Rosacea: a guide to treatment

The first-line treatment for rosacea symptoms is prescription treatment. You may need these long-term or short-term when you have symptom flare-ups.

You get them from having a consultation with your doctor or a skincare specialist (a dermatologist). You can also order certain rosacea medicines online at euroClinix.

There are two main types of rosacea treatment available on prescription: topical and tablets.

Rosacea creams & gels

There are a variety of topical treatments available on prescription. These treatments target the spots, redness and inflammation.

Some of the most commonly prescribed creams include:

• Azelaic acid (Finacea or Azelex) - This is a type of acid made naturally from yeast. It has antibacterial properties that reduce bacteria in the skin that causes inflammation. You can use it long-term.
• Metronidazole (Rozex or Metrogel) - This is an antibiotic gel that targets the bacteria which cause pustules and redness. Use it in short stints of 2 - 4 months, depending on the brand.
• Brimonidine (Mirvaso) - Belongs to a class of medicines called alpha agonists. It tackles redness by narrowing the blood vessels and reducing excess blood flow. Doing so reduces redness.
• Ivermectin (Soolantra) - Ivermectin is a newer treatment on the rosacea market. It has an anti-inflammatory effect that reduces the appearance of blemishes. It also kills tiny mites in the skin that can cause rosacea symptoms. You can use it for up to 4 months.

These treatments should be applied once or twice a day. Use a gentle cleanser before and apply the rosacea treatment before any other product or makeup.

Your doctor will decide what topical treatment is best for your rosacea.

Antibiotic tablets

Oral antibiotics work by reducing the growth of certain bacteria. They treat many different infections, but can also treat skin conditions.

Rosacea is one of them. Bacteria in the skin can cause redness, pimples and inflammation typical of rosacea. Antibiotics target these bacteria, thereby reducing symptoms.

Antibiotics for rosacea include:

• Doxycycline (Efracea)
• Oxytetracycline
• Tetracycline
• Minocycline

These medicines can be used short or long-term, depending on the advice of your doctor or dermatologist.

For more severe cases of rosacea, there are several procedures available. However, these tend to only be available privately.

Laser treatment

IPL is the most popular and well-known procedure for rosacea. It is a non-invasive laser treatment that is safe and effective for rosacea. According to the American Academy of Dermatology Association, laser treatment can reduce blood vessels by 50-70% and redness by 20%. The procedure can be done in a clinic or at home using a small device every 3 - 4 weeks.

IPL stands for intense pulsed light. As the name suggests, it is a type of light therapy. It treats rosacea as well as sun damage, wrinkles, birthmarks and spots.

IPL uses controlled light in specific wavelengths to destroy broken visible blood vessels and reduce the appearance of dilated blood vessels in your face. It does so by increasing the temperature of the proteins in your blood. This improves skin texture, reduces redness and calms any irritation.

Your skin may appear worse after treatment as it heals. But after 3 - 6 weeks, you should notice a significant improvement in your symptoms.

Electrosurgery

Another procedure available for rosacea is electrosurgery or desiccation. It involves applying a weak electrical current to the skin using a thin needle.

The electrical current causes enlarged blood vessels to clot, shrink and eventually disappear. Doing so reduces any redness and bumps with few risks. Scabs may form in the treatment areas after the procedure but heal after a few days.

Cryosurgery

A more surprising procedure for rosacea is known as cryosurgery. It uses liquid nitrogen to reduce inflammation and the appearance of rosacea symptoms. Cryosurgery can also treat skin tags, warts and age spots.

A dermatologist will apply the treatment to the affected areas for a few seconds. You will need to have treatment every 3 - 6 weeks. Research has shown that you can see dramatic improvements in as little as 10 weeks.

Rhinophyma is a complication of rosacea that is most common in untreated cases. It causes the skin on the nose to thicken and the oil glands to enlarge, making the nose appear round, bumpy and bulbous.

Laser treatment can shrink the nose and prevent further growth. There is also a more specific procedure known as dermabrasion. It involves surgically scraping layers of skin, making it feel more smooth and refreshed as the skin regrows.

It is a minimally invasive procedure with a low risk of complications. But, you may experience sensitive skin as your skin heals.

Few people realise that rosacea can also affect the eyes, a type known as ocular rosacea. It can cause symptoms such as:

• swollen eyelids
• bloodshot eyes
• crusty eyelids or lashes
• dryness
• irritation

There are several eye drops that you can get over the counter. Artificial tears and hydrating eye drops can help with any dryness or irritation. Your doctor can also prescribe you steroid eye drops for symptom flare-ups.

You may also benefit from cleansing your eyelids. You can use warm water or a specialised cleanser for eye infections.

There are many products available over the counter. They contain gentle ingredients and tend to be sold as anti-redness products.

Some ingredients to look for include:

• aloe vera
• green tea
• liquorice root
• arnica
• oatmeal

Azelaic acid is also available over the counter at a lower dose.

Many products also have UV protection. Others may have a green tint to help neutralise redness.

Acne and rosacea are different skin diseases. However, both conditions can cause pimples, redness and inflammation.

Oral antibiotics, such as doxycycline and oxytetracycline, can treat both rosacea and acne symptoms. They work best for the type of rosacea that causes pimples.

But what about acne-specific products? Research has found that certain acne products like adapalene gel (Differin) and isotretinoin (Accutane) work for rosacea as well.

However, these treatments are not licensed for rosacea. Do not use any of these treatments for rosacea unless your doctor has specifically told you to.

While rosacea isn’t curable, there are several things you can do to reduce your symptoms.

Avoid rosacea triggers

Rosacea flare-ups can be triggered by certain environmental factors:

• cold and windy weather
• spicy foods
• alcohol
• stress
• hot beverages
• overheating (e.g. from exercise)

It’s about learning about your skin, what can cause it to worsen and then you can learn how to manage it. For instance, if you find that cold weather is your trigger, you can wrap up warm and cover your face.

Sun protection

The most important part of your skincare routine is sun protection. Sunlight is the most common trigger for rosacea. Too much sun exposure can also cause permanent skin damage.

You should wear sun cream with at least 30SPF or more every day, even if it doesn’t look sunny outside. The weather forecast will also tell you the UV levels, so you know when to wear a stronger SPF.

Have a good skincare routine

As well as your rosacea treatments, you should have a simple but consistent skincare routine.

1. Cleanse your face using a gentle cleanser, not a harsh soap.
2. Use your rosacea cream or gel.
3. Use a moisturiser. You can use a thicker moisturiser in the evening.
4. Apply sun cream at 30SPF or higher.

Avoid treatments that have harsh chemicals or are overly scented, as these can worsen symptoms of rosacea.