Rosacea – Treatment 

Treating rosacea 

Pharmacy services: New Medicine Service (NMS)

If you are prescribed a medicine to treat a long-term condition for the first time, you may be able to get extra help and advice about your medicine from your local pharmacist through a new free scheme called the New Medicine Service (NMS).

Media last reviewed: 16/09/2013

Next review due: 16/09/2015

Treatment for blushing

Blushing (flushing) with rosacea usually disappears after a minute or two.

However, some people find severe and frequent blushing can affect both their personal and professional life.

Several treatments are available for severe blushing, such as psychological treatments or a type of surgery known as endoscopic thoracic sympathectomy (ETS). 

Read more information about how blushing is treated.

Compare your options

Take a look at a simple guide to the pros and cons of different treatments for rosacea

Rosacea can be treated in a number of ways.

Lifestyle changes

The initial treatment for rosacea is to avoid known triggers, or factors that make  symptoms worse. These factors can be unique to every individual but the most important step is to avoid exposure to the sun.

Read more information about preventing rosacea.

Medication

A range of topical (skin-based) and oral (taken by swallowing) treatments have been used for rosacea.

They are effective mainly for treating inflammatory types of rosacea (papules and pustules). There is little evidence to support their use for the vascular form of rosacea (flushing, redness and thread veins). This is best treated with laser and light-based therapies (see below).

For mild rosacea, topical treatment agents include metronidazole, azelaic acid and sodium sulfacetamide-sulfur. Second line therapies include benzoyl peroxide, clindamycin, topical retinoids and calcineurin inhibitors.

For patients with moderate-to-severe rosacea or those with affected eyes (ocular rosacea), combination therapy with oral and topical agents is often needed. Options include tetracyclines and erythromycin. In severe cases, low dose isotretinoin may be effective.

Metronidazole

Metronidazole cream or gel (topical metronidazole) is usually recommended for the treatment of mild to moderate spots and pimples.

When applying metronidazole cream or gel, be careful not to get any in your eyes or mouth. You will need to apply topical metronidazole once or twice a day for several months.

Metronidazole does not usually cause side effects, although it may irritate your skin. This is usually more common with gels that contain alcohol. Avoid exposure to strong sunlight or UV light (used in some lamps and nightclubs).

Azelaic acid

An alternative to topical metronidazole is azelaic acid. Azelaic acid helps unblock pores and reduce inflammation (redness and swelling).

You will need to apply azelaic acid cream or gel twice a day, and avoid contact with your mouth and eyes. As with topical metronidazole, you may need to use azelaic acid for several months before you notice any significant improvement in your symptoms.

The side effects of azelaic acid can include:

  • burning and stinging of the skin
  • itchiness
  • dry skin

About a third of people who use azelaic acid will experience side effects. However, any side effects are usually short-lived.

Antibiotic medicines

For more serious symptoms of spots and pimples, oral antibiotics may be recommended. In this case, antibiotics are used for their ability to reduce inflammation of the skin rather than their ability to kill bacteria.

As with other treatments, you will need to take oral antibiotics for several weeks before you notice a significant improvement in your symptoms. You may need to continue the course once or twice a day for several months or longer.

Long-term use of antibiotics should be avoided. One potential strategy is to gradually lower the dose of oral antibiotics after six to 12 weeks, eventually switching to topical agents only. A new technique is to use daily doxycycline given at a low dose, which may reduce inflammatory lesions when given alone or in combination with metronidazole therapy.

The two antibiotics that are most commonly used to treat rosacea are:

Tetracyclines

These include tetracycline, oxytetracycline, doxycycline, lymecycline and minocycline.

Tetracyclines are not suitable for:

  • women who are pregnant or breastfeeding, as they can cause birth defects in unborn children and interfere with normal bone development in breastfed children
  • people with a history of kidney disease

Tetracyclines should be used cautiously in people with:

Tetracyclines may cause oral contraceptives (the contraceptive pill) to fail during the first few weeks of treatment. Sexually active women of childbearing age should use a barrier method of contraception while taking tetracyclines, such as a condom, to avoid becoming pregnant.

