This rosacea cream contains 5 active pharmaceutical ingredients: azelaic acid, which has antioxidant and anti-microbial properties, brimonidine topical gel is used in adults to treat facial redness that does not go away and caused by rosacea, ivermectin, a topical anti-parasitic that decreases inflammation, and metronidazole, a topical antibiotic, with anti-inflammatory properties. Niacinamide helps to modulate the overactive immune response associated with rosacea.