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Find The Rosacea Treatment for You
While there is no cure for rosacea, early treatment can stop it from worsening and make it less noticeable. Avoiding triggers, like wine and cold weather, and following a gentle skin care regimen will help you manage flushing and other symptoms, like broken blood vessels. Fortunately, dermatologists also have a full arsenal of rosacea treatment options at their disposal and can craft an effective plan of attack against this chronic skin condition.
In fact, your dermatologist can tailor a unique rosacea treatment plan for you, based on the stage and severity of your rosacea. Options range from topical and oral medications to lasers and light therapy. It may take weeks or months of rosacea treatment before there is noticeable improvement, but with consistency and patience, you should see results.
Treatment for Mild Rosacea
Symptoms of the first subtype of rosacea, erythematotelangiectatic rosacea, are flushing, facial redness, and sometimes visible blood vessels. This stage is difficult to treat with medication, so patients are urged to avoid triggers that can irritate the skin.
Molly Wanner, MD, a dermatologist at Massachusetts General Hospital in Boston, says pulsed dye or KTP (potassium titanyl phosphate) lasers and intense pulsed light are the best ways to remove any visible blood vessels. Usually two to four treatments are needed, depending on how widespread the blood vessels are.
Beta blockers like Inderal (propranolol) and Corgard (nadolol) and alpha antagonists like Catapres (clonidine) can help with severe flushing, although their use in treating rosacea has not been specifically approved by the U.S. Food and Drug Administration. Beta blockers are normally prescribed for high blood pressure and heart disease, while alpha antagonists are used to treat high blood pressure and menopausal hot flashes.
Estrogen can be used when hot flashes aggravate rosacea. But hormone therapy carries a risk of breast cancer, heart disease, and stroke, and Dr. Wanner says this is not a strategy that dermatologists regularly employ, because hot flashes and rosacea flushing are two different things.
Treatment for Moderate Rosacea
Pimples and facial redness are the hallmarks of the second rosacea subtype, papulopustular rosacea. Topical treatments and oral medications that reduce inflammation and clear up breakouts are:
- Finacea and Azelex (azelaic acid) are anti-inflammatory gels that work to control bumps, lesions, and swelling.
- Metrogel and Noritate (metronidazol) are topical antibiotics that also help control bumps and redness.
- Other topical medications, like benzoyl peroxide, retinoids, and sodium sulfacetamide and sulfur lotions, are sometimes used.
- Oral antibiotics like tetracycline and doxycycline are often prescribed to reduce inflammation, but prolonged use can cause antibiotic resistance.
- A low-dose doxycycline — Oracea — has been developed to specifically treat rosacea. It's strong enough to fight inflammation, but not strong enough to kill bacteria, so it doesn't cause antibiotic resistance and can be used long term.
Doctors often use oral and topical medications at the same time to get quicker results, and then switch patients to a single therapy to prevent flare-ups.
Treatment for Severe Rosacea
In phymatous rosacea, the third subtype of rosacea, the major problem is skin thickening and enlargement, especially around the nose. Along with topical and oral medications, lasers are a good treatment for this subtype, Wanner says. Carbon dioxide and erbium: YAG lasers can be used to remove excess skin and improve contours of the nose. Wanner says extra tissue also can be removed surgically. Thickening of the nose should be treated early because advanced stages can cause difficulty breathing or nostril collapse. If emotional problems develop because of damaged self-esteem due to the appearance of the skin, seek professional help.
Treatment for Rosacea Eye Problems
Ocular rosacea may result in bloodshot, watery eyes and other problems. Treatments include artificial tears, oral antibiotics, and daily cleansing of eyelashes with baby shampoo. Wanner says when patients report problems with burning, itching eyes or a history of styes, she refers them to an ophthalmologist.
For all types of rosacea, the length of maintenance treatment varies from person to person. "Some patients experience frequent flares and some flare rarely. Those who flare rarely may find they don't need maintenance treatments other than gentle skin care and sunscreen," Wanner says.
Wanner urges people with rosacea to regularly use sunblock with SPF (sun protection factor) 15 or higher because chronic sun exposure can make rosacea worse and trigger flares. Following that advice, avoiding all triggers, and sticking to your treatment plan can help you get the upper hand on rosacea.
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