Rosacea
Flushing, redness, little visible blood vessels and sometimes pimple-like bumps. Common after 30, not contagious, not from poor hygiene, and very manageable.
The rosacea ladder
Start with sun protection and gentle skin care. Creams take 8 to 12 weeks, so judge them by the calendar, not the mirror on day 3.
- Step 1 · Self-careSunscreen, gentle skin care and trigger-spottingSPF 50+ every day, soap-free cleanser, lukewarm water. A diary to find your triggers.
- Works
- Not tested in trials, but reduces flares for many; the foundation for every other step
- Cost
- About $10–25 for sunscreen and cleanser
- How long
- Every day, for good
- Watch for
- Scrubs, toners and alcohol-based products: they sting
Your 12-step skincare routine is 10 steps too many for rosacea.
- Step 2 · PharmacyAzelaic acid gelCalms bumps and some redness. Available from the pharmacy.
- Works
- Bumps fall about 50–60% vs 40% on plain gel in trials; for mild to moderate bumps
- Cost
- About $25–35 a tube
- How long
- 8–12 weeks to judge
- Watch for
- Stinging and itching for the first few weeks; usually settles
The sting is temporary. The temptation to quit in week 1 is the real enemy.
- Step 3 · PrescriptionIvermectin or metronidazole creamOnce- or twice-daily creams for bumps and pimples. Ivermectin is often the most effective.
- Works
- Ivermectin clears or nearly clears bumps in about 4 in 10 by 12 weeks (vs 1–2 in 10 on plain cream)
- Cost
- Private script: about $60–65 (ivermectin) or $30–50 (metronidazole) a tube
- How long
- 8–12 weeks to judge; often used long term
- Watch for
- Mild burning, dryness. A brief flare when starting ivermectin
Not a quick fix, but the steadiest rung on the ladder.
- Step 4 · PrescriptionLow-dose doxycycline tabletsFor more widespread bumps, often with a cream.
- Works
- Bumps roughly halve by 16 weeks (vs about a quarter on a dummy treatment)
- Cost
- Under the $25 PBS co-payment, about $20–25 a month
- How long
- A few months, then step back to a cream
- Watch for
- Sun sensitivity, heartburn (take upright with water). Not in pregnancy or under 8
Treats bumps, not redness. Redness needs a different rung.
- Step 5 · PrescriptionBrimonidine gel for rednessShrinks blood vessels to reduce redness for about 12 hours.
- Works
- Big drop in redness on the day in 1 in 4 to 1 in 3 users (vs 1 in 10 on plain gel)
- Cost
- Private script, about $60–90 a tube
- How long
- On the day; best kept for occasions
- Watch for
- Rebound redness when it wears off, sometimes worse than before
A party trick, not a daily driver.
- Step 6 · ProcedureVascular laser or IPLThe best option for persistent redness and visible blood vessels.
- Works
- Clear benefit in small trials; often reduces redness and visible vessels after a few sessions
- Cost
- About $200–500 a session; usually no Medicare rebate
- How long
- Usually 3–4 sessions; touch-ups as redness returns
- Watch for
- Bruising, swelling, short-term redness. Rarely blistering or skin colour change
The one thing that actually tackles stubborn redness, at a price.
- Step 7 · SpecialistDermatologist treatmentsLow-dose isotretinoin for stubborn bumps, or laser or surgery for a thickened nose.
- Works
- Low-dose isotretinoin: about 6 in 10 get bumps 90% cleared (vs 1 in 10 on a dummy treatment)
- Cost
- Private script, about $30–80 a month, plus specialist fees
- How long
- Months, with regular check-ups
- Watch for
- Dry lips and skin. Isotretinoin causes severe birth defects: no pregnancy during and for 1 month after
Big guns, used carefully.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Steroid creams on the faceThey make rosacea much worse, especially when stopped. Can cause harm.
- Scrubs, peels and exfoliating acidsRosacea skin is already irritated, and scrubbing makes it angrier. No evidence they help.
- Tea tree oilSmall, low-quality studies, and it often irritates sensitive skin. Essential oils are not essential.
- Apple cider vinegar tonersNo evidence, and acid on inflamed skin stings for a reason. Keep it in the salad.
What you can do
- Common triggers: sun, heat, hot drinks, alcohol, spicy food, exercise and stress. You don’t need to avoid them all, just yours.
- Mineral (zinc or titanium) sunscreens are often better tolerated.
- Green-tinted make-up hides redness.
- Keep cool: sip cold water and use a fan when exercising.
See your GP if
- Redness or bumps aren’t controlled by sun protection and gentle skin care
- Your eyes are often red, gritty or sore (warm compresses and lid cleaning help; drops if needed)
- The skin on your nose is thickening
- It’s affecting your confidence or mood
See a doctor the same day for a painful red eye, sensitivity to light or blurred vision, as rosacea can damage the eye.
Common questions
What triggers rosacea flares?
Common triggers are sun, heat, hot drinks, alcohol, spicy food, exercise and stress. A diary helps find yours.
What is the best cream for rosacea?
For bumps and pimples, prescription ivermectin cream is often the most effective. Azelaic acid (from the pharmacy) or metronidazole also help. Allow 8 to 12 weeks.
What helps rosacea redness?
Vascular laser or intense pulsed light (IPL) is the best option for persistent redness and visible blood vessels. Brimonidine gel reduces redness for about 12 hours, but redness can rebound.
Can rosacea affect the eyes?
Yes, about half of people get dry, gritty or sore eyes. See a doctor the same day for a painful red eye, sensitivity to light or blurred vision.
What causes rosacea?
The exact cause isn’t known. It involves overactive blood vessels and immune responses in the skin, a tendency that runs in families, and possibly tiny skin mites (Demodex). Triggers like heat, sun and alcohol make flares more likely but don’t cause it.
Can rosacea be cured?
Not yet, but it can be well controlled. Creams, tablets and laser or light treatment reduce redness and spots for most people, and knowing your triggers helps prevent flares.
Is rosacea the same as acne?
No. Rosacea can cause pimple-like spots, but there are no blackheads or whiteheads, and it usually starts after 30 with flushing and redness on the cheeks and nose. Some acne treatments can irritate rosacea, so it’s worth getting the right diagnosis.
Helpful resources
- Rosacea Diary (National Rosacea Society)Booklet to track flares and pin down your personal triggers. Free, from a US non-profit.
- SunSmart Global UV appShows when UV is high so you know when to cover up, as sun is the top rosacea trigger. Free, works worldwide.
Evidence and more information
- Healthdirect: Rosacea
- Healthdirect: Medicines information
- Thiboutot et al: Azelaic acid 15% gel for rosacea, RCTs (2003)
- Stein Gold et al: Ivermectin 1% cream for rosacea, RCTs (2014)
- Del Rosso et al: Low-dose doxycycline for rosacea, RCTs (2007)
- NICE evidence summary: Brimonidine gel for rosacea redness
- Sbidian et al: Low-dose isotretinoin for rosacea, RCT (2016)
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