While there are no effective cures for rosacea, it is possible to treat its symptoms, including the redness and change in skin texture associated with the condition.
Treatment depends on the symptoms displayed. If a patient displays pimples or pustules, these should be treated first. They can spread and also tend to cause many people the most concern about how they look. Problems with the eye are also an area of concern and call for prompt treatment. If there are changes to the skin — thick, nodules on a rosy skin — those should be examined promptly as well.
The Internet is rife with information devoted to home and herbal remedies for rosacea. Most of them have not been scientifically tested nor approved by the FDA and as such, are not listed here. Your doctor, however, may know from clinical experience if a particular natural remedy may be beneficial for you and as such recommend it.
Topical Treatments for rosacea pimples and pustules
The principal treatment for the lesions commonly associated with rosacea are ointments that are rubbed on the skin. There are many of these medications, some more effective than others, but a treatment that is effective for one person may not help another.
Patients should be prepared to try more than one ointment to learn which is the most effective for them personally.
Azelaic acid (Finacea)
In gel form, this is used as an anti-inflammatory medication. It can darken skin where it is applied (hyperpigmentation) and should therefore be used cautiously by darker skinned patients. It should not be used around the eyes or mouth. Apply twice daily. For fairer-skinned individuals, there is evidence that it is effective.
Benzoyl Peroxide (BenzEFoam, MaxClarity, PanOxyl)
This is a gel used chiefly to treat acne, but one recent study found that the 5% benzoyl peroxide solution does in fact provide some relief for rosacea. It should be noted, however, that this product is not a first line of defense when treating rosacea pimples. Another acne treatment, Clindamycin phosphate, was found to provide no relief whatsoever for rosacea.
Isotretinoin (Sotret Oral)
Ingested orally, this drug was originally introduced to treat acne but has also been found to provide some relief from rosacea.
Ivermectin (Soolantra)
This cream is an anti-parasitic medication that is also available orally, however, only the cream should be used to treat rosacea. It’s used to reduce the presence of demodex mites and should not be applied around the eyes. Use 1% Ivermectin cream once daily.
Metronidazole (Metrogel)
This gel has long been the most popular treatment for rosacea pimples and is still considered highly effective. Ivermectin is judged slightly more effective, but is also more expensive. After applying the gel, wait half an hour before using cosmetics.
Treatments for redness and spider veins
The redness — also known as erythema — may result from capillaries carrying blood close to the surface of the skin. Medications can temporarily reduce this activity, but for a longer-lasting solution there is laser surgery. The objective is to seal off the capillaries just below the skin so the deep redness is reduced or possibly even removed.
Brimonidine (Mirvaso)
This gel is effective in reducing mild to severe erythema. Patients typically find that it works well, although the effects wear off after 12 hours. A sudden flushing may occur some 3 – 4 hours after application, but tends to be no more common than a typical flare-up without the gel.
Clarithromycin (Biaxin)
This antibiotic has been found to have the side-effect of reducing erythema.
Oxymetazoline hydrochloride (Rhofade)
This 1% active ingredient cream that showed promise when tested on patients with mild to severe erythema. Use a small dab of the cream, covering the face and forehead while avoiding the eyes and mouth.
Pulse dye laser
This treatment is used for both the redness and spider veins associated with rosacea. Pulse lasers produce flashes of light that create a mild, pin-pricking sensation on the skin. For redness, the laser is moved across the entire affected area, which may be most of the face and forehead, and can require several sessions. For spider veins, the session tends to be shorter as the laser only needs to focus on the affected area.
Recovery takes a few weeks and can include swelling and bruising. Patients who are unprepared for these first results can become quite alarmed. After three or four weeks, however, the healing progresses enough for beautiful, long-term results to become visible. Spider veins disappear and the redness is reduced to a pinkish glow.
Broad Band Light (BBL)
BBL has been found to be another effective treatment for rosacea. This particular technology is a non-ablative procedure, and works by emitting bright lights at high energy frequencies. The treatment stimulates the skin to increase collagen production and breaks up unevenness in the complexion, contributing to a more balanced skin appearance. The thermal energy of BBL also targets and removes the vessels that provoke skin redness, which is the main symptom of rosacea.
