How to treat rosacea

Start with a diagnosis, not an acne treatment

Arrange a GP appointment if you suspect rosacea. Signs include flushing, persistent facial redness, burning or stinging with water or skincare, visible blood vessels and small bumps that sometimes contain yellowish fluid. Redness can be harder to see on brown or black skin. Acne, dermatitis and lupus can look similar, so appearance alone is not enough to choose a treatment.3

Rosacea is not acne and does not improve with ordinary acne products bought without a prescription. A clinician can often diagnose rosacea through an examination and questions about your medical history. Tell them about burning, flushing and eye irritation as well as any bumps: the treatment needs to address more than the most visible symptom.4

Build a routine that does not aggravate your skin

Skincare supports medical treatment rather than replacing it.2

1. 1Cleanse gently with a mild cleanser rather than traditional soap, which can irritate rosacea.
2. 2Apply prescribed medication following its directions. For azelaic acid foam or gel, apply after cleansing; makeup can follow once the medication dries.
3. 3Moisturize frequently as part of your ongoing routine.
4. 4Use sunscreen with SPF 30 or higher every day. Zinc oxide or titanium oxide sunscreens can be better tolerated than chemical sunscreens.

Avoid exfoliants and alcohol based skincare. Do not use steroid creams to treat facial rosacea: they can aggravate the condition. If you already use a prescribed steroid, discuss its use with your prescriber rather than treating it as another skincare product.1

Find your triggers rather than banning everything

Keep a symptom diary to identify what precedes a flare, then avoid the triggers you identify. Common examples include sunlight, temperature changes, hot baths, exercise, alcohol, spicy food and cosmetic products. Some medicines that widen blood vessels can also trigger symptoms. Treatments often target just one feature of rosacea, so several symptoms can require a combination of therapies.1

Triggers vary from person to person. Limit hot beverages, alcohol or spicy food if they aggravate your symptoms, and avoid strenuous activity in hot weather. Stress reduction can also help; deep breathing, yoga or other relaxation techniques are options. Wind, cold weather and particular skincare products are worth watching too. Avoiding your own triggers can help prevent or reduce flares without treating every possible trigger as equally relevant.4

Cover your face in cold weather and try to avoid excessive heat, sunlight and humid conditions. Rosacea is not caused by poor hygiene and is not contagious. Scrubbing harder is not the answer.3

Which medicines treat redness and bumps?

Brimonidine and oxymetazoline can cause rebound flushing when discontinued after persistent use. Discuss how often to use them with your dermatologist. Green tinted cosmetics can disguise redness, but camouflage is a different job from treatment, despite the cosmetics aisle's enthusiasm for multitasking.1

How long does treatment take?

Topical treatment for bumps can show slight improvement after 3 or 4 weeks, but a noticeable difference usually takes 2 to 3 months. Redness medicines work differently: brimonidine and oxymetazoline usually give their best results 3 to 6 hours after application, then the color gradually returns.2

A GP can prescribe creams or gels and sometimes oral antibiotics for 6 to 16 weeks. If treatment is not working, referral to a dermatologist is an option.3

For severe rosacea that has not improved with other medicines, a specialist can consider isotretinoin, a strong medicine. Surgery can remove swollen nose tissue in severe cases. These are options for specific problems, not the starting point for every person with rosacea. Treatment controls the condition rather than curing it, and lasting changes in appearance can occur.4

What helps visible blood vessels?

Laser or light treatments can reduce visible vessels and persistent color. Intense pulsed light can also reduce flushing. Choose an experienced dermatologist: poorly performed procedures can cause burns, scars or permanent color changes.2

Eye symptoms need their own treatment

Seek urgent medical assessment if you have rosacea and eye pain, blurred vision, light sensitivity, a red eye or a gritty feeling. These can signal keratitis, inflammation of the cornea that can threaten sight.35

Ocular rosacea affects the eyelids and front of the eye. It can cause dryness, burning, soreness, watering and debris around the eyelashes, and can appear before facial symptoms. Eye symptoms are not specific to rosacea, so they need assessment rather than an assumption that facial treatment will cover them.5

For diagnosed ocular rosacea, care can include warm compresses on closed eyelids for 5 to 10 minutes daily, cleaning the eyelid margins and artificial tears for dryness. Follow your clinician's cleaning instructions. Avoid contact lenses if they irritate an inflamed eye. Prescription treatment can include eye antibiotics, anti inflammatory drops or oral antibiotics. Oral antibiotic courses commonly last 6 to 12 weeks, followed by a gradual reduction directed by the clinician.5

Do not put skin antibiotics in your eyes; use only the eye treatment prescribed for you. Steroid eye treatments require medical supervision because prolonged use can cause glaucoma and cataracts.25

Treatment can reduce discomfort and improve quality of life, not just change how rosacea looks.6