Treating rosacea on the face

23 Apr
 
2022

Facial rosacea is a long-term skin condition that gets better and worse over time. While symptoms are worse, it’s often treated with prescription creams, oral antibiotics or laser. At other times, it can be successfully managed by a combination of careful skin care and avoiding triggers.

What is rosacea?

Rosacea is not simply a cosmetic issue.

Rosacea is a chronic (i.e. long term) health condition causing inflammation and overgrowth of blood vessels and skin of the face.

Unfortunately rosacea is not curable, but treatments and careful management can significantly improve the signs of rosacea, leading to a better quality of life.

Causes of rosacea

The underlying cause of rosacea is not well understood. People with rosacea experience inflammation and increased blood flow in the face in response to certain influences. There is a genetic component, since rosacea tends to run in families, but skin organisms such as Demodex folliculorum and gut organisms may activate the immune response in facial skin to cause symptoms.

In people with rosacea, various triggers cause inflammatory response with increased blood flow through the vessels of the face. This results in an episode of facial flushing: an uncomfortable hot sensation with redness of the cheeks and nose.

Symptoms of rosacea

A middle-aged woman with severe rosacea: redness and a network of blood vessels in the nose and cheeks
A middle-aged woman with severe rosacea: redness and a network of blood vessels in the nose and cheeks

Rosacea symptoms include:

  • Persistent redness of the cheeks
  • Flushing of the face, often brought on by specific triggers
  • Visible blood vessels (sometimes called “broken blood vessels”) which may form a network over the cheeks and red lines around the nostrils and chin
  • Pimple-like lumps known as papules. These may or may not be filled with pus and are often mistaken for acne
  • Redness, soreness and a gritty dry sensation of the eyes
  • If untreated for many years, rosacea can lead to overgrowth of the skin of the nose causing a misshapen and bulbous appearance

Rhinophyma - enlarged nose - due to long term untreated rosacea
Rhinophyma - enlarged nose - due to long term untreated rosacea. Image courtesy of DermNet NZ (https://dermnetnz.org/topics/rhinophyma-images)

How rosacea impacts the skin on your face

People with rosacea may have permanently red facial features. The cheeks are mostly commonly affected, but the nose and chin may also be red. The area around the mouth is often spared.

Rosacea often makes the facial skin unusually sensitive so that it stings to apply perfumes, cosmetics, sunscreens and other products.

The skin’s moisture barrier is less effective than normal. There is moisture loss, and the skin becomes dry and flaky.

Increased blood flow to oil glands may make the skin feel oily. Many people with rosacea experience both dry and oily skin.

Managing your rosacea triggers

Episodes of facial flushing are commonly caused by triggers, which can include heat, exercise, emotional stress and spicy or hot foods.

An essential part of managing your rosacea is to avoid or minimise exposure to rosacea triggers as much as possible. For more information, see our Rosacea triggers page.

Treating facial skin rosacea

The aims of treatment are to:

  • Avoid or minimise exposure to triggers and irritants
  • Maintain skin health
  • Reduce inflammation

Most people with rosacea can manage minor symptoms by avoiding triggers and irritants and implementing a good skin care program, but sometimes medical treatment is required.

Some common treatments for facial skin conditions can make rosacea worse.

It’s always important to have skin condition symptoms assessed by a doctor to distinguish rosacea from other conditions that can cause redness of the face, including acne, dermatitis and rosacea.

 

Cinical treatment options for facial rosacea

Two main options for medical treatment are prescription medications, usually antibiotics in the form of a cream, oral antibiotics, and light-based treatment (laser or intense pulsed light). Usually, the best results are achieved with a combination of medications and laser/IPL treatments.

Medical treatments must be prescribed by a doctor. They are most useful for managing symptoms of flushing, papules and sensitive skin.

Medical treatments don't improve the appearance of visible blood vessels.

Topical treatments for rosacea

Topical treatments are applied directly to the skin in the form of a cream, gel or lotion. They include:

  • Metronidazole: Applied twice daily for at least6 weeks but usually up to 12 weeks
  • Ivermectin: Once daily for up to four months. Maybe more effective in cases of papular rosacea (i.e. where there are acne-like bumps)
  • Azelaic acid: Used once or twice daily. Available over the counter without a prescription. Can cause skin irritation, but usually can be used for several months.

Sometimes, the first course of topical treatment is not successful, but others may work better. If the result is still unsatisfactory, oral treatments may be considered.

Oral medications

Close-up view of a packet of doxycycline capsules
Doxycycline capsules are frequently prescribed to manage rosacea

Most oral treatments for rosacea are low dose antibiotics. Doxycycline and minocycline are the most prescribed. They have an anti-inflammatory effect which is useful for treating popular rosacea. Side effects include sensitivity to sunlight with increased risk of sunburn, and irritation of the stomach and oesophagus. These medications must not be taken by pregnant or breastfeeding women.

