What treatments are available for rosacea?
General measures
Some people with rosacea have sensitive skin which stings easily following use of topical applications. Topical treatments which cause problems include soaps, exfoliants, astringents, perfumes, certain types of sunscreen and alcohol or acetone containing products. These products should be avoided if they cause discomfort. When washing the face it is best to use only luke-warm water and a simple moisturizing wash such as Cetaphil rather than a soap. Avoid anything which forms a lather and use fingers to gently wash the face, but avoid scrubbing with a flannel. Some people with rosacea find that sunlight makes things worse, if so using a high factor sunblock e.g. Sunsense Daily Face is helpful. Finding a good moisturizer and using it regularly is important.
Flushing and redness
Flushing can be a very troublesome symptom in rosacea. It is often useful to discuss the possible trigger factors with a dermatologist and perhaps also to keep a diary to identify whether any specific foods, drinks, emotional stresses or environmental factors (e.g. heat, cold, sunlight) trigger flushing attacks and whether these can be avoided. There are no drug treatments yet that have been developed to specifically control flushing, but under expert supervision certain tablet medications that are usually used to treat other conditions (e.g. high blood pressure, depression) can be very helpful in reducing flushes. Applying moisturizer that has been kept in the fridge may be helpful for uncomfortable flushing attacks. The most effective treatments for redness and visible surface blood vessels are light and laser treatments such as intense pulsed light (IPL) or pulsed dye laser (PDL). In 2014 topical Brimonidine (Mirvaso) should become avaialble which is the first effective topical antiflushing cream. Brimonidine can reduce redness within 30 minutes and its effect can last for the rest of the day.
Inflamed spots
The most effective treatment for inflammatory rosacea (producing spots) are medications that can either be applied topically or taken as tablets. Topical treatments include metronidazole (an antibiotic) and new formulations of azelaic acid among others.Your dermatologist or GP may recommend a course of an oral antibiotic treatment such as a tetracycline for a few weeks or months to give the best improvement. Other oral medications are also sometimes very helpful. A new and effective low-dose non-antibiotic tablet treatment for rosacea (Efracea) is available in the UK.
Phymatous rosacea
Early phymatous rosacea (e.g. rhinophyma) can be effectively treated with a course of an oral treatment called isotretinoin (Roaccutane). This is a powerful medication related to vitamin A which is used in the treatment of acne. It works in rhinophyma by shrinking the sebaceous (grease-producing glands) which are numerous in rhinophyma. More advanced rhinophyma can be treated very well using an electrosurgical technique to remove the overgrown tissue.
Ocular rosacea
The symptoms of ocular rosacea can be relieved to some extent by using lubricating eye drops. The most effective treatment for troublesome ocular rosacea are oral antibiotics.
