Medications for rosacea

Rosacea is not simply a cosmetic issue. It’s a chronic (i.e. long term) health condition causing inflammation and overgrowth of blood vessels and skin of the face.

Unfortunately, rosacea is not curable, but treatments and careful management can significantly improve the signs of rosacea, leading to a better quality of life.

Treating facial rosacea

The aims of treatment are to:

• Avoid or minimise exposure to triggers and irritants.
• Maintain skin health.
• Reduce inflammation.

Most people with rosacea can manage minor symptoms by avoiding triggers and irritants and implementing a good skin care program, but sometimes medical treatment is required.

Some common treatments for facial skin conditions can make rosacea worse. It’s always important to have skin condition symptoms assessed by a doctor to distinguish rosacea from other conditions that can cause redness of the face, including acne, dermatitis and rosacea.

Clinical treatment options for facial rosacea

Two main options for medical treatment are prescription medications, usually antibiotics in the form of a cream, oral antibiotics, and light-based treatment (laser or intense pulsed light). Usually, the best results are achieved with a combination of medications and laser/IPL treatments.

Medical treatments must be prescribed by a doctor. They are most useful for managing symptoms of flushing, papules and sensitive skin.

Medical treatments don’t improve the appearance of visible blood vessels.

Topical treatments for rosacea

Topical treatments are applied directly to the skin in the form of a cream, gel or lotion. They include:

• Metronidazole: Applied twice daily for at least six weeks but usually up to 12 weeks.
• Ivermectin: Once daily for up to four months. May be more effective in cases of papular rosacea (i.e. where there are acne-like bumps).
• Azelaic acid: Used once or twice daily. Available over the counter without a prescription. It can cause skin irritation, but it can usually be used for several months.
• Brimonidine: Causes short-lived constriction of blood vessels. Taken to prevent episodes of flushing in situations where they can be predicted.

Sometimes, the first course of topical treatment is not successful, but others may work better. If the result is still unsatisfactory, oral treatments may be considered.

Oral medications for rosacea

Doxycycline and minocycline are antibiotics which have an anti-inflammatory effect useful for treating papular (pimple-like) rosacea. These medications must not be taken by pregnant or breastfeeding women.

• Dosage: One tablet or capsule daily for about three months.
• Skin sensitivity to sunlight: Skin is more sensitive to sunlight while you are taking this medication. Make sure you wear sunscreen every day and avoid excessive sun exposure.
• Reduce the risk of stomach and oesophagus irritation: Always take after food, and follow with a glass of water. Don’t lie down for half an hour after taking.

Treatments for rosacea

IPL and laser for treating visible blood vessels

Intense pulsed light (IPL) and laser treatments can target and destroy specific structures in the skin. In cases of rosacea, the overgrown vessels of the face are treated with a wavelength of light that targets red structures, i.e. dilated capillaries and other blood vessel structures such as angiomas.

LED light therapy

Low level light therapy using an LED light source has been shown to reduce inflammation and provide energy to skin cells to boost healing. There have been published case studies of patients experiencing significant improvement in rosacea symptoms following a series of LLT treatments.

LLLT is safe with virtually no reported side effects. It could potentially be an alternative for people who can’t take medications or tolerate IPL/laser treatments, including pregnant patients.