Treatments usually need to be continued for several months.

From time to time, courses of maintenance treatment are required.

Resistant cases

Resistant rosacea may need to be treated by a dermatologist who can prescribe medications not available to other doctors. These medications can have serious side effects and are usually only prescribed if all other treatments have failed.

IPL and laser for treating visible blood vessels

Intense pulsed light (IPL) and laser treatments can target and destroy specific structures in the skin. In cases of rosacea, the overgrown vessels of the face are treated with a wavelength of light that targets red structures, i.e. dilated capillaries and other blood vessel structures such as angiomas.

For more information, see our IPL treatment for rosacea page.

Low level light therapy

Low level light therapy using an LED light source has been shown to reduce inflammation and provide energy to skin cells to boost healing. There have been published case studies of patients experiencing significant improvement in rosacea symptoms following a series of LLT treatments.

LLLT is safe with virtually no reported side effects. It could potentially be an alternative for people who can’t take medications or tolerate IPL/laser treatments, including pregnant patients.

 

DIY options for rosacea skin care

Maintaining your skin health is the first and most crucial step in managing rosacea. Many rosacea patients can reduce their symptoms without medical treatments by following a healthy skin care routine.

If you can’t keep symptoms under control using these measures, you should have your rosacea medically reviewed by a doctor to decide on further treatment options.

Skin care products should always be formulated for sensitive skin. They should not contain:

  • alcohol
  • fragrance
  • colours
  • essential oils

In general, avoid soaps and any heavy cosmetics or sunscreens which must be scrubbed or wiped firmly to remove.

Cleansers and moisturisers suitable for rosacea

Daily skin care should always include broad spectrum sunscreen, moisturising and cleansing the facial skin.

Recommended cleansers and moisturisers are summarised in the following table, adapted from Armour K. Cosmeceuticals in the treatment of rosacea. Opin Prog Cosmet Dermatol 2021; 1(2):50-52
Moisturisers Cleansers
Cerave

Facial Moisturising Lotion

Hydrating Cleanser
Cetaphil

Daily Advance Ultra Hydrating Lotion

Moisturising Cream

Moisturising Lotion

Gentle Skin Cleanser
Propaira Micellar Cleansing Cream
Bernier

SolarCareB3 Moisturiser

SolarCareB3 Intensive B3 Moisturiser

La Roche Posay

Toleraine Sensitive Facial Moisturiser

Toleraine Sensitive Riche Facial Moisturiser

Toleraine Ultra Light Sensitive Moisturiser

Toleraine Ultra Overnight Sensitive Moisturiser

Toleraine Caring Wash Cleanser

Toleraine Dermo Cleanser

QV Face Ultra Calming Moisturiser Gentle Cleanser

Cosmeceutical products with ingredients that relieve rosacea symptoms

“Cosmeceutical” skin care products contain ingredients known to enhance skin health and repair. In rosacea, the main actions of cosmeceutical ingredients are:

  • protect or repair the epidermal barrier: niacinamide/nicotinamide, chitosan, colloidal oatmeal, panthenol, allantoin
  •  reduce inflammation; aloe vera, feverfew, bisabolol (chamomile extract), gingko biloba
  • act as an anti-oxidant: vitamin C, green tea
Examples of recommended cosmeceutical products, adapted from Armour K. Cosmeceuticals in the treatment of rosacea. Opin Prog Cosmet Dermatol 2021; 1(2):50-52
Product Ingredients and actions
The Ordinary Niacinamide 10% + Zinc 1% serum Niacinamide: anti-inflammatory, anti-oxidant, skin barrier repair
Zinc: soothing
Propaira Rozaway cream Niacinamide: anti-inflammatory, anti-oxidant, skin barrier repair
Zinc: soothing
Bisabolol: anti-inflammatory
Allantion: soothing

Facial rosacea is treatable

Rosacea is a long-lasting condition that requires different types of treatment at various stages. Medical treatments include prescription creams and antibiotics for settling inflammation, while laser and IPL can reduce redness and visible blood vessels.

Rosacea requires a commitment to skin health.

Daily sunscreen, cleansing and moisturising are necessary and certain cosmeceutical product scan help relieve mild symptoms.

Rosacea treatments at Spot Check Clinic

Our doctor is a primary care physician with a special interest and qualifications in skin cancer and certain skin conditions. You do not need a referral from a GP for a rosacea assessment or treatment appointment at Spot Check Clinic.

Treatments available at Spot Check Clinic include:

  • Prescriptions for topical and oral treatments
  • BBL intense pulsed light
  • Low level light therapy using Healite II

More information...