Treatments for rosacea

There is currently no known cure for rosacea, but there are treatments available to help to reduce the symptoms. There may be periods of time where you notice an improvement in symptoms and can stop treatment, however long-term treatment is considered normal. For most people, treatment will involve a combination of self-help measures and medication. The specific treatments that are recommended will depend on your individual symptoms and should be discussed with your doctor.

Treatments for papules and pustules

Papules and pustules are a common symptom of rosacea. Papules are round red bumps that rise from the skin. Pustules are similar however these bumps or swellings contain pus. Topical treatments (applied to the skin) or oral treatments (taken by mouth) can be used to treat these.

  • Topical medications are usually prescribed first. These include:
  • Metronidazole cream or gel
  • Azelaic acid cream or gel
  • Ivermectin cream

Topical Metronidazole cream or gel, applied twice daily, can be as effective as oral treatments and is considered the treatment of choice for pupules and pustules arising from rosacea.

Azelaic acid is a relatively new topical medication which studies have shown to be as effective as Metronidazole.

Topical treatments usually need to be applied once or twice per day, taking care not to get them in the eyes or mouth. It may be several weeks before you notice a significant improvement in your symptoms. Rosacea is a chronic (long term) condition and therefore you may have to use these medications for a long period of time in order to control your symptoms.

Side effects of these treatments can include a burning, stinging sensation, itchiness and dry skin. If you are at all concerned about possible side effects, you are advised to speak to your GP or other healthcare professional.

If your symptoms are more severe, an oral antibiotic (an antibiotic taken by mouth) may be recommended by your doctor as these can help reduce inflammation of the skin. Antibiotics used to treat rosacea are chosen for their anti-inflammatory properties rather than to treat infections.

The most common oral antibiotics often used to treat rosacea include Tetracycline, Oxytetracycline, Doxycycline and Erythromycin. These medications are usually taken for four to six weeks, but longer courses may be necessary if the spots are persistent.

Common side effects of these medications include feeling and being sick, diarrhoea, bloating and indigestion, abdominal (tummy) pain and loss of appetite.

Some of the medications used can also make your skin sensitive to sunlight and artificial sources of light, such as sun lamps and sunbeds. If you are concerned in any way about possible side effects, it is advisable to see your GP or other healthcare professional.

As with the topical treatments mentioned above, these medications usually need to be taken once or twice a day and you may not notice a significant improvement in your symptoms for several weeks.

If you are pregnant, or are planning on becoming pregnant, make sure you let your doctor know before starting any new medicines. If you are pregnant, or planning on becoming pregnant, your doctor may prescribe a topical antibiotic (an antibiotic applied to the skin) such as Clindamycin or oral Erythromycine. This is because the use of oral Tetracycline or Metronidazole cream or gel is not advised during pregnancy. Topical antibiotics are usually applied across the entire face rather than just on affected areas (as with the other topical treatments mentioned above).

Treatments for facial redness and flushing

Self-help measures

Treatment of facial redness and flushing will usually start by identifying the triggers that cause your rosacea symptoms to worsen and avoiding those rosacea triggers. It is also advisable to adapt your skincare regime to include the use of mild cleansing agents such as emollients and to protect your skin from the sun with wide-brimmed hats and broad-spectrum sunscreens (minimum sun protection factor of 30). Self-help measures are likely to be helpful to treat facial redness and flushing. In addition, to reduce the visibility of these symptoms, you may wish to consider using camouflage make-up.

Topical and oral treatments

There are some medications which can be used to treat redness:

Isotretinoin - a strong oral treatment only prescribed by a dermatologist (a skin specialist). At low doses, Isotretinoin can be used to treat rosacea. Isotretinoin is a strong medication which is known to have several side effects including:

  • dryness and cracking of the skin, lips and nostrils
  • inflammation of your eyelids (blepharitis) or eyes (conjunctivitis)
  • headaches
  • muscle or joint pain
  • back pain
  • blood in your urine (haematuria)
  • mood changes
  • Isotretinion can also cause birth defects if taken during pregnancy.

Brimonidine Tartrate - a relatively new topical treatment for facial redness caused by rosacea. This is applied to the face once a day. The medication works by restricting the dilation (widening) of the blood vessels in your face. Research has shown it can start to have an effect about 30 minutes after it is first used, and this can last for around 12 hours. Common side effects of Brimonidine Tartrate include itchiness and a burning sensation where the gel is applied. Less common side effects can include a dry mouth, headaches, pins and needles, and dry skin. A rebound effect, where flushing becomes worse, has also been reported with this medication.

Clonidine - an oral treatment used to treat blood pressure called Clonidine may sometimes be prescribed. A low-dose of Clonidine has been found to be effective in controlling flushing, especially in women who are post-menopausal. Clonidine works by restricting the blood vessels.

Beta Blockers – alternatively, Beta Blockers may have a similar effect to Clonidine by decreasing the activity of the heart.

Your doctor will further discuss all your options with you.

Treatments for redness and visible blood vessels

Laser treatments

Redness and visible blood vessels (Telangiectasia) can sometimes be successfully improved with vascular laser or intense pulsed light (IPL) treatment. These treatments may also improve flushing.

A referral to a dermatologist is usually required before having this type of treatment and these are not usually available on the NHS, so you may need to pay for them privately. Treatments usually involve 2-4 sessions so this can be expensive if paying privately.

Laser and IPL machines produce narrow beams of light that are aimed at the visible blood vessels in the skin. The heat from the lasers damages the dilated veins and causes them to shrink so they are no longer visible, with minimal scarring or damage to the surrounding area.

Laser treatment can cause pain, but most people do not need an anaesthetic. The side effects of laser treatment are usually mild, they can include bruising, crusting of the skin, swelling and redness of the skin, blisters (in rare cases), infection (in very rare cases). The side effects usually only last a few days but in rare cases they may be permanent.

Treating rhinophyma

Rhinophyma (thickened skin) is a common rosacea complication that can occur with rosacea. If you have severe rhinophyma, your GP may refer you to a dermatologist or plastic surgeon to discuss ways the appearance of your skin can be improved.

Surgical treatments can be used to remove any excess tissue and remodel the nose if it has become distorted. This may be done with a laser, a scalpel or specially designed abrasive instruments using a technique called dermabrasion.
Treating ocular rosacea

Ocular rosacea (eye problems) is another potential complication that can occur with rosacea. Good general eye hygiene is useful to try and prevent eye problems. If you notice you have irritated, dry or bloodshot eyes you may need to use lubricating eye drops or ointment. This should work to relieve the pain, reduce inflammation, dilate the pupil, and reduce any scarring which may occur. If your symptoms are severe and you experience swelling or inflammation on parts of the eye such as eyelids, or the white or coloured part of the eye, steroids and antibiotics may also be prescribed by your GP or health practitioner.

Sources of evidence available on request

Information contained in this Articles page has been written by talkhealth based on available medical evidence. Our evidence based articles are accredited by the PIF TICK, the only UK quality mark for trustworthy health information. The content however should never be considered a substitute for medical advice. You should always seek medical advice before changing your treatment routine. talkhealth does not endorse any specific products, brands or treatments.

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Information written by the talkhealth team

Last revised: 12 April 2016
Next review: 12 April 2019