Rosacea - Treating rosacea

There is no currently no known cure for rosacea, but there are treatments available to help keep the symptoms under control.

Long-term treatment will usually be necessary, although there may be periods where your symptoms improve and you can stop treatment temporarily.

For most people, treatment will involve a combination of self-help measures and medication. The specific treatments that are recommended will depend on your symptoms.

Read on to learn about the different treatments you may be offered. You can also see a summary of the pros and cons of these treatments, which allows you to easily compare your options.

Self-help measures

There are a number of important things you can do yourself to help keep the symptoms of rosacea under control, including:

• avoiding things that trigger your symptoms – for example, by using sun cream and covering yourself up if direct sunlight makes your symptoms worse
• taking good care of your skin – for example, by using products suitable for sensitive skin
• using make-up – patches of persistent red skin can be disguised using specially designed "camouflage" make-up
• keeping your eyelids clean – if rosacea is causing your eyelids to become inflamed (blepharitis)

Read more about self-help measures for rosacea.

Treating papules and pustules

If you have papules (round red bumps that rise from your skin) and pustules (pus-filled swellings) caused by rosacea, there are a number of different medications that can be effective.

These can be divided into topical treatments (applied to the skin) or oral treatments (taken by mouth).

Topical treatments

For mild rosacea, topical medications are usually tried first. The two medications most often recommended are metronidazole or azelaic acid creams and gels.

There is some evidence azelaic acid may be more effective than metronidazole in treating rosacea, although it is also more likely to cause side effects such as skin irritation, a burning or stinging sensation, itchiness, or dry skin.

You will usually need to apply these topical treatments once or twice a day, taking care not to get them in your eyes or mouth. It may be several weeks before you notice any significant improvement in your symptoms.

Oral antibiotics

If your symptoms are more severe, an oral antibiotic medication may be recommended as these can help reduce inflammation of the skin.

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
• 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.

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.

Oral isotretinoin

Isotretinoin is a medicine often used to treat severe acne, but at lower doses it's also occasionally used to treat rosacea.

As isotretinoin is a strong medication that can cause a range of side effects, it can only be prescribed by a dermatologist (a specialist in treating skin conditions) and not your GP.

Common side effects of isotretinoin include:

• 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)

Treating facial redness

Treating facial redness and flushing caused by rosacea is generally more difficult than treating papules and pustules caused by the condition. 

But as well as the self-help measures mentioned above, there are some medications that can help.

Brimonidine tartrate

Brimonidine tartrate is a relatively new medication for facial redness caused by rosacea. It comes in the form of a gel that 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.

Oral treatments

Alternatively, there are a number of oral medications that may help improve redness caused by rosacea.

These include:

• clonidine – a medication that relaxes the blood vessels
• beta-blockers – medications that decrease the activity of the heart
• anxiety medications – medications sometimes used to help calm the person and reduce blushing 

It's not clear how effective these medications are at treating redness caused by rosacea, but they may sometimes be prescribed under the supervision of a dermatologist.

Laser and intense pulsed light (IPL) treatment

Redness and visible blood vessels (telangiectasia) can also 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 these treatments and they are not usually available on the NHS, so you may need to pay for them privately. Around two to four treatments may be needed, so the overall cost may be significant.

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. Side effects of laser treatment are usually mild and can include:

• bruising
• crusting of the skin
• swelling and redness of the skin
• blisters (in rare cases)
• infection (in very rare cases)

These side effects usually only last a few days and are rarely permanent.

Treating thickened skin

In some people with rosacea, the skin of the nose can become thickened. This is known as rhinophyma.

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.

A number of surgical treatments are available to remove any excess tissue and remodel the nose into a more pleasing shape.

This may be done with a laser, a scalpel or specially designed abrasive instruments using a technique called dermabrasion.

Treating eye problems

If rosacea is affecting your eyes (ocular rosacea), you may require further treatment. 

For example, you may need to use lubricating eye drops or ointment if you have dry eyes, or oral antibiotics if you have blepharitis.

If initial treatment is ineffective or you develop any further problems with your eyes, you will need to be referred to an eye specialist called an ophthalmologist for further assessment and treatment.

Read about treating dry eye syndrome and treating blepharitis.