For optimal results from BBL, a course of four to six treatments is required. These sessions should be delivered several weeks apart. However, your dermatologist or surgeon will most likely examine your case and formulate a treatment plan uniquely suited to the severity of your case. Although BBL may not completely eliminate rosacea, the treatments can offer long-lasting improvements. In addition, this laser treatment is virtually painless and has minimal side effects.
Intense Pulsed Light (IPL)
IPL is a non-invasive treatment that uses multiple wavelengths of light to treat prominent blood vessels on affected areas of the face. The light emitted is absorbed into the skin and the capillaries that cause facial redness are destroyed. Overall, facial inflammation, flushing and red patches are diminished.
IPL works most effectively as a course of four to six initial treatments, delivered a month or more apart. There may be some residual facial redness following the session, but this subsides after several days. There is virtually no downtime, and the patient can resume normal activities immediately.
While IPL may not permanently eliminate the appearance of rosacea, the condition can be successfully contained and managed with regular IPL maintenance treatments.
Treatments for eye irritation and redness
If you’ve been diagnosed with skin rosacea, ask your doctor whether you should undergo periodic eye exams. A specific treatment to help control ocular rosacea may also be required.
Artificial tears
Eye lubricants are available over the counter at most pharmacies. Use as often as necessary throughout the day. For many people, these products serve as the first line of defense in getting rid of red, itchy eyes.
Cyclosporine (Restasis)
Cyclosporine is available as an eye drop or as a tablet, but one study found that the eye-drop form is more effective in treating rosacea. The product was originally developed to increase the tearing of dry eyes and its use in treating rosacea is still somewhat experimental.
Metronidazole (Flagyl)
This is the same medication used as a gel on rosacea pimples and pustules, but in this form it is swallowed as a tablet. Alcohol cannot be consumed while taking this medication. Rare but severe side effects (nerve damage, seizures) make it an unlikely first choice as a medication.
Steroids
Although steroids placed on the eyelid can have beneficial effects, it is a last resort measure only, and must be discontinued as soon as possible. Steroids can do permanent damage to the cornea and increase the erythema on the face.
Tetracycline (Oracea)
The class of antibiotics containing tetracycline, doxycycline and minocycline are the most common treatment for the eye problems associated with rosacea. (Note: antibiotics are not recommended for treatment of rosacea that is not associated with eye symptoms.)
It may be surprising to see an antibiotic prescribed, as rosacea is not caused by bacteria, but in this case the drugs have a secondary effect that protects the cornea from damage. The dosage is much lower than that prescribed for antibiotic purposes. Once the symptoms are cleared up, patients can take an even smaller dose to reduce the chances of a flare-up. This minimal dose medication may continue indefinitely.
How much do rosacea treatments cost?
Insurance should cover the cost (with perhaps a co-pay) of your initial visit to your primary care physician for a diagnosis. Any topical medications or tablets prescribed will depend on the details of your pharmaceutical plan.
A survey taken by the National Rosacea Society in 2014 found that 72% of those surveyed reported their insurance plans covered the topical and oral medications. This coverage doesn’t mean that the medications are free, but prices are reduced.
The laser and electrosurgical treatments are both fairly long-lasting but more expensive than other approaches. The survey data was unclear about these procedures because most of those surveyed didn’t know whether their insurance covered them or not.
Health insurance companies are reluctant to cover surgery they consider cosmetic, and many patients find their insurance lacking when it comes to covering rosacea treatments.
The surgery is usually performed on an outpatient basis without the need for an anesthesiologist. There will be an assistant whose costs must also be covered. Laser treatments can require several sessions, with each session including a basic, office-use price. The laser surgery itself is in the range of $250 to $600 per session. Note, however, that treating rosacea growths on the nose, ear and other parts of the face is generally more expensive.
Find a Rosacea Treatment Expert
With such a wide range of possible symptoms and treatment options, it can be difficult for even the most seasoned professional to make a proper diagnosis. Working with a board-certified doctor experienced in rosacea treatment is the best way to ensure you undergo a treatment option that’s both effective and suits your specific needs.