Tetracyclines can also make your skin more sensitive to sunlight.

Tetracyclines can interact with a number of medications, including:

  • warfarin, an anticoagulant (blood-thinning medicine) used to stop your blood clotting
  • antacids, taken to treat indigestion and heartburn

Erythromycin

Erythromycin can be used in women who are pregnant or breastfeeding. It should be used cautiously if you have:

  • a history of liver or kidney problems
  • myasthenia gravis, a condition that causes some of your muscles to become weak 

Erythromycin can interact with a number of medications, including:

  • warfarin, an anticoagulant (blood-thinning medicine) used to stop your blood clotting
  • statins, taken to lower your cholesterol levels

Isotretinoin

Isotretinoin is a medicine often used to treat severe acne. However, at low doses it is also occasionally used to treat rosacea. As isotretinoin is a strong medication, it can only be prescribed by a dermatologist (an expert in treating skin conditions) and not your GP.

Isotretinoin can cause side effects, including:

  • birth defects in unborn babies
  • dry skin, lips and eyes
  • headaches
  • back pain
  • muscle or joint pain
  • bleeding and bruising more easily
  • blood in your urine

See the patient information leaflet that comes with your medicine for a full list of side effects.

Laser and intense pulsed light (IPL) treatment

The symptoms of redness and visible blood vessels (thread veins, telangiectasias) can be successfully improved with vascular laser or intense pulsed light (IPL) treatment. These treatments may also improve flushing. A referral to a dermatologist is usually required and is unlikely to be available on the NHS, so you may need to pay for it. Two to six treatments may be needed, so cost may be significant.

Laser and IPL machines produce narrow beams of light that are aimed at the visible blood vessels in the skin. The heat from the lasers damages the dilated (widened) red veins and causes them to shrink so they are no longer visible, with minimal damage to surrounding tissue or scarring. There is evidence that the light also helps with remodelling of the skin matrix so it provides vessels with better support.

Laser treatment can cause pain, but most people do not need an anaesthetic.

Side effects of laser treatment are usually mild and can include:

  • bruising
  • crusting of the skin
  • swelling and redness of the skin
  • blisters (in rare cases) 
  • infection (in very rare cases)

These side effects usually only last a few days and are rarely permanent. An infection will require treatment with antibiotics.

Make-up

It may be possible to disguise patches of persistent red skin using specially designed 'camouflage' make-up. The charity Changing Faces offers a skin camouflage service, available nationally and free of charge, to help with the use of these creams.

Your GP or dermatologist can refer you to the skin camouflage service and prescribe skin camouflage make-up.

Surgery

Thickened skin (rhinophyma) is a symptom of rosacea that often affects the nose. If you have severe rhinophyma, your GP may refer you to a dermatologist or plastic surgeon.

Plastic surgery is not the same as cosmetic surgery. Cosmetic surgery is surgery carried out by choice (elective) and undertaken for the sole purpose of improving a person’s physical appearance. It is not usually available on the NHS. Plastic surgery is for repairing and reconstructing damaged skin and tissue.

A number of surgical treatments are available to remove any excess tissue and remodel the nose into a more pleasing shape. This may be done with:

  • a carbon dioxide laser (a beam of carbon dioxide)
  • a scalpel
  • dermabrasion

Ocular rosacea

If the rosacea symptoms affect your eyes (ocular rosacea), you may require further treatment such as:

  • ocular lubricants eye drops or eye ointment which can be used to treat dry eyes
  • eye hygiene measures if you have blepharitis (inflammation of the eyelids), you may need to clean your eyelids with a warm compress (a cloth warmed with hot water) or cotton bud 
  • long-term oral antibiotics may be used in severe cases

People who have ocular rosacea with complications will need referral to an opthalmologist (eye specialist).

Read about treating dry eye syndrome and treating blepharitis.


Over-the-counter treatments

  • Over-the-counter (OTC) medicines are not effective for treating rosacea and sometimes they may make it worse
  • Topical corticosteroids (cream, gel or ointment that contains steroids, such as hydrocortisone) should not be used because they can make the symptoms worse in the long term
  • Your pharmacist can give you advice about using moisturisers, sunscreens and soaps

Page last reviewed: 03/07/2012

Next review due: 03/07/2014

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Comments

The 17 comments posted are personal views. Any information they give has not been checked and may not be accurate.

