What is the Best Treatment for Rosacea?

Once you have been diagnosed with rosacea, everyone naturally wants to know What is the best treatment for rosacea?

Wouldn’t it be great if there was a simple answer to this question that satisfied everyone who has rosacea!

Hopefully it doesn’t come as a surprise to find out that there is no known panacea for rosacea.

This high level paper from The Journal of Family Practice seeks to summarise the available published research into rosacea treatments. Thus the treatments being labelled `best’ by this study are only ever going to be the ones that have been proven by years of research and development and real life testing.

What I’m trying to warm you up to is the idea that you should only ever expect to see the well known prescription topical and systemic treatments emerge from these sorts of studies.

Clinical Inquiries: What is the most effective treatment for acne rosacea?

J Fam Pract. 2011 Feb;60(2):108a-c., May D, Kelsberg G, Safranek S.

Topical metronidazole and azelaic acid are equally effective for the papulopustular lesions of acne rosacea, although metronidazole is better tolerated. Oral doxycycline, tetracycline, and metronidazole are also effective, but not enough evidence exists to determine whether one is more effective than another or more effective than topical therapy (strength of recommendation [SOR]: A, systematic review and individual randomized controlled trials [RCTs]).

Some evidence supports a benefit for topical sodium sulfacetamide with sulfur, and benzoyl peroxide (SOR: B, small single RCTs).

Pulsed-light and laser therapy may improve the erythema and telangiectasias associated with acne rosacea (SOR: C, case series).

All patients with acne rosacea should use sunscreen and emollients, and avoid skin irritants (SOR: C, expert opinion)

Recommendations

The American Acne and Rosacea Society guidelines state that good evidence supports topical treatments—metronidazole,
azelaic acid, and sulfacetamide/sulfur—as well as anti-inflammatory doses of oral doxycycline.

The guidelines also list other topical and oral antibiotic treatments, but cite low-quality evidence for their efficacy and concerns about the emergence of antibiotic resistance. They advise appropriate skin care, including gentle cleansers, moisturizers, and sun protection.

Full Article PDF: What is the most effective treatment for acne rosacea?

Best Topical Therapy

Topical Metronidazole (Metrogel) and Azelaic Acid (Finacea) are indicated as being better than placebo, but “the studies
were generally weak because of poor methodology and reporting, small sample sizes, and lack of quality-of-life measures.”

Overall Metrogel is better tolerated than Finacea.

Best Systemic Therapy

Oral Metronidazole (Flagyl) and Oral Tetracycline as well as anti-inflammatory dose oral doxycycline (Periostat/Oracea) have been found to be effective.

Best Therapy for Redness

The best therapy for redness and broken blood vessels was found to be pulsed light therapy, laser therapy and photodynamic therapy with red light. No great surprises there.

Other Tips

“They advise appropriate skin care, including gentle cleansers, moisturizers and sun protection”. That is good advice we should all heed.

Can YOU Answer This Question?

Perhaps this paper won’t happily satisfy everyone’s quest for rosacea relief, but maybe you can.

You meet a newly diagnosed rosacea sufferer who is distressed. You have memories of being there yourself. What advice will you give them – what do you think is the best treatment for rosacea?

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About the Author

About the Author: David Pascoe started the Rosacea Support Group in October 1998. .

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22 Reader Comments

  1. Jenny says:

    The best ‘treatment’ I found was the Candida diet. No gluten, sugar, preservatives…the list goes on. High levels of protein and ‘good’ fat with low levels of carbohydrates. It’s not easy to stick with and is a long term approach to healing. Won’t suit most people’s lifestyles either as it is hard to stick to. But…when desperate you try pretty much anything! That combined with red light therapy to help with sensitive and irritated skin – again another long term treatment.
    The positive thing about this is the cost is not in on-going medication and/or topicals. A once-off outlay for a red light device but the rest is food.
    That’s my 2 cents worth.

