The best ways to treat rosacea, according to a dermatologist
- You can treat rosacea by using gentle skincare products, avoiding triggers, and using topical and oral medications.
- Some of the most common triggers for rosacea include alcohol, heat, sunlight, spicy foods, stress, and caffeine.
- When picking skincare products, be sure to avoid ingredients like camphor, sodium lauryl sulfate, or menthol, which may exacerbate rosacea.
- This article was medically reviewed by Debra Jaliman, MD, a board-certified dermatologist with a private practice in New York City.
Rosacea is more than just a tinge of pink on your cheeks. It can make your cheeks, nose, and even your chest and back red and inflamed. This redness can be treated with a number of remedies including topical treatments, oral medications, and lifestyle changes. Here's how to soothe the symptoms of rosacea.
What is rosacea?
Rosacea is a chronic skin condition that most commonly causes redness or flushed skin on the face, although it can sometimes also affect the ears, back, and chest. Some people also develop bumps or pustules that can resemble acne.
It is most common in adults in their thirties and tends to affect lighter-skinned people more frequently — especially people from Celtic or Scandinavian ancestry, according to the American Academy of Dermatology.
"It's not dangerous, but it can be uncomfortable," says Laura Ferris, MD, associate professor of dermatology at the University of Pittsburgh School of Medicine and director of clinical trials for UPMC Department of Dermatology.
Causes of rosacea
While experts haven't pinpointed a cause, they speculate that one or more of the following factors could be the culprit:
- Genetics, since rosacea tends to run in families.
- An immune system reaction to a bacterium called bacillus oleronius.
- A mite called demodex that lives on everyone's skin might also be a culprit. Researchers have found that people with rosacea have more of these mites than others, but there are also people without rosacea who have large populations of demodex mites, so more research is needed.
- Higher than normal amounts of a protein called cathelicidin that may lead to inflammation triggering redness and bumps.
If you think you might have rosacea, it's worth learning a little more about how to effectively manage your skin condition.
Treatment options for rosacea
There are a number of remedies available for rosacea — both prescription and over the counter. You may also want to consider making lifestyle changes to avoid triggers that may cause flare-ups.
Use gentle skincare products
You should be washing your face twice a day with a non-abrasive cleanser. Look for a gentle cleanser without any acids or rough exfoliants like salt or sugar granules, says Ivy Lee, a dermatologist in private practice in Pasadena, California. Then add a gentle moisturizer and use it twice a day.
You should also avoid skincare products with ingredients like camphor, sodium lauryl sulfate or menthol. These ingredients can exacerbate rosacea flare-ups, so check the back of any skincare products before purchase.
People with rosacea should also avoid using toners or astringents since these can be irritating to skin.
Avoid triggers
Sometimes your skin will flush, or sting, in an episode called a flare-up. Any factor that can cause your rosacea to flare up is called a trigger. Common triggers for rosacea include:
- Alcohol
- Heat
- Sunlight
- Spicy foods
- Stress
- Caffeine
- Cold weather
- Visit the American Academy of Dermatology for more triggers.
If you can identify your triggers, you can take steps to avoid them — and hopefully dodge a flare-up. That's key because repeated flare-ups can cause your skin to stay red or flushed for a longer period of time. That can make treatment more challenging.
Apply topical treatments
Your doctor may offer you one of several different topical treatments for your rosacea:
- Blood vessel constrictors: If you have rosacea, small blood vessels under your skin dilate very easily, which makes your skin look red. A topical treatment can constrict the blood vessels and reduce the redness. Two examples are brimonidine (brand name Mirvaso) and oxymetazoline (brand name Rhofade), both of which are available by prescription. However, the effect is temporary and only lasts for a few hours. Lee calls this the "Cinderella effect" because "you want to be home when it wears off," she adds.
- Azelaic acid: Azelaic acid is an anti-inflammatory cream that can reduce redness. It can also help get rid of those acne-like blemishes by killing off bacteria that can get into your pores. This treatment can make your skin dry and itchy, so let your doctor know if you experience this side effect. You can get azelaic acid in low doses in over-the-counter medicines, or in higher doses as a prescription.
- Topical antibiotics: A topical antibiotic like metronidazole can also reduce the redness and blemishes on your skin. These creams can reduce inflammation and have an effect on the demodex mites that may be causing rosacea. Lee likes to prescribe metronidazole to her patients, which is available in gel, cream, or lotion form.
- Retinoids: If you have pimples or pustules, your dermatologist might suggest trying a vitamin A derivative cream, also known as a retinoid. They can unclog any pores that might be causing rosacea-induced blemishes. Retinoids also have an anti-inflammatory effect, which decreases the redness in your skin.
- Ivermectin: Ivermectin is a topical medicine that knocks out those pesky demodex mites that might be causing inflammation and pustules, says Ferris.
Sometimes, dermatologists will suggest a combination of treatments. For her patients with severe rosacea, Ferris says she recommends combining metronidazole, ivermectin, and azelaic acid. "It should help to reduce the red bumps and to some extent the redness as well," she says.
Try oral medications
A course of an oral antibiotic, usually doxycycline, could be just the ticket for addressing your rosacea because of its anti-inflammatory effects. Your dermatologist might prescribe a higher dose for a period of time — Ferris says she limits a high dose to three months — or a lower dose for a longer period of time.
Another option for some people with rosacea is a drug called isotretinoin. It's a vitamin A derivative that's typically used for cases of severe acne, but it can also target lesions and pustules of hard-to-treat cases of rosacea. Women who take this medication will need to be vigilant about using birth control since it can cause birth defects.
For more advice on types and effectiveness visit Insider's guide on birth control.
Other treatments
There are a few other treatments that might be options for you, depending on your situation:
- Laser therapy: A laser can remove those visible blood vessels that make your skin look so red and flushed. If you don't think you can stick with a daily treatment regimen, laser therapy might be a good option for you, says Ferris.
- Surgery: Some people with rosacea develop a thickening of the skin called phyma — or rhinophyma if it affects the nose. If it gets severe enough, you may want to consider surgery to remove some of that excess, thickened skin.
Sun protection for prevention
With rosacea, you must be vigilant about protecting your skin from sun damage. The sun is a common trigger for rosacea. But you should be extra careful in the sun if you're taking an antibiotic like doxycycline, says Ferris. Doxycycline tends to make people extra sensitive to the sun, so you can get burned more easily.
Stock up on broad-spectrum sunscreen with an SPF of at least 30 and apply it every day before you go outside. It's best to use physical sunscreens containing zinc oxide, as chemical sunscreens can irritate rosacea. Also, stay out of the sun during peak hours, which are usually between 10 am and 4 pm. And if you do go outside, be sure to wear protective clothing like hats to protect your face.
One last note: some people can develop redness and inflammation in their eyes, a condition known as ocular rosacea. If you think you may have it, see an eye doctor so you can get the best treatment. You don't want to risk your eyesight by ignoring it.