User863669 said on 10 April 2014

I am only bothered with flushing and ocular problems (dry eyes = problems with contact lenses), however I am struck that no one is trying to solve this problem with something more systemic other than the antibiotics. We all know its bad to be on antibiotics for an extended period of time, so that doesnt' seem to be the long term answer either. We must be missing something in our system, or have something that's not supposed to be there? Surely some doctor has to be working on that...please?

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John of Yorkshire said on 07 November 2013

Further to galiforce's comment, if you suspect you might have the type of rosacea caused by the tiny mites or anaerobic fungi (e.g. in my case when I first began treating it with tea tree oil mixed with moisturiser after using GP's Metrogel the symptoms appeared to move/coagulate a few millimetres across the nasal skin to a lump that's now disappeared) then obviously it is important to open the skin's pores before applying the treatment (as long as doing so is not too painful: best done when the skin has calmed down as maintenance).
To do this I clean the affected area with anti-bacterial liquid soap then bathe it in warm water with a flannel. Sometimes the pores need clearing of any pus by gently squeezing/cleaning, before apply either Metrogel, clotrimazole (antifungal) or the moisturiser+tea tree oil cream in rotation. This prevents the mites/fungi from developing immunity. Though I experience some stinging occasionally it soon goes away.

**If you're under a doctor's treatment you should consult them first, but if you an stand it regularly cleaning your nose/area affected with antibacterial soap+warm water first should enhance any topical treatment offered.

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JLHughes said on 30 August 2013

I'm determined to let people know about proskin rosacea as an effective treatment for rosacea. It has made a massive difference to my skin and my life - and I felt desperate for something to help even a bit, after trying GP-prescribed creams and gel and antibiotics - which didn't work and made me feel rubbish. You need to use this cream x2 daily for at least 2 weeks before you start to see a difference.

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Elly_S123 said on 20 April 2013

Hi there, I just wanted to add my experience just in case its helpful to other people. I was diagnosed with Rosacea at the end of 2011 and was prescribed Metronidazole gel by my GP which I had a really bad reaction to with severe burning to my skin and increased redness which took months to clear. I saw a dermatologist who reccomended Doxycycline but having read about the side effects, I did not feel happy taking this, especially not long term as was suggested.
I researched lots of different products on the internet and tried out various things and feel I have finally got a skin care regime that minimises the effects of my symptoms of rosacea. I think though that everyone is unique and its a matter of experimenting with different products till you find what works best for you.
As is always mentioned, trying to reduce the stress in your life is a big factor. In addition, the main products I have found helpful have been lavender oil and tea tree oil.
In the morning I soak a cotton wool pad in spring water (as tap water aggravates my skin) and add 3- 4 drops of lavender oil which I use to cleanse and then use spring water to wash my face with. I also take Oil of Evening Primrose daily as this helps the skin. I use no 7 colour calming primer and then CeraVe AM SPF30 as my main moisturiser.
In the evening I soak a cotton wool pad in spring water and 3- 4 drops of tea tree oil. I rinse this off with spring water and 2- 3 x week use Zenmed anti redness mask before applying Zenmed Support Serum before going to bed.
Like I say everyone is different but from experimenting for months, I have found this routine helpful and now rarely have flushes and my skin is nothing like as bad as it was.
Please feel free to contact me if you think I can be helpful as I had an awful time for about a year with Rosacea and thought it would never get better. It did really affect my self confidence and although I have occasional flareups, its nothing like it was.
Elly

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bldaz said on 11 November 2012

I have had this skin disorder since childhood. ( 40+ years) I believe along with excema or somehting like that, and acne. No products work for long. Dandruff shampoos will sometimes releive some of the crustyness, ones with a selsen component. Most if not all poducts with alcohol irritate and make worse. Hyorcortisone does help with redness at least temporarily but can make pimpils. The change of seasons or hot to cold make it come out more. Seeing yet another