What are the common treatments for rosacea?

There is no permanent cure for rosacea. There is nothing you can do to prevent rosacea from starting. However, treatments can ease the symptoms. The treatments used may vary, depending on what symptoms develop. Treatment may need to be adjusted over time depending on your response to treatments, and if you develop different symptoms.

General measures

Avoid strong sunlight to the face. Sunlight is thought to make symptoms worse. Use a sunblock cream on the face, with a high protection factor (30 or higher and with ultraviolet A (UVA) and ultraviolet B (UVB) protection). It is difficult to say what is strong sunlight. Therefore, many doctors would advise that you apply sunblock every day before you go out, whatever the level of sunshine. A wide-brimmed hat will also help to protect your face from the sun.

If you have dry skin, you can try a hypoallergenic, non-perfumed and non-greasy moisturising cream. Also, you should generally avoid using any steroid creams (unless advised by your doctor) or other abrasive creams on your face. Men may also find that using an electric razor rather than shaving with a blade helps their symptoms.

Treatment for facial flushing

There is no medicine that can prevent or stop flushing. However, some people find that certain things aggravate the skin and trigger flushing or make the flushing worse. The most common things reported that may trigger the skin to flush are: extremes of temperature (in particular, excessive heat), alcoholic drinks, strenuous exercise, stressful situations, sunlight, spicy food, hot drinks. If any of these seem to trigger bouts of flushing, or make the flushing worse, then avoiding them is sensible.

Some medicines used for other conditions may also trigger flushing - for example, calcium-channel blockers. If you suspect that a medicine is making the flushing worse, then discuss this with your doctor. An alternative medicine may be available.

Treatment for facial redness (erythema) and telangiectasia (tiny blood vessels)

There is little evidence that medication has any effect on clearing erythema or telangiectasia. However, a treatment for spots (listed below) may be advised to prevent spots from developing if you have persistent erythema.

Also, people with erythema often have sensitive skin which can make erythema worse. Therefore, it is best to avoid using anything that may sensitise the skin. For example, cleansers containing acetone or alcohol, abrasive or exfoliant preparations, oil-based or waterproof make-up, perfumed sunblocks, or those containing insect repellents.

Camouflage creams can help to cover and conceal erythema and telangiectasia. (The British Red Cross provides cosmetic camouflage clinics free of charge - see address below.)

Another option which is becoming more popular is light or laser therapy. Briefly, a laser or very bright light of a certain wavelength can destroy tiny blood vessels under the skin but without damaging the nearby tissue. This can remove telangiectasia and improve erythema. Your doctor or skin specialist will advise if this is an option for you.

Treatment for spots and cysts (papules and pustules)

Certain antibiotics are the usual treatment. They usually work well, but it is not clear why they work, as there is no proven bacterium (germ) that causes rosacea. Some antibiotics reduce inflammation in the skin as well as killing bacteria and this may be why they work for rosacea. A topical (rub-on) antibiotic called metronidazole is the common treatment if you have just a few small spots. If you have many spots or cysts then antibiotic tablets such as a tetracycline or erythromycin may be used.

Some improvement may occur after 2-3 weeks of treatment. However, it commonly takes a 6- to 12-week course of antibiotics to clear spots and cysts. One reason why antibiotic treatment fails is that some people give up on treatment after a few weeks without completing the full course.

When a course of antibiotic treatment is finished, the spots or cysts commonly return at some point. Therefore, repeated courses of treatment may be needed from time to time. As an alternative, once the spots have cleared, some people take a regular maintenance dose of antibiotics or use a topical antibiotic (regularly or intermittently) long-term to prevent the spots and cysts from returning.

Topical azelaic acid is an alternative to topical antibiotics to treat mild-to-moderate spots. However, some people find that it can cause side-effects such as burning, stinging, itching, scaling, and dry skin.

If you do not respond to any of these treatments, other therapies are sometimes tried in specialist clinics.