OBJECTIVES: Treatment patterns with topical rosacea agents have not been evaluated extensively. This study sought to evaluate yearly prescriptions for topical treatments and rates of treatment switch. METHODS: MarketScan Commercial Claims Encounters and Medical Care Supplemental databases from 1/1/2010-12/31/2014 were used to identify rosacea patients (ICD-9-CM code: 695.3) who were new initiators of topical metronidazole, azelaic acid, sodium sulfacetamide/sulfur, and benzoyl peroxide. Patients were ≥30 years old, continuously eligible with medical and pharmacy benefits with ≥12 months pre- and post-treatment, and without evidence of oral antibiotic, rosacea conjunctivitis, acne, dermatitis, or lupus erythematosus during the study period. Treatment pattern outcomes were evaluated post-treatment initiation and included rate of index prescription fills and treatment switch (defined as a prescription fill for a different drug or formulation from the index drug/formulation at any time post-treatment).  RESULTS: There were 20,510 patients included in the study. The most common treatments were metronidazole (72.5%) and azelaic acid (23.3%); 72.6% of all treatments was gel. Mean age (in years) was different between treatment groups (azelaic acid, 52; benzoyl peroxide, 50; metronidazole, 55; sulfacetamide/sulfur, 53; P<0.0001). More females initiated treatment with azelaic acid (79.8% vs benzoyl peroxide, 68.1%; metronidazole, 71.3%; sulfacetamide/sulfur, 69.9%; P<0.0001). Average yearly prescription fills for the index treatment were 1.5 for metronidazole and 1.6 for all other treatments (P<0.0001). Rate of switch from the index treatment was highest for sulfacetamide/sulfur (11.0%) initiators, followed by benzoyl peroxide (7.1%), azelaic acid (5.6%), and metronidazole (4.3%; P<0.0001). Mean days to treatment switch were similar between treatment groups (145 days; P=0.1702).   CONCLUSIONS: Initiators of topical rosacea treatments filled on average <2 prescriptions yearly, indicating low retention on treatment. Although therapy change rates were lowest with the market leaders, metronidazole and azelaic acid gel, additional treatment or formulation options may improve rates of retention and switching.