Skin redness or flushing is a common symptom of rosacea, with redness developing around the cheeks and spreading to the chin or forehead. Small blood vessels in your face may become more apparent, and some people experience eye symptoms and nose enlargement. (1) While rosacea can be distressing, your dermatologist can come up with a treatment plan to diminish redness, swelling, and acne-like pimples. Treatment is important because rosacea can worsen over time. But just as rosacea symptoms can vary from one individual to another, so do treatment methods. (2) Some therapies may prove more effective than others, so you may have to experiment with different treatments, or a combination of therapies, until you find an approach that works best for your skin.
Treating Rosacea With Topical Creams and Gels
Several topical treatments can make living with rosacea easier. The type of treatment your doctor prescribes depends on your specific symptoms.
Rosacea Redness or Flushing
Rosacea can cause increased blood flow to the facial area and widening (or dilating) of the blood vessels underneath the skin, triggering skin redness or flushing (erythematotelangiectatic rosacea). To combat this effect, your doctor may prescribe a topical gel or cream designed to constrict your blood vessels and reduce discoloration. Medications often prescribed for redness include brimonidine topical (Mirvaso) or oxymetazoline topical (Rhofade) cream. (3) Niacinamide, a topical form of vitamin B3, can also be used to reduce flushing. Although effective, the downside is that topical gels applied to the skin only temporarily reduce superficial redness, according to Tsippora Shainhouse, MD, a board-certified dermatologist based in Beverly Hills, California. It can take about 30 minutes for these medicines to work, with effects lasting 8 to 12 hours, she notes. (3) Since rosacea redness can return after the medication wears off, you’ll need to reapply these products daily. Be mindful that side effects can occur with topical creams and gels. You may have increased redness, burning, pain, or itching. Side effects are generally mild and lessen over time, but they can also persist and become bothersome. (3) See a doctor if side effects are severe or don’t resolve. You may need an alternative medication to get rid of rosacea symptoms.
Rosacea Acne
Topical gels and creams are also effective for treating acne-like bumps or pimples caused by papulopustular rosacea. Effective treatments for these types of breakouts include:
azelaic acid (Finacea)metronidazole (Flagyl)sulfacetamide sodium and sulfur (Plexion)ivermectin (Stromectol) (4)
These medications reduce swelling and redness. Side effects of these medications can include burning, itching, dryness, or tingling. The good news is that side effects may lessen with continual use. (4,5) Once you have acne and redness under control, your doctor may recommend applying a retinoid to your face after daily cleansing. Retinoid is a form of vitamin A that can unclog pores and reduce inflammation, thereby reducing the frequency of flares. This product isn’t right for everyone, though. Make sure you consult your doctor before applying a retinoid cream or liquid. (4) It’s also believed that people with rosacea have more demodex mites on their skin than others. These tiny mites are usually harmless and live near the hair follicles of mammals. (6) “Sometimes, applying a prescription topical anti-mite cream can help manage acne rosacea symptoms, too,” says Dr. Shainhouse. Ivermectin may be prescribed in this way.
Ocular Rosacea
Rosacea can also affect your eyes. This is known as ocular rosacea, and it can produce symptoms similar to eye allergies. Topical ophthalmic eye drops can reduce red eyelids, pink eye, itching, sensitivity to light, tearing, and grittiness. (7) Some ocular rosacea patients require an ongoing low dose of antibiotics to mitigate risk of corneal abrasion.
Using Laser/Light Therapy to Treat Rosacea
Your doctor may include laser therapy as part of your treatment plan for skin thickening or visible blood vessels. This type of therapy can eliminate or decrease the size of blood vessels and reduce redness, as well as remove thick skin. (3,8) Laser therapy results vary from person to person, but it is possible to achieve a complete reduction of blood vessels. (3) The problem is that results aren’t always permanent and new blood vessels may appear. On the upside, results typically last for several years. Skin thickening can also return after treatment, requiring follow-up laser treatments. (8) Results from laser or light therapy aren’t immediate, and you may need multiple treatments. (2,4) Side effects can include temporary redness, skin tightening, itching, and pain. (4) Permanent scarring can also occur, but there’s a low risk of scarring when a highly experienced dermatologist performs the procedure. (4)
Reducing Rosacea With Antibiotics
Some people need an antibiotic to improve the appearance of rosacea skin. These medications kill bacteria on the skin and they also have an anti-inflammatory effect to reduce pink bumps, explains Shainhouse. Oral antibiotics are an effective treatment for ocular rosacea. (2,7) Initially, your doctor may prescribe a low dose of the antibiotic doxycycline (Vibramycin). Because there’s a lower risk of antibiotic resistance and side effects with this medication, it’s safer to take long-term. (4) If this doesn’t work, other antibiotics for rosacea include: (5)
tetracycline (Sumycin)minocycline (Minocin)erythromycin (MY-E)metronidazole
Typically, you’ll need to take an antibiotic for 6 to 12 weeks. (9) Severe rosacea may require stronger therapy. In this case, your doctor may prescribe oral isotretinoin (Accutane) for four to six months. (5) Talk to your doctor if you’re pregnant or thinking about becoming pregnant. Isotretinoin can cause birth defects. (5)
Understanding Rosacea Triggers and Natural Remedies
Understand that numerous factors can trigger rosacea, like sunlight, wind, spicy foods, and hot drinks. Knowing your individual triggers can help reduce the frequency of flares. (1) To pinpoint triggers, keep a rosacea diary and write down your meals and activities for each day, and then make a note of days when symptoms appear or worsen. If your symptoms worsen after exposure to sun or wind, apply a broad-spectrum sunscreen with SPF 30 or higher before heading outdoors, or wear a scarf to protect your face from wind or icy temperatures. (10) Avoiding certain skin-care products may also improve symptoms. Some astringents, cleansers, moisturizers, and products containing alcohol can irritate your skin. Use non-soap cleansers and fragrance-free products. (5) Although oral and topical medications are effective treatments for rosacea, natural remedies may also reduce rosacea redness, acne, eye symptoms, and inflammation. Some alternative therapies like oregano oil, colloidal silver, and emu oil are used to relieve rosacea symptoms, but there isn’t conclusive research on their effectiveness, according to the Mayo Clinic. (5) For ocular rosacea, alternative therapies include:
Gently massaging your face with your finger to reduce swelling and inflammationApplying a warm compress to your eyes several times a dayCleansing your eyelids with baby shampoo (2,3,10)
Talk with your doctor before using any alternative therapy or herbs to treat rosacea.