  2. shantelle says:

    I’ve found that the best treatment for flushing is Oral Plaquenil (Hydroxychloriquine) and v-beam pulsed dye laser.

  3. Zoe says:

    I agree with Jenny. I have found that eliminating Yeast and sugar from diet is helping immensely. I would also recommend that you use the most gentle cleanser and moisturisers as when i first started out, i reacted to the redness in my face with very harsh methods, and looking back, i now realise i was so desperate to get rid of the facial flushing and spots, that i took silly measures, like putting chemical peels on for example… Its not always the way to go although you want a “quick fix” it might actually shoot you in the foot in the end. Hope this helps someone.

  4. David says:

    I found the VB laser to be the best, unfortunately the clinic I was going too no longer provides this laser treatment. I would dearly love to find another clinic in Sydney to continue treatment but have not been able to locate one…..any ideas?

  5. Kim says:

    The best treatment I have found is twice a day I wash my face with Head and Shoulders shampoo, then I put some baking soda on a small plate and add some peroxide to it (it is runny like water) then apply and allow to dry, then I wash it off with Cetaphil Soap, then I mix some dry mustard with water (again runny like water and not too much mustard because this burns) apply all over face and allow to dry, then I wash again with the Cetaphil soap, finally I mix epsom salts with water (again water consistency) and before I apply I make sure face is totally dry from the previous washing and I apply an over the counter hydrocortisone cream and then apply the epsom salt mixture all over my face and allow to dry. I do not wash this off but apply Neutrogena clay mask (it is white) so very lightly and rub into affected areas and then apply my makeup. I do not have the redness type of rosacea but the pustules and papules. I hope this helps someone else. I have tried everything other than medications which I refuse to do and this regimine keeps the flares from getting out of control and when the flare is finished there is no dry flaky skin just beautiful smooth skin.

    • Lori Noel says:

      My goodness, Kim, I don’t think I could possibly take the time to do all this! I do use hydrocortisone cream every night on clean skin, although it is supposedly bad for rosacea, in fact it is the only thing I’ve found which prevents pustules erupting most of the time. I’ll try washing with Head and Shoulders, as I know this helps with facial warts. Also, I’ll try Epsom Salts mixed with water as a skin toner. The only thing I found which almost totally got rid of my rosacea was when I was prescribed Voltaren 50mg tablets for a painful and swollen knee. It worked on the knee very quickly, but also drastically toned down my rosacea. Unfortunately, this is a dangerous medication to use long-term as it can cause heart problems. Anyway, it totally proved that rosacea is caused by inflammation in the body and not anything else.

  6. Joel says:

    I use SkinCeption Rosacea Relief Serum twice a day. It works quite well initially, with the redness mostly resolved after the application, but within 5-6 hours the redness might resume. I have found that the best cleanser to use and one that produces no irritation at all is Aveeno Skin Relief body wash (frangrance free). Cleans well with no irritation whatsoever.

  7. Monika says:

    I hope this helps at least one fellow rosacea sufferer out there!

    I first got diagnosed with rosacea (pupular perioral and periocular) when I was about 20 (10 years ago) and dermatologist put me on a 3-month course of Doxy and said it could reappear in 2-3 years. It went away beautifully and the three-year mark went by without a glitch. Late last year I started seeing a naturopath for some other health issues, and went on a diet free from gluten, sugar, unfermented dairy, alcohol, caffeine, additives and preservatives. I was very shocked when, after about 6 weeks on the diet, I noticed a red spot next to my eye. I knew immediately what it was and knew it would soon start spreading. It did, but not too quickly thankfully. I was extremely surprised because from what I had read, this type of diet seemed to help rosacea sufferers, and certainly not retrigger outbreaks! Anyway, I was freaking out and my naturopath suggested trying some lavender essential oil. So I got an (organic) one and applied it to the rosacea. It stung!!! I decided to give it a few minutes, and after a few minutes the stinging went away. But it seemed to make the area extremely dry, and it looked like it was starting to peel. I didn’t know if this was good or not, but I kept using it several times a day. I noticed a difference after about 24 hours – the rosacea was still there, but it wasn’t as pronounced. It did still look like it was peeling – that doesn’t look too nice. It wasn’t like a sunburn peel, but almost like I had accidentally rubbed some chalk on the area. It looked dry and peeling until it went away. It seemed to me that the lavender oil gently and gradually exfoliated the rash and I was left with clear skin. It came up again a few times after that, but I attacked it with the lavender oil straight away and it never got out of hand. I haven’t had a recurrence for a few weeks now, so I’m very happy. I’m not sure if the lavender oil helps prevent outbreaks, but it certainly helped me control and get rid of the rash.

