Rosacea treatment

Avoiding triggers of rosacea outbreaks is important for all types of rosacea but by itself is generally insufficient to induce remission. Most experts recommend keeping a diary in order to help identify and reduce rosacea triggers.

Skin protection

Protecting the skin from environmental damage, particularly UV radiation, as well as chemical and physical irritants is critical for preventing, stabilizing and improving rosacea. See our articles on the basics of skin protection and particularly sun protection. When choosing a sunscreen, it is important to consider irritation potential of specific sun-blocking ingredients. Physical sun blocks, such as zinc oxide, tend to be less irritating. Some chemical sun blocks may also be acceptable but need to be chosen and used carefully. For detailed information, see our section on specific sun blocking agents.

Antibiotics

Certain antibiotics, particularly oral tetracyclines (tetracycline, doxycycline, and minocycline) and topical metronidazole are helpful in rosacea types associated with papules and pustules, where bacterial overgrowth seems to play a role.

Doxycycline hyclate, a variant of doxycycline antibiotic, may have benefits beyond its antibacterial activity because it also inhibits matrix metalloproteinases (MMP), the enzymes involved in the degradation of skin matrix. MMP inhibition may improve rosacea symptoms by increasing the integrity of the dermis, reducing leakage, reactivity and proliferation of capillaries and so forth.

Vascular lasers and intense pulsed light

Lasers/light based methods are among the most widely used and effective treatments of rosacea (especially for erythematotelangiectatic type). The wavelength of the device is selected in such a way as to be primarily absorbed by hemoglobin, the key protein in red blood cells. As a result, blood vessels can be ablated with minimal damage to surrounding tissue or scarring. With a sufficient number of treatments, this approach can eliminate redness almost completely. However, if the underlying cause persists, the redness tends to eventually reappear, requiring further treatments. In each case, the optimal laser/light device is selected depending on the size and depth of the blood vessels to be ablated. For details on specific devices, see our section on nonablative laser/light treatments.

Other treatments

A number of other treatments supported by limited scientific evidence are currently in use on a relatively small scale. More research is needed to confirm and better define their role in treating rosacea.

Topical azelaic acid: Azelaic acid (Azelex, Finevin, Skinoren) may help reduce inflammatory lesions, bumps and papules.

Oral retinoids: Oral retinoids, such as isotretinoin (Accutane), are among the most effective acne treatments. Yet they are infrequently used due to high risk of serious side effects. It appears that low doses of oral isotretinoin may be useful in treating papules and pustules associated with rosacea. Such low doses may be less risky those typically used to treat acne. Still, more research is needed to determine risks, benefits and optimal use, if any, of oral retinoids in treating rosacea.

Non-vascular lasers: The use of non-vascular lasers is rosacea is limited. Ablative carbon dioxide lasers are sometimes used to remove excess tissue caused by phymatous rosacea. Nonablative (non-vascular) lasers may help induce skin remodeling and thereby improve dermal matrix degeneration common in rosacea.

Angiogenesis inhibitors: A promising approach to treating the vascular component of rosacea is to inhibit new blood vessel growth. This can be achieved via compounds called angiogenesis inhibitors. One such compound, dobesilate, was reported to improve vascular rosacea after topical use. More research is needed to better evaluate the promise of this and other angiogenesis inhibitors in rosacea.

Furfuryladenine (kinetin): In one study, topical furfuryladenine (often sold under trade name kinetin), a plant-derived growth factor/regulator, was reported to improve the signs and symptoms of rosacea with no or minimal side effects. More studies are needed to corroborate these findings.

Sea buckthorn oil: This has not been researched much but it appears that sea buckthorn oil-based topicals might be helpful. At a minimun, sea buckthorn oil deserves further research as an ingredient in topical rosacea treaments.