How To Treat Rosacea

Medically reviewed by Brendan Camp, MD

Rosacea is a common and chronic (long-term) skin condition that causes symptoms like facial redness, thickened skin, flushing, visible blood vessels, and dryness. A primary care healthcare provider may initially treat your symptoms, but severe cases may require the support of a dermatology (skin doctor) or ophthalmologist (eye doctor). Common treatments include topical creams and medications, but surgeries and therapies are available for severe cases.

Common Treatments by Rosacea Type

While there is no cure for rosacea, there are treatments that can help provide symptom relief. Your exact treatment plan will depend on the type of rosacea you have.

Erythemato-telangiectatic Rosacea Treatments

Erythematotelangiectatic rosacea (ETR) causes facial redness, stinging, telangiectasia (visible blood vessels), and flushed or warm skin. To treat this type of rosacea, your healthcare provider may recommend:

• Topical vasoconstrictor ointments: Mirvaso (brimonidine tartrate) is a gel and Rhofade (oxymetazoline hydrochloride) is a cream that you can apply directly to the skin to narrow blood vessels and reduce redness. Both treatments are FDA-approved. The effectiveness of these treatments typically wears off after 12 hours, but symptoms improve gradually over several weeks of re-application. Potential side effects include skin irritation, dryness, and some allergic reactions.

• Oral beta-blockers: Inderal (propranolol) or Coreg (carvedilol) are pills that you can take to reduce skin flushing. It's worth noting that these are FDA-approved for heart conditions. But, these medications are sometimes given off-label to improve rosacea symptoms. Side effects may include drowsiness, dry mouth, constipation, low heart rate or blood pressure, dizziness, and fatigue.

Papulopustular Rosacea Treatments

Papulopustular rosacea (PPR) causes facial redness with papules (red bumps) and pustules (pus-filled bumps) that often resemble acne. This type of rosacea may occur alone or with ETR type. Common treatments for PPR include:

• Skincare: Products that include ingredients such as sulfur, benzoyl peroxide, and retinoids can treat acne, but are also helpful for PPR symptoms. You can find these ingredients in over-the-counter (OTC) skincare treatments. But, retinoids are also available via a prescription.

• Topical medications: If OTC treatments aren't effective, your healthcare provider may prescribe you topical medications you can apply directly to your skin. MetroGel (metronidazole) and Azelex (azelaic acid) reduce swelling and kill germs, Soolantra (ivermectin) can lower inflammation, Elidel (pimecrolimus) may improve redness, and Zilxi (minocycline) minimize bumps.

• Oral antibiotics: Your provider may also prescribe oral medications like Sumycin (tetracycline), Minocin (minocycline), E-Mycin (erythromycin), Z-pak, Zithromax (azithromycin), and Flagyl (metronidazole) to help improve symptoms. For people who take antibiotics long-term, there is a possibility of antibiotic resistance, which occurs when the medications aren't as effective in treating symptoms as before. The FDA approved a long-term, low-dose antibiotic known as Oracea (doxycycline) to combat this concern. A lower dose of this medication reduces the risk of antibiotic resistance.

Ocular Rosacea Treatments

Ocular rosacea affects your eyes and causes eye swelling, redness, dryness, itching, and burning. You may also notice that you are more sensitive to light, feel like there is something in your eye, or have vision changes. To improve symptoms, your eye care provider may recommend:

• Wearing sunglasses

• Cleaning your eyelids with a gentle eye cleanser

• Using warm compresses

• Trying lubricating or antibiotic eyedrops

• Applying topical creams to your eyelids

• Taking antibiotics

Granulomatous Rosacea Treatments

Granulomatous rosacea is a less common type and causes firm, red, or yellowish bumps on the cheeks, chin, or around the eyes. Treatment typically involves oral antibiotics like Sumycin (tetracycline) and Avlosulfon (dapsone) or prescription-strength topical creams like Elidel (pimecrolimus).