    All the best to everyone out there.

    • Lori Noel says:

      Thanks, Monika. I’ll try lavender oil as I don’t have dry skin. I’ve been prescribed doxycycline for infections in the past, but never tried it for rosacea. What dose do you use?

  8. Lisa tippett says:

    Whilst in Spain I had a flare up and got the drug Myoxam – fabuous results. But can’t get it in the UK any idea’s anyone I have searched the internet?

  9. rob says:

    hi.my name is rob.i live in nelson new zealand.ihave had bad rosacea for about 8years.very red cheeks and nose which would flare up without warning and make me look like id been in the oven for an hour.this has caused me severe anxiety over the years.i had tried all sorts of topical lotions and creams for my skin,tablets both prescribed and others id been recommended.i had varied my diet majorly over the years with no real results.i still had this lingereing bright red mask.i spent thousands buying everything i seen or heard recommended to help with rosacea but nothing worked.well the reason i write this now is that i have been having vpl lazer treatment on my rosacea for the past 8 months.i have had 5 treatments at a cost of around$255 a treatment.i personally have had excellent results with this treatment.i was initially sceptical but i knew i had to at least try it.in honesty i am thrilled with the results.the redness is almost completely gone.i still get the occasional flare up that we all as rosacea sufferers get but because the red ness has lessened so much on my face even a flare up is hardly notieable now.i am very very happy with the results as its given me so much self confidence back.i have been going to caci clinic in nelson to get my treatments.in my opinion it is money very well spent because of the awesome results.i dont know if it works for everyone the same as it has me but i would encourage giving vpl lazer surgery a go as i well know the anxiety that comes from being a roseacea sufferer. i truly hope this can help someone.it has allowed me to feel normal again.

    • Lori Noel says:

      Hi, Rob. I’m glad this works for you and you can afford it. I’ve had rosacea since I was at school and am now 74. As I’m female, at least I can use camoflage make up, but can’t afford laser treatment. It’s a horrible condition to have as people lucky enough to have normal skin are totally unable to understand the trauma and stress caused by rosacea, and doctors dismiss it as something trivial. I wish I could wave a wand and give them severe rosacea for a week and see how they like it.

  10. Heather Russell says:

    I was diagnosed with severe ocular rosacea a couple of years ago. As a result, I take daily Oracea or doxycyline tabs. I have a sensitivity to preservatives in eye drops so was prescribed compounded preservative free dexamethasone .01% eye drops which I have to have refilled every two weeks. I do lid scrubs with baby Ocusoft eyelid wipes followed by a rinse off with gauze pads every morning; cannot use a face washer as the detergent residue serves as an irritant. I also use preservative free mineral eye drops and other lubricating drops during the day. I would appreciate hearing of others’ experiences with ocular rosacea and how you cope.

    Last week I tried to wean myself off the Dexamethasone eye drops; it was a foolish idea and I am paying for it now. .

