Besides redness, rosacea can cause swelling, acne-like breakouts, bumps with pus (pustules) or without (papules), thickened skin, eye irritation, and even a change in the shape and size of your nose.
“Given the many different ways that rosacea can affect the skin, I would encourage patients with rosacea to discuss their care with a dermatologist to develop a personalized treatment plan,” says John Barbieri, MD, a research fellow in dermatology at the University of Pennsylvania’s Perelman School of Medicine.
While there’s no cure for rosacea, prompt attention and therapy can prevent some of its long-term complications. Here, some options to consider when searching for the best rosacea treatment for you.
When he’s helping patients select a rosacea treatment, Richard Torbeck, MD, a dermatologist and Mohs surgeon in New York, first gauges which aspects of the condition are the most distressing.
If redness ranks high, he targets that, often beginning with a non-invasive treatment. One option is metronidazole; while it’s technically an antibiotic, doctors believe that for rosacea, it works to decrease inflammation and irritation.
For more intense cases of redness, a cream or gel called oxymetazoline may constrict blood vessels and decrease blood flow, says Robyn Gmyrek, MD, a board-certified dermatologist at Union Square Laser Dermatology in New York City. A similar product is brimonidine gel. Both reduce redness for about 12 hours.
For rosacea cases that involve papules or pustules, your doctor may recommend twice-daily applications of a gel, foam, or cream containing azelaic acid. These products also fight bacteria. Plus, they decrease levels of a compound called keratin—a fibrous protein that provides structure to hair, skin, and nails but can block pores if you produce too much of it.
Finally, a cream called ivermectin is sometimes prescribed. This drug is effective in killing off microscopic skin mites called Demodex folliculorum, which are thought to contribute to some cases of rosacea, Dr. Gmyrek says.
Because rosacea can be caused or aggravated by bacteria—some of which may live within the mites, Dr. Gmyrek says—oral antibiotics are sometimes used to address flare-ups. Your doctor may prescribe a course of drugs such as tetracycline, minocycline, doxycycline, or erythromycin to bring your rosacea symptoms under control.
However, taking antibiotics at high doses for long periods of time can contribute to what’s called antibiotic resistance, when illnesses become impervious to these germ-killers. You might soon switch to a lower dose of doxycycline, which acts more as an anti-inflammatory than an antibiotic, Dr. Torbeck says.
With less-intense formulations, “you're not building resistance or getting the complications you get with long-term antibiotic use,” including the unintentional disruption of beneficial bacteria, he says. But what you do receive is relief from the eye problems related to rosacea as well as prevention of new papules and pustules.
Laser and light therapies
Other treatments for rosacea can be administered in a dermatologist’s office. One popular treatment for rosacea is the pulsed dye laser. Heat and energy from the laser’s beam target a compound called hemoglobin in your blood vessels; small vessels then collapse, decreasing the appearance of redness, Dr. Torbeck says.
Treatments using other forms of focused light—including intense pulsed light, which works by similar mechanisms—can also reduce redness. Though both are effective for many people with rosacea, they’re not permanent, he notes. Repeated treatments are necessary to address new blood vessels as they form.
Besides banishing redness, laser or light therapy can also temporarily reduce thickening of the skin, including the type that frequently distorts the shape of the nose, Dr. Gmyrek says.
When patients have rosacea symptoms in their eyes, Dr. Torbeck recommends they see an ophthalmologist at least once per year. Treatment can include prescription eye drops and oral antibiotics in these cases too. Laser treatments may also open glands in the eyes that become blocked in rosacea.
In the meantime, there are steps you can take to ease discomfort and irritation, such as washing your eyelids with diluted baby shampoo and placing warm compresses over them.
If you’re looking at options for natural rosacea treatment, know that there are many powerful steps you can take that don’t involve drugs at all. Making notes about your triggers—which often include spicy foods, exercise, stress, and hot liquids—can help you learn what worsens your rosacea, Dr. Gmyrek says.
From there, you can alter your habits to avoid these triggers when possible. When it’s not feasible or recommended—for instance, in the case of an otherwise health-promoting trigger such as exercise—you can time your other treatments to reduce a trigger's impact. For instance, wash your face and apply one of your prescription creams soon after you stop sweating, Dr. Torbeck says.
Finally, using gentle, non-irritating skin products can ease your symptoms. Steer clear of strong fragrances, scrubs, toners, and astringents. Instead, look for mild cleaners and moisturizers specifically formulated for sensitive or rosacea-prone skin.
While many therapies require a prescription, you can buy some types of rosacea treatment over the counter. This includes one of the most critical tools for keeping your skin healthy: sun protection.
“A mineral sunscreen is the first and last line of defense and prevention,” says Carolyn Jacob, MD, medical director of Chicago Cosmetic Surgery and Dermatology.
In addition, creams and washes containing sulfa—and even some with azelaic acid—are also available at the drugstore, Dr. Gmyrek says. Topical antioxidants may also prevent cell damage and ease redness, Dr. Jacob says.
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