Phymatous Rosacea Treatments

Phymatous rosacea causes the skin to thicken and sebaceous (oil) glands on your skin to become larger. This type of rosacea commonly affects the nose, which may affect your appearance and breathing. Accutane (isotretinoin) might help in the early stages. Surgery or laser therapy may be necessary to remove excess tissue for those with severe symptoms.

Medical Procedures

When topical creams and oral medications aren't effective, some people with rosacea benefit from laser therapy or surgery to reduce redness, blood vessels, and excess tissue.

Laser Therapy

Intense pulsed light (IPL) or pulsed dye lasers (PDL) are laser therapies that use light beams to shrink blood vessels or break down damaged skin cells. This reduces redness and improves skin tone. Laser therapy is particularly effective for the ETR type, but may also help with PPR.

Keep in mind: it's a good idea to check insurance coverage beforehand, as sessions cost a few hundred dollars each. Multiple sessions are necessary for optimal results, which develop gradually over weeks to months. While laser therapy is generally safe, temporary side effects include redness, swelling, or bruising. Rare complications such as skin color changes or scarring may occur. To minimize these complications, it's important to find a board-certified dermatologist.

Surgery

If your healthcare provider recommends surgery, your exact procedure will depend on the type of rosacea you have and your specific symptoms. Currently available surgical options include:

• Electrosurgery: Uses high-frequency electrical currents for precise tissue cutting. This procedure is ideal for small areas of your skin. The recovery time for surgery is minimal, but there are potential risks of scarring, infection, or pigment changes.

• Surgical excision: Removes excess tissue using surgical instruments like scalpels. It is more suitable for severe rosacea cases and often has a longer recovery time. Side effects may include swelling and bruising.

• Skin grafting: Transplants skin from one area to another, which may be necessary for skin reconstruction. If you receive this procedure, your provider will monitor you frequently, as the risk of infection, graft rejection, and changes in skin texture and tone are more common.

Complementary and Alternative Medicine

There is some evidence to use the following home remedies and alternative treatments for rosacea. However, before you start using these options, it's best to talk to your healthcare provider to ensure they are safe for you.

• Cool compress to reduce redness and swelling

• Skincare that includes vitamin C, aloe vera, Ginkgo biloba, licorice extract, niacinamide, or chamomile

• Green tea

• Oral zinc supplements

• Omega-3 fatty acid supplements

• Probiotic supplements

Living With and Managing Rosacea

Rosacea can be uncomfortable, frustrating, and isolating. Some people with rosacea find relief through a combination of avoiding triggers, adopting gentle skincare routines, and following their treatment plan. While triggers can vary from person to person, common triggers of rosacea flares (periods where symptoms are active) include:

• Sun or wind exposure

• Spicy foods

• Alcohol

• Nicotine

• Hot drinks

• Niacin (vitamin B3)

• Vasodilating medications (which widen blood vessels)

• Harsh skin care products (such as those with added fragrances, alcohol, menthol, exfoliators, sodium-laurel sulfate)

• Stress

A rosacea-friendly skincare routine includes a mild, pH-balanced (from 5.5-7) facial cleanser like Cetaphil. Gently wash your face using your fingers rather than a washcloth and rinse with cool or lukewarm instead of hot water. Pat your face dry with a soft towel, apply a moisturizer, and use a high-SPF, lightweight sunscreen.

For extra care, consider an anti-inflammatory cleanser night mask. These masks contain gentle cleansers and botanical ingredients like chamomile or green tea. If you use cosmetics to cover the redness, use a light-weight, green concealer or color corrector.

A Quick Review

Rosacea can be frustrating to live with, but treatments are available to help reduce symptoms. Your exact treatment plan will depend on the type of rosacea you have. Common approaches include topical creams and oral medications. For severe cases, your provider may recommend laser therapy or surgery. Avoiding triggers, using gentle skincare, and trying home remedies can also help keep symptoms at bay.

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