    • Lori Noel says:

      Hello Heather. I was interested in your post because I’ve never been diagnosed with ocular rosacea, but for as long as I can remember I’ve needed moisturising drops every morning, and as I’ve got old my eyes have become slightly bloodshot all the time (I don’t drink any alcohol!). Last year, I had cataract surgery on one eye which was totally successful, but at my post-op appointment, a big splash of dilating eye drops was put in both my eyes and those drops totally messed up my night vision – I see streaks of light, multiple moons, blurring of all bright objects. It’s called positive dysphotopsia and is worse in the unoperated eye, This is an extremely unusual reaction to dilating drops and it has not gone away. I’m wondering if this severe reaction has something to do with my rosacea. I’ll ask a doctor about trying Dexamethasone eye drops in case they possibly help. Can they be prescribed by a GP? Opthalmologists have not helped me at all.

  11. James says:

    Just wanted to ask if anyone knows of any pills or capsules you can get to take for the hotness of a Rosacea attack.

    • John says:

      James: If you’re talking about something OTHER than an antibiotic then no. I know of nothing other than a RX for a flare-up.

      I take 100 mg of Doxycycline once a day when my rosacea returns. I’ll take it for 14-days and then go off the meds for 14-days. I hate to be on an antibiotic all the time since I’m concerned regarding gut health and the long-term risks of taking an antibiotic. FYI: I also take a probiotic daily.

      If it’s less expensive, you might ask your doctor for the antibiotic Minocycline. For me, it’s easier on the stomach.

      I feel for you, buddy. Good luck!

      John

      • Lori Noel says:

        I was presribed Minocycline and it did absolutely nothing for my rosacea. The only thing that helps is hydrocortisone cream every night and Voltaren 50mg tablets almost completely cured my rosacea. They were prescribed for something else and cannot be used long-term unfortunately.

    • Jennifer says:

      Hi James. In my opinion, the heat of a rosacea flush is worse than the accompanying red face. I find that a couple of Nurofen (anti inflammatory) and regular spraying of the face with Avene Thermal Spray seems to reduce the feeling of heat and helps the flush to pass more quickly. I also up my intake of water. The Rosacea Treatment Clinic in Melbourne has an excellent product, Cooling Stress Lotion, which is available online. This is very good for taking the heat out of the skin and reducing the redness but it is very expensive and because it is preservative free it must be used within four months of opening. However, it has been a life saver for me on numerous occasions. It also does double duty as a good non-irritating moisturiser. Good luck!

      • James Pillow says:

        Thank you very much. I really appreciate the info.

      • Lori Noel says:

        Jennifer, I also live in Melbourne but cannot afford expensive treatments. I’ll look up the Rosacea Treatment Clinic. Did they help you in any other way? My rosacea is constant but the redness flares up whenever I’m agitated or excited or too hot. I have permanent red blood capillaries and occasional outbreaks of pustules since I got past 60. Not much fun.

  12. Suzanne says:

    Having dealt with all aspects of Rosacea over the last 25 years, I’ve finally been able to treat my skin for the last 8 months without the use of any prescriptions. The solution for me begins with cleansing as follows: treat the dryness symptom first by applying 1 tbsp. of a good organic jojoba oil to the entire face; rinse gently with tepid water; then cleanse with La Roche Posay Dermo cleanser; rinse off gently; then as a toner, splash with some chilled bottled water mixed with Organic Apple Cider Vinegar, a ratio of 15 oz water to 1 oz of ACV; rinse well; again apply a small amount of jojoba oil, rinse lightly, dry slightly followed by La Roche Posay Soothing Protective Skin cream as the final moisturizer. Do this at bedtime and morning with the use of sunscreen consisting of a high percentage of zinc for daytime. The application of makeup is not part of my routine because they all have too many harmful chemicals. I realize this regimen seems lengthy, but once you settle in with it and discover the calming affect it gives your face, it’s well worth the time and effort. I hope this works as well for you as it has for me.

  13. Lori Noel says:

    Suzanne, dry skin is not the same as rosacea. My skin is not at all dry even though I’m over 70 and any oil on my skin brings me out in pustules. Without make up, I look like a freak, so you’re lucky your problem is obviously not severe. Some people find zinc works for rosacea so that is probably the main thing helping you. Do you ever get bright red, inflamed pustules all over your face? That is rosacea.

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