Rosacea
A long-term skin condition causing facial flushing, persistent redness, visible small blood vessels and sometimes pimple-like bumps. Most common after 30 and in fair skin. About half of people also get dry, gritty or sore eyes. Not contagious and not caused by poor hygiene.
Treatment options
Ratings show how strong the research is.
- Strong evidenceIvermectin creamA prescription cream once a day for bumps and pimples. Often the most effective cream. Allow 8 to 12 weeks.
- Strong evidenceMetronidazole or azelaic acidPrescription gels or creams for mild to moderate bumps and redness. Azelaic acid can sting at first.
- Strong evidenceAntibiotic tabletsSuch as doxycycline, usually at a low dose for a few months, for more widespread bumps. Often combined with a cream.
- Moderate evidenceLaser or intense pulsed light (IPL)The best option for persistent redness and visible blood vessels. Usually several sessions. Redness can return over time.
- Moderate evidenceBrimonidine gelShrinks blood vessels to reduce redness for about 12 hours. Best kept for occasions, as redness can rebound when it wears off.
- Moderate evidenceSpecialist treatmentA dermatologist may use low-dose isotretinoin for stubborn bumps, or treat a thickened nose with laser or surgery.
- Limited evidenceEye careWarm compresses and gentle eyelid cleaning for sore eyes. Prescription drops or tablets if needed.
- Limited evidenceTablets for flushingSome blood pressure medicines (such as carvedilol or clonidine) may reduce severe flushing.
- Not recommendedSteroid creams on the faceThey can make rosacea much worse, especially when stopped.
What you can do
- Keep a diary to find your triggers: common ones are sun, heat, hot drinks, alcohol, spicy food, exercise and stress.
- Use SPF 50+ sunscreen every day. Mineral (zinc or titanium) types are often better tolerated.
- Wash with a gentle soap-free cleanser and lukewarm water. Avoid scrubs, toners and alcohol-based products.
- Green-tinted make-up can hide 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
- 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.
Evidence and more information
maladywise.com/rosacea/