finacea

• Finacea is for external use on the face only. Avoid contact with eyes, mouth, and mucous membranes.
• Mild stinging or burning is common during the first few weeks and usually settles.
• Use sunscreen with SPF 30 or higher daily, as rosacea-affected skin is sun-sensitive.
• Stop using Finacea and seek medical advice if you develop severe irritation, blistering, or an allergic reaction.
• Keep out of the reach and sight of children.

Understanding rosacea

Rosacea is a chronic, relapsing inflammatory condition primarily affecting the convexities of the central face: the cheeks, nose, chin, and forehead.

It is classified into several subtypes, though many patients display features of more than one subtype simultaneously.

Erythematotelangiectatic rosacea is characterised by persistent central facial redness and visible blood vessels (telangiectasia). Papulopustular rosacea involves inflammatory papules and pustules superimposed on a background of facial redness.

Phymatous rosacea involves thickening and enlargement of the skin, most commonly on the nose (rhinophyma). Ocular rosacea affects the eyes, causing grittiness, burning, and lid margin inflammation.

The pathophysiology of rosacea involves dysregulation of the innate immune system, neurovascular dysfunction, and altered skin barrier function.

A key molecular pathway involves the serine protease kallikrein-5 (KLK5), which cleaves cathelicidin precursor protein into the active peptide LL-37.

In rosacea, both KLK5 and LL-37 are overexpressed, triggering an exaggerated inflammatory response characterised by vasodilation, leucocyte infiltration, and cytokine release.

External triggers including ultraviolet radiation, heat, spicy food, alcohol, stress, and certain skincare products can provoke flares by activating transient receptor potential (TRP) ion channels on sensory neurones in the skin.

Papulopustular rosacea is the subtype most responsive to topical treatment. Azelaic acid, metronidazole, and ivermectin are the three most commonly prescribed topical agents for this subtype in UK practice.

How Finacea works: mechanism of action

Azelaic acid exerts its therapeutic effect in rosacea through multiple complementary mechanisms.

It inhibits the production of reactive oxygen species (ROS) by neutrophils, which are key drivers of tissue damage and inflammation in rosacea lesions.

It suppresses the KLK5-cathelicidin pathway, reducing levels of the pro-inflammatory peptide LL-37 that is central to rosacea pathogenesis.

Azelaic acid also inhibits nuclear factor kappa-B (NF-kB) signalling, a master regulator of inflammatory gene expression.

These anti-inflammatory actions reduce the redness, swelling, and tenderness associated with papules and pustules.

Additionally, azelaic acid has mild antimicrobial activity against organisms colonising the skin surface, including Cutibacterium acnes and Staphylococcus epidermidis, and normalises disordered keratinisation within the pilosebaceous follicle.

Although rosacea is not primarily an infectious condition, altered microbial colonisation (including increased Demodex folliculorum mite density) may contribute to the inflammatory burden, and the antimicrobial properties of azelaic acid may provide ancillary benefit.

Azelaic acid also inhibits tyrosinase, an enzyme involved in melanin biosynthesis.

This property makes azelaic acid useful for managing post-inflammatory hyperpigmentation that may follow rosacea lesions, though it can occasionally cause unwanted lightening of normal skin, particularly in patients with darker skin tones.

Clinical evidence and UK prescribing guidance

Azelaic acid 15% gel (Finacea) has been studied in several large, randomised, double-blind, placebo-controlled trials in patients with papulopustular rosacea.

In pivotal trials, Finacea applied twice daily for 12 to 15 weeks produced statistically significant and clinically meaningful reductions in inflammatory lesion count and erythema severity compared with vehicle gel.

Approximately 70 to 80% of patients achieved "clear" or "marked improvement" ratings on the Investigator Global Assessment (IGA) scale after 12 weeks of treatment.

Head-to-head studies have compared azelaic acid with metronidazole 0.75% gel, the historical gold standard topical treatment for rosacea.

These studies demonstrated that azelaic acid 15% gel was at least as effective as metronidazole 0.75% gel in reducing papule and pustule counts, with some studies showing superiority for azelaic acid in reducing erythema.

Ivermectin 1% cream (Soolantra) is a newer topical option that has shown superiority over metronidazole in clinical trials; however, direct comparisons between ivermectin and azelaic acid are limited.

NICE CKS on rosacea recommends topical metronidazole, topical azelaic acid, or topical ivermectin as first-line treatments for mild to moderate papulopustular rosacea.

The choice between these agents depends on patient preference, tolerability, and cost.

For moderate to severe cases, combination with a low-dose oral antibiotic (typically modified-release doxycycline 40 mg once daily) may be recommended.

The Primary Care Dermatology Society and British Association of Dermatologists guidelines are broadly aligned with these recommendations.

Finacea compared with other topical rosacea treatments

Three topical agents are widely used for papulopustular rosacea in the UK: azelaic acid 15% gel (Finacea), metronidazole 0.75% gel or cream (Rozex, Metrosa), and ivermectin 1% cream (Soolantra).

Metronidazole has the longest track record and is generally well tolerated but must be applied twice daily and has a slower onset of visible improvement than azelaic acid in some studies.

Ivermectin has the advantage of once-daily application and has demonstrated superiority over metronidazole in large trials, but it is more expensive and may not be available on all NHS formularies without prior authorisation.

Azelaic acid offers the additional benefit of treating post-inflammatory hyperpigmentation and has a well-established safety profile, including relative safety in pregnancy.

Your prescriber will recommend the most appropriate option based on your symptoms, skin type, preferences, and local prescribing guidelines.

How to apply Finacea

Wash your face with a gentle, soap-free cleanser and lukewarm water. Pat dry with a clean towel.

Squeeze approximately a pea-sized amount of Finacea gel onto your fingertip for each affected area.

Apply a thin, even layer to the affected areas of the face, gently massaging it in. Avoid the eyes, nostrils, mouth, and any broken skin.

Allow the gel to absorb for several minutes before applying moisturiser or sunscreen. Wash your hands after application.

Apply Finacea twice daily, in the morning and evening.

Consistency is important; use it every day as directed, even when your skin appears clear, to maintain the therapeutic effect and prevent flares.

Treatment duration is typically 8 to 16 weeks for initial improvement, though your prescriber may recommend longer courses depending on your response.

Side effects of Finacea

Common local reactions

Burning, stinging, and tingling at the application site are the most frequently reported side effects, affecting approximately 1 in 4 patients during the first 1 to 2 weeks of treatment.

These sensations are usually mild and diminish as the skin adapts. Other common local reactions include dryness, scaling, erythema (redness), and pruritus (itching).

Using a gentle, fragrance-free moisturiser after the gel has absorbed can help manage dryness and irritation.

Uncommon and rare side effects

Uncommon effects include contact dermatitis, skin irritation, warmth at the application site, and photosensitivity.

Rare effects include hypopigmentation (lightening of treated skin), which is more relevant for patients with darker skin tones and is usually reversible after stopping treatment.

Systemic side effects are extremely unlikely given the minimal absorption of azelaic acid from the gel.

When to seek medical advice

Stop using Finacea and contact your GP or call NHS 111 if you develop severe skin irritation, blistering, a widespread rash, or signs of an allergic reaction.

Report any suspected adverse reactions to the MHRA via the Yellow Card scheme at yellowcard.mhra.gov.uk .

Warnings and precautions

Contraindications

Finacea is contraindicated in patients with known hypersensitivity to azelaic acid, propylene glycol, or any excipient in the formulation.

Skin care during treatment

Rosacea-affected skin is characteristically sensitive. During Finacea treatment, use gentle, fragrance-free cleansers and moisturisers. Avoid alcoholic toners, abrasive scrubs, chemical peels, and heavily fragranced skincare products.

Apply a broad-spectrum sunscreen with SPF 30 or higher every morning, as UV exposure is a common trigger for rosacea flares and can counteract the benefits of treatment.

Pregnancy and breastfeeding

Systemic absorption of azelaic acid from topical application is very low (approximately 3.6% of the applied dose).

Animal studies at oral doses far exceeding topical exposure have not demonstrated teratogenic effects.

The SPC states that Finacea may be used during breastfeeding because azelaic acid is a naturally occurring substance in breast milk and the additional contribution from topical use is negligible.

Use during pregnancy should be discussed with your GP or midwife.

How to get Finacea in the UK

Finacea is a prescription-only medicine in the UK. Your GP can prescribe it following a clinical assessment of your rosacea.

Dermatologists may also prescribe Finacea as part of a specialist management plan.

Authorised online prescribers registered with the General Pharmaceutical Council (GPhC) can issue prescriptions after an appropriate consultation.

The standard NHS prescription charge in England is currently 9.90 pounds per item; prescriptions are free in Scotland, Wales, and Northern Ireland.

Living with rosacea: practical advice alongside Finacea

Managing rosacea involves more than topical treatment. Identifying and avoiding your personal triggers can significantly reduce flare-ups.

Common triggers include sun exposure, extremes of temperature, hot drinks, spicy food, alcohol (particularly red wine), stress, and certain skincare products. Keep a trigger diary to identify patterns.

Protect your face from the sun with daily sunscreen and a hat. Use lukewarm (not hot) water to wash your face.

Choose mineral-based makeup if you wish to camouflage redness, as it is generally better tolerated by rosacea-prone skin than liquid foundation.

The National Rosacea Society and Changing Faces (a UK charity supporting people with visible differences) offer helpful resources and peer support.

Sources

• Finacea 15% Gel, Summary of Product Characteristics (EMC)
• Azelaic acid, British National Formulary (BNF)
• NICE CKS: Rosacea
• Rosacea, NHS
• British Association of Dermatologists: Rosacea
• MHRA Yellow Card Scheme