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What Treatment Options Are Available for Rosacea?

Dr. Nancy Shannon

Medically reviewed by Dr. Nancy Shannon, MD, PhD on August 31, 2021

Rosacea is a chronic condition, meaning that there is no known cure for it and those who experience it will likely cope with it throughout their lives. That doesn’t mean that there’s no hope, though: there are many highly effective treatments available for rosacea.

The right treatment for you will vary depending on the type of rosacea you have, its severity, your skin type, and a number of other relevant factors. If you’re hoping to familiarize yourself with some of the most popular options, here’s what you need to know:

  1. Topicals

The first go-to rosacea treatments are topicals: medications that you apply directly onto the skin, whether regularly or when flare-ups occur. 

  • Metronidazole

Metronidazole is an antibiotic cream or gel used to treat rosacea. Though the exact manner in which it combats rosacea has yet to be established, its impacts are clear, particularly when it comes to the treatment of acne rosacea: one study found that patients who regularly used metronidazole saw their number of rosacea-related pustules and papules by between 48 and 65%. Topical metronidazole is FDA-approved for rosacea and works best for the papulopustular subtype. It is not effective for erythematotelangiectatic rosacea. Besides metronidazole, other topical antibiotics are sometimes used for rosacea, including erythromycin and clindamycin. 

  • Azelaic Acid

Naturally occurring in barley, wheat, and rye, azelaic acid is a compound generally recommended for the treatment of acne and rosacea. It acts as a natural anti-inflammatory, preventing your skin from becoming too irritated and thus dampening any flare-ups that do occur. Because it soothes inflammation, azelaic acid can be used by almost anyone, no matter how sensitive their skin. Topical azelaic acid is FDA-approved for rosacea and works best for the papulopustular subtype. It is not effective for erythematotelangiectatic rosacea.

  • Sodium sulfacetamide with 5% sulfur 

Sulfur is an antibacterial and can help exfoliate the top layers of the skin, and it can be effective at preventing and treating rosacea. Even those with sensitive skin are unlikely to be irritated by topical sulfur products. 

Below are some other topical medications sometimes prescribed to treat rosacea. Nurx does not typically prescribe or deliver these treatments, and they are less likely to be covered by insurance:

  • Brimonidine

Brimonidine, first approved by the FDA for rosacea treatment in 2013, comes in the form of a gel designed to combat the redness associated with the condition and is generally prescribed for individuals with the erythematotelangiectatic subtype of rosacea. Though daily applications of brimonidine are recommended, the drug can also have a significant impact on flare-ups when they do occur: one study found that brimonidine can significantly reduce facial redness within 30 minutes of its first application, though the strongest reductions come after 3 to 6 hours. One potential side effect of brimonidine is that some patients develop rebound redness after the medication wears off or they can develop compensatory redness on other areas of the skin like the chest. 

  • Oxymetazoline

Oxymetazoline has powerful decongestant properties, making it one of the most common ingredients in anti-allergy nasal sprays. It’s also a highly effective anti-inflammatory, and can be used to treat rosacea when applied as a cream. Like brimonidine, oxymetazoline is generally prescribed as a long-term, daily treatment for erythematotelangiectatic rosacea, but those who use it can expect to see reductions in redness within 1 to 3 hours upon its application.  

  • Ivermectin

Used orally as an antiparasitic in order to treat intestinal conditions, ivermectin can also be formulated as a topical treatment (sold as Soolantra, ivermectin 1% cream). While it does have anti-inflammatory properties, ivermectin’s biggest asset in the fight against rosacea is likely the effect it has on Demodex folliculorum, a common dust mite whose presence on the face is correlated with incidences of rosacea. Ivermectin kills populations of these mites and in doing so helps prevent flare-ups. 

  1. Oral Antibiotics

Oral antibiotics are a common supplement to topicals in the treatment of rosacea, particularly when the rosacea causes pimple-like blemishes to appear. Antibiotics can help calm the conditions in and around your pores that make the development of pustules possible. The most common antibiotic used to treat rosacea is doxycycline, often at a lower anti-inflammatory dosing to avoid developing antibiotic resistance.

  1. Laser and Light Therapy

Light therapy is an increasingly popular treatment for rosacea that can reduce redness in the long term. Repeated exposure to certain kinds of light either at home or in a clinic can cause the blood vessels in the face to shrink or even disappear, thus reducing the severity of redness in the future. Laser can be particularly effective for erythematotelangiectatic rosacea.

Patients with more severe phymatous rosacea may also benefit from laser or other surgical procedures to restore the appearance of the phymatous areas (like the nose). 

Between all of the different treatment options for rosacea, it’s easy to feel overwhelmed. Get in contact with a member of our medical team today to learn more about which ones may work best for you.

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