Do you have a favourite over the counter treatment for your rosacea ? Depending on your health insurance and access to doctors and pharmacies, prescription treatments are out of the reach of many rosacea sufferers. So what can you try as a rosacea treatment that is easy to source, cheap and available without a prescription ? Is there anything ?

Please help your fellow rosacea sufferers with your best discoveries of treatments that you can get without a prescription or without visiting a doctor.

Here are some suggestions that I have collected that seem to be popular with members of the rosacea support group;

Prosacea

Prosacea is a topical gel, available over the counter at stores like Walgreens. It is also available on the internet at cvs.com. It contains 10% sulphur. The jury is still out, but reading prosacea user reviews, it looks to me like we should include prosacea as a bona fide rosacea treatment.

Rosacea-LTD

Rosacea-LTD is a topical treatment made of various compressed salts. It worked well for me to reduce papules and pustules and it is available only over the internet (which I guess counts as over the counter). This treatment is not cheap like many of the other suggestions in this listing, but I thought it definitely should be included as an over the counter treatment. For more information have a read of Rosacea-LTD User Reviews

Disclosure: rosacea-ltd is a site sponsor of rosacea-support.org

Aspirin

There has been some introductory research suggesting that a daily low dose of aspirin may help with rosacea swelling and flushing. For some it may lead to more flushing, but as an easily available and cheap over the counter treatment, aspirin may be worth a try.

Rosacea Swelling Relief Regime

Dr. Linda Sy has suggested in her rosacea swelling relief regimen, that there are some OTC meds that are easier (than prescription drugs) on the system such as: aspirin (blocks prostaglandin synthetase), antihistamines – ex. Chlor-trimeton which blocks H1 receptors; Cimetidine (Tagamet) which blocks H2 receptors. Pyridoxine (vit.B-6) has also been found to be helpful as a prophylaxis. She has sugested the following over the counter regime;

at Bedtime;

• 1 baby aspirin
• 1 Chlor-Trimeton (an antihistamine)
• 1 Tums (to offset the gastro effects of the aspirin)

and in the AM;

• a B complex vitamin with 50mg of B-6, but without Niacin (niacinamide is ok).
• 1 Tagamet

during a flush;

• apply a cool (not cold) compress to the face
• do deep breathing 10 times slowly.

Flaxseed Oil

Studies have shown that flaxseed oil may help improve acne and for some other Omega 3 sources like Fish Oil may offer additional benefits.

When Dr. Eric Jones was asked about the possibility of any nutritional link to ocular rosacea symptoms he responded “that here are studies with just dry eye, where flaxseed oil and omega 3s are quite effective. Foodwise, everyone is individual. There have been some surveys, and everyone was different. Some said spicy foods, others said hot drinks, alcohol, cold drinks. People have to find their individual triggers, I think.”

Nasalcrom

As an alternative to the steroid based nasal sprays, something like Rynacrom or Nasalcrom may help with allergic rhinitis and relieve other allergic symptoms. Certainly if you think your rosacea symptoms are allergy related this is worth trying. Even if it only relieves other chronic symptoms is might help you get your head around the other symptoms that occupy your thinking.

Afrin / Oxymetazoline

It is early days yet, but some preliminary research and some rosacea sufferers are reporting reductions in redness from using topicals such as Afrin. Rosacea sufferers are cautioned against applying Afrin directly to their skin as it is actually for allergic rhinitis so contains ingredients which may be irritating to rosacea sufferers.

Keep an eye out for updates related to Oxymetazoline based treatments like Afrin. See this forum posting Afrin cure ? for some more information. There are many over the counter products that contain oxymetazoline.

Cleansers and Moisturizers

OK officially cleansers and moisturizers aren’t rosacea treatments. This is a bit of a step backwards for rosacea sufferers. Once you understand that a gentle cleansing and moisturising regime is a good basis for beating rosacea, you are already off to a good start.

Make your own Cleanser

We know from a recent rosacea news article that colloidal oatmeal (Avena sativa) has interesting cleansing, moisturizing, buffering, soothing, protecting and anti-inflammatory properties.

Want to try something natural, perhaps something that you know exactly what it contains because you have made it yourself ? Some of the highlights from the Homemade Mixes community forum include simple natural sunscreens, licorice treatments, a honey cleanser and more.

Colloidal Oatmeal

Officially `Colloidal’ oatmeal is defined as a product made from grinding and processing whole oat grain with strict requirements on the particle size and fat content. In the past rosacea support group members have made their own cleansing masks with oatmeal and water. An extra bonus is that it can sop up flakes associated with seborrheic dermatitis.

Jojoba Oil

I have found that a small amount of jojoba oil blends in really well on wet skin and gives an excellent moisturized feel to my skin. Jojoba oil is cheap and easy to find in health food stores. We do know that jojoba oil has anti-inflammatory properties so it could be an ideal over the counter product.

A final warning

Please do be careful with products that you can get over the counter. Just because something is available without a prescription doesn’t mean it is even safe for rosacea skin. For example some OTC products might secretly (or quietly) contain steroids. As we now know, over the counter steroids can cause steroid induced rosacea.

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OK, so I have made my list, please give some more suggestions below in the comments.

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Rhinophyma that is severe enough to require surgery is rare. Knowing that it is rare should firstly put you as ease. This means that most like you will never require surgery.

Before you get too far along this route, and see too many grotesque pictures on the internet, can I suggest that you read – How to cure a red swollen nose. This article offers some good non-surgical options that you can consider along with your doctor.

Should you find yourself in the situation where you do require surgery, then suddenly how it works becomes much more interesting.

For sure this sort of surgery requires careful research into the methods available from your treating surgeon.

Going back in the archives we find this 2001 paper which was published in the respected journal Lasers in Surgery and Medicine. You can also find more recent papers featuring the combined erbium:yttrium-aluminium-garnet (YAG)/CO₂ laser – for eg. see the 2004 paper The Gold Standard for Decortication of Rhinophyma: Combined Erbium-YAG/CO2.

So here is the abstract for the 2001 paper;

Treatment of rhinophyma with Er:YAG laser, Lasers Surg Med. 2001;29(3):230-5. Orenstein A, Haik J, Tamir J, Winkler E, Frand J, Zilinsky I, Kaplan H.

Rhinophyma is a benign, disfiguring disorder of the nose which presents the end stage of acne rosacea, and can also occasionally result in nasal airway obstruction. We describe the first series of patients treated with Erbium laser.

Study design/Materials and Methods: Severe-to-moderate rhinophyma in six patients were treated at our institution between 1995 and 1996, using the Erbium:YAG (Erb:YAG) laser.

Results: All patients achieved marked cosmetic improvement, with no complications. Post-operative healing time was seven to fourteen days-signicantly shorter than similar other modalities.

Conclusions: The Erbium laser provides very accurate tissue ablation and allows the sculpturing of the hypertrophied areas, offering good cosmetic results, with a very short healing period as shown in our study

The laser was used in a 5mm beam diameter and a power of 1.2J, a pulse frequency of 10Hz, with up to 10 passes on the prominent lobules and 3 passes between the lobules.

The paper tells us that the post-operative redness subsided after 1 month and none of the patients required re-treatment in the following 2 years. Further “The surgical results were good to excellent. A good result was defined as an acceptable nasal contour with minimal scar formation and an excellent result was defined as normal nasal contour without clinical scarring. All patients were satisfied with their results. No post operative complications were encountered”. The patients ranged in age from 46 to 84, and their cosmetic results are listed as either good or excellent.

A gauze with diluted adrenaline was used to control bleeding, the paper also refers to the usage of a meshed Omniderm sheath. The Er:YAG offers minimal thermal damage to the neighbouring tissue.

The final conclusion of the paper was “the Er:YAG laser ideal for removal of superficial skin layers with maximum sparing of adjacent structures, short healing process and minimal and short-term redness.”

You may also like to read about a new surgical technique for rhinophyma using a microdebrider + floseal. For some more background reading see treating rhinophyma with accutane.

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The red swollen nose of rosacea is a much hated symptom. I know that this was the symptom that I despised most and indeed drove me 10 years ago to start to look for good information about how to treat rosacea. Incidentally, this drive lead to the creation of the internet based Rosacea Support Group in 1998.

I hated that I looked like I had adult acne and a constant sun-burned nose. Especially as I have somewhat fair skin, a red nose stood out a mile away.

There has been quite a lot of interest in a article I wrote titled “how to cure a red face (facial erythema or redness)“. That article gave some tips on how to deal with general facial redness. What about a red and swollen nose ? What can you do to treat a red rosacea nose ? Read on for some suggestions.

A rosacea nose has the extra complication that one might end up suffering from rhinophyma. Although rare, rhinophyma is also a much hated symptom of rosacea. While we don’t know for sure how any particular rosacea sufferer’s symptoms will progress, reducing your inflammation and flushing is a good start to winning the battle.

Here are my top tips for dealing with the red nose of rosacea.

Rosacea-LTD III

Rosacea-LTD was one of my first discoveries after starting to look for treatments on the internet in 1998. They consist of compressed disks of sulfur and various salts. You wet your face and glide them over the skin, leaving a thin film. For me these `disks’ did a great job of reducing the papules and pustules on my nose. I could feel them shrinking all those acne looking lumps and bumps. As much of my redness was associated with my papules and pustules, this treatment was a good step in the right direction. I continued to use rosacea-ltd for several years.

Disclaimer: rosacea-ltd is a site sponsor of rosacea-support.org

Oral Antibiotics

If the nasal swelling is associated with the papules and pustules normally seen in rosacea, then systemic antibiotics along with topical metrogel or finacea may also be of benefit. Once the papules and pustules are under control, the associated swelling may be reduced enough to see an overall benefit in appearance. One of the newer antibiotics on the market is a low dose form of doxycycline called Oracea, which may be useful in helping to maintain a long term benefit from antibiotic usage.

Accutane

Accutane or roaccutane has been used for many years to treat cystic acne. There is a good body of evidence to say that you can successfully treat rosacea with accutane. Additionally there are some published papers that deal specifically with treating rhinophyma with accutane.

Isotretinoin has also been demonstrated to decrease nasal volume in rhinophyma. The most significant regression has been noted in younger patients with less advanced disease.

…

Isotretinoin has also been demonstrated to decrease nasal volume in rhinophyma. The most significant regression has been noted in younger patients with less advanced disease.

Biopsy specimens from phymatous skin prior to isotretinoin therapy showed numerous large sebaceous glands. During isotretinoin therapy, the glands diminished in size and number. Other studies have confirmed the usefulness of isotretinoin for phymatous change.

[See treating rhinophyma with accutane]

Accutane is not a drug to be taken lightly. If you would like to try this as an option, the above references might help you find a doctor that can support you using this as a treatment option. You may also want to discuss the option of low-dose accutane with your doctor.

Covering Up

As you start to reduce the inflammation, you will probably also benefit from covering over some of the redness. Some options include the easily available Clinique Redness Solutions, or Eucerin Redness Relief which may be able to offer some relief from the redness. Additionally the green tinted version of the Tone Perfecting Cream may cover some redness.

Perhaps you can find some foundation or tinted moisturizer that you can also include in your daily regime. It might not be easily obtainable worldwide, but The Cancer Council in Australia has a range of tinted moisturiser SPF 25 that looks interesting. Don’t discount a liquid foundation as a possibility, even if you are a guy.

IPL and Lasers

We now know that IPL is excellent for treating a red face and broken blood vessels. Will any of the benefits of IPL also help a red swollen nose ? In general IPL and pulsed dye lasers are useful in reducing the redness flushing, burning,  itching, dryness and swelling of rosacea.

The AAD suggests that for thickening of the skin on the nose and cheeks as seen in rhinophyma, the CO2 laser and erbium:YAG laser can be used.

Surgical Options

When the growth of the nose tissue becomes impossible to manage with topicals or isotretinion, surgical intervention can be an option. Surgery can naturally have its own risks. With the removal of extra tissue also comes the risk of scarring.

CO2 Laser

A 2004  paper; The Gold Standard for Decortication of Rhinophyma: Combined Erbium-YAG/CO2 Laser, details how the authors suggest that the combined YAG/CO2 laser is superior to other lasers, scalpel, radiotherapy and skin grafts in dealing with rhinophyma.

Also some related comments from the AAD page Is laser treatment right for your rosacea? ;

Some patients with longstanding rosacea develop thickening skin on the nose and cheeks, which is called rhinophyma. The CO₂ laser and erbium:YAG laser can be used to remove this thickening skin and improve the contour of the nose. Other surgical procedures used to treat this condition include dermabrasion and excision with a scalpel. Treatment options may be combined to obtain best results.

Dermatologists recommend early treatment of rhinophyma to help prevent the condition from progressing and becoming more difficult to treat. In the advanced stages, rhinophyma can cause difficulty breathing through the nose. It also is possible for the nostrils to collapse.

Other Surgical Methods

A 2003 paper; New surgical adjuncts in the treatment of rhinophyma: the microdebrider and FloSeal details a novel technique using a standard microdebrider followed by a haemostatic sealant to eliminate bleeding.

Now Over to You

What have you found to be useful in your battles with a red nose ? Please help your fellow rosacea sufferers by leaving a comment below.

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A question we hear from time to time from rosacea sufferers is `how do I go about reducing the size of my skin pores ?’ This is quite a difficult question to properly answer. The enlarged pores that you sometimes see with rosacea or acne can feel like they will never go away.

You are here on this page because you feel sure that there must be a way to reduce the inflammation that leads to swollen pores on your face.

Here are some insightful thoughts from Dr. Linda Sy;

Pores can appear enlarged if filled with sebum & keratinized cells. When the epithelial cells are exfoliated or the sebum production is inhibited (example: by topical tretinoin or accutane prescription), the pores appear smaller. Therefore, any prescription that will reduce accumulation of sebum & keratin in the pores, will most likely help reduce the size.

I doubt that many doctors would recommend that you undertake a treatment regime of accutane just to reduce visible facial pores. If you also have the lump and bumps of acne, or severe pustules and redness of rosacea, you may find accutane is helpful in reducing the pore size also.

The NRS Ask the Doctors Blog also has a post asking Rosacea has made the pores on my face large. When I get my rosacea under control, will my pores return to their normal size?

The Rosacea Experts also come to a similar conclusion as Dr. Sy;

Topical and oral antibiotic therapy may be prescribed for mild cases, but more severe cases may sometimes be treated with isotretinoin, which is an oral medication typically used for severe acne. Clinical studies have shown that patients’ large sebaceous glands were diminished in size and number during isotretinoin therapy. There is also evidence that retinoids, topical medications with many of the same properties of isotretinoin, may decrease skin thickening and sebaceous gland enlargement. Spironolactone, a mild diuretic with anti-androgen properties, can also be used to decrease pore size.

Good to see some more suggested treatments for enlarged pores as I know this is something that worries many rosacea sufferers.

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Please leave a comment below with any hints or tips you have found that have helped you answer the question “how do I reduce the size of my pores ?”

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Otophyma: A Case Report and Review of the Literature of Lymphedema (Elephantiasis) of the Ear., Am J Dermatopathol. 2008 Feb;30(1):67-72, Carlson JA, Mazza J, Kircher K, Tran TA

Phymas (swellings, masses, or bulbs) are considered the end-stage of rosacea and mostly affect the nose (rhinophyma), and rarely involve the chin (gnatophyma), the cheek (metophyma), eyelids (blepharophyma), or ears (otophyma).

Herein, we report the case of a 57-year-old man who developed unilateral enlargement of his left ear over 2 years. Biopsy revealed changes of rosaceous lymphedema associated with Demodex infestation. Corticosteroid and minocycline therapies resulted in partial reduction of the ear enlargement. Literature review examining for cases of lymphedema (elephantiasis) of the ear revealed that chronic inflammatory disorders (rosacea (most frequent), psoriasis, eczema), bacterial cellulitis (erysipelas), pediculosis, trauma, and primary (congenital) lymphedema can all lead to localized, lymphedematous enlargement of the ear. Depending on the severity, medical treatment directed at the inflammatory condition for mild, diffuse enlargement to surgical debulking for extensive diffuse enlargement or tumor formation can improve the signs and symptoms of otophyma.

Decreased immune surveillance secondary to rosaceous lymphedema may explain why Demodex infestation is common in rosacea and support the suspicion that phymatous skin is predisposed to skin cancer development.

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Alpine Pharmaceuticals are promoting SinEcch as a natural homeopathic dose of Arnica Montana. I have to say that I am unconvinced by the whole homeopathic story. Can treating `like with like’ really offer provable results ? Their FAQ pages go on to say that for bruising and swelling, a single remedy, Arnica, can be prescribed for everyone, rather than a regime customized for each person.

The herb Arnica Montana is toxic, but the homeopathic doses are not toxic. According to their web site “the smaller doses seen in Homeopathic preparations may exhibit the reverse effect of the larger doses used in herbal medicine. However, even Homeopathic doses may be cumulative over time. Prolonged pre-operative dosing regimens of Arnica Montana, for example, may increase intra-operative bleeding, whereas the single pre-operative dose used in the SinEcch protocol has been reported to increase intra-operative bleeding in only one case out of over 300,000.”

SinEcch is approved by the FDA and is available over the counter. One package is designed to treat one patient for one surgery and consists of 12 capsules.

CHOICE Australia did a review of natural first aid remedies and had this to say about arnica:

Arnica montana is a medicinal herb with a long history of use for treating swelling and bruising resulting from blows, and injuries such as sprains. Arnica flower is commonly available in both herbal and homeopathic preparations.

Clinical evidence for arnica as an effective first aid treatment is lacking, but people with osteoarthritis might want to give it a go.

Another related natural/herbal treatment is the anti-flushing protocol as used by Dr. Soldo between IPL treatments. This protocol uses, amongst other things, either aloe vera gel or Calendula Gel from Califlora.

Paula Begoun, in her article, When Blushing is Not by Choice: Causes and Treatments for Rosacea (web archive link), lists Arnica as something that potentially should be avoided.

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We want your help !

Please give us your feedback. Have you ever used Arnica or Calendula as part of your laser or IPL treatments, or even as part of your daily regime ? I’m looking for some good feedback on other naturopathic remedies as well. Please leave a comment below and let us know how you got on.

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Definition: edema – swelling of any organ or tissue due to accumulation of excess lymph fluid, without an increase of the number of cells in the affected tissue..

Measurement of oedema in irritant-exposed skin by a dielectric technique, Skin Res Technol., 2006 Nov;12(4):235-40 ,Miettinen M, Monkkonen J, Lahtinen MR, Nuutinen J, Lahtinen T. Department of Applied Physics, University of Kuopio, Kuopio, Finland.

Background: Easily applicable water-specific instruments measuring local oedema in skin are not available. The aim of this study is to demonstrate quantitative assessment of skin oedema with the dielectric technique by measuring increase of skin water content related to sodium lauryl sulphate (SLS)-induced irritant contact dermatitis.

Methods: Irritant skin reaction and resulting oedema were induced by an irritant patch test on volar forearms in 12 healthy volunteers with the application of 1% SLS for 6 h. After occlusion the volunteers were
divided into two groups: the patch test site of group I (six volunteers) received no treatment other than a base cream for the skin reaction, while for group II (six volunteers) a strong corticosteroid (clobetasol propionate) was applied on the irritant skin. During a follow-up of 72 h, erythema was scored visually, and irritant-induced oedema was measured with a novel water-specific instrument MoistureMeter-D.

Results: In the untreated irritant skin, a maximum increase of 45% in skin water content was found at 10 h postocclusion and water content was still elevated at 72 h. With these persons, the degree of oedema agreed well with the ultrasound-measured skin thickness (P=0.053). In the corticosteroid-treated skin, an increase of 8% in water content was measured during 72 h but there was no correlation between oedema and skin thickness. There was no correlation between erythema and oedema in untreated or corticosteroid-treated skin.

Conclusion: The new instrument can easily be applied for noninvasive quantitative evaluation of local oedema and fluid retention in irritant-exposed skin.

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This paper is stating that even though the latest versions of the Pulse Dye laser don’t produce the same amount of purple/black scabbing as previous versions, it can still produce a lot of redness, swelling and pain. I know that I looked like a koala with a black scabby nose after my pulse dye laser treatment a few years ago. Sadly my treatments didn’t really help my symptoms, but the Pulse Dye Laser has had several technology updates since then.

Clinically Significant Facial Edema After Extensive Treatment With Purpura-Free Pulsed-Dye Laser, Alam M.; Omura N.E.; Dover J.S.; Arndt K.A., Dermatologic Surgery, Volume 29, Number 9, September 2003, pp. 920-924(5)

Background. Long-pulsed pulsed-dye lasers permit treatment of facial erythema and telangiectasia with purpura-free technique, which may be more comfortable for the patient than purpura-inducing treatment. However, there are anecdotal reports of treatment-associated discomfort even when purpura is not elicited.

Objective. To determine whether patients experience clinically significant erythema, edema, and pain after purpura-free treatment with pulsed-dye laser.

Methods. In this prospective, controlled study, subjects included 15 patients who were undergoing purpura-free treatment of diffuse erythema and fine telangiectasia of at least half the facial surface area with purpura-free pulsed-dye, and it included 15 age, gender, and skin-type matched control subjects who were undergoing similar treatments but with the induction of trace to mild purpura. Patients were seen in person and were surveyed by phone regarding symptoms and signs during their postoperative courses.

Results. Postoperative erythema of a mean 3.3-days duration and 3.4/5.0 intensity was reported by 73% (11 of 15) of the purpura-free patients. Among purpura patients, the duration was 5.6 days. The intensity was 4.0, and again, 73% of patients reported this finding. Postoperative edema occurred among 87% of purpura-free patients, but such edema occurred in all of the purpura patients, in whom it lasted longer and was more intense. Symptomatic eye swelling and uncomfortable/painful edema were seen in 27% and 20%, respectively, of purpura-free patients, but in 40% and 53% of purpura patients. Among purpura-free patients receiving fewer than 250 laser pulses per treatment, erythema and edema lasted less than 1 day and 2.5 days, whereas the mean durations were 3.4 and 5.0 days for purpura-free patients receiving greater than 250 pulses.

Conclusion. Extensive purpura-free treatment for erythema and telangiectasia of the face with the long-pulsed pulsed-dye laser can lead to clinically significant erythema, edema, and discomfort in patients. The duration, magnitude, and frequency of these undesired effects are markedly less with purpura-free treatment compared with purpura-inducing treatment and are also less for less extensive purpura-free treatments.

• PubMed Extract
• Abstract Online

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• See Also: Photoderm Blisters: First, Do No Harm