Medications for rosacea

Rosacea is not simply a cosmetic issue. It is a chronic (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 symptoms and quality of life.

Treating facial rosacea

The aims of treatment are to:

• Avoid or minimise exposure to triggers and irritants.
• Maintain healthy skin with appropriate skin care.
• Reduce inflammation.

Many people with rosacea can manage mild symptoms through trigger avoidance and good skin care, but medical treatment is sometimes required.

Some facial skin conditions can resemble rosacea or make it worse. It is important to have persistent redness assessed by a doctor to distinguish rosacea from other conditions such as acne or dermatitis.

Clinical treatment options for facial rosacea

Two main medical treatment approaches are used for rosacea: prescription medications and light-based treatments such as laser or intense pulsed light (IPL). In many cases the best results are achieved with a combination of medications and light-based treatments.

Some treatments require a prescription, while others are available from a pharmacy. The choice depends on your symptoms and medical circumstances; strengths, frequency and duration are discussed during consultation.

Medication treatments do not usually improve visible blood vessels. These are more effectively treated with laser or IPL treatments.

Topical treatments for rosacea

Topical medications are applied directly to the skin in the form of creams, gels or lotions. These treatments are often used for several weeks or months to reduce inflammation and acne-like bumps.

• Metronidazole and ivermectin: options for inflammatory bumps and pustules.
• Azelaic acid: an option for inflammatory symptoms; it can irritate sensitive skin.
• Brimonidine: can temporarily reduce persistent facial redness. Worsening redness can occur, so discuss suitability and use with your doctor.

If the first topical medication is not effective, another may work better. If symptoms remain difficult to control, oral medication may be considered.

Oral medications for rosacea

Antibiotics such as doxycycline and minocycline have anti-inflammatory effects that can be helpful for treating papular rosacea.

Your doctor selects the medicine and course. Tell them if you are pregnant, planning pregnancy or breastfeeding. Follow the medicine’s instructions about food, water and sun protection; do not use a general webpage as a dosing guide.

Other treatments for rosacea

Laser and IPL treatment

Intense pulsed light (IPL) and vascular laser treatments can target specific structures in the skin. In rosacea, these treatments focus on the dilated blood vessels responsible for persistent redness.

Light energy is absorbed by haemoglobin in the blood vessels, causing them to gradually close and be cleared by the body. These treatments are commonly used to reduce visible capillaries and persistent redness.

LED light therapy

LED may be discussed as an adjunct, but evidence for rosacea is limited. It does not replace established treatments or assessment of persistent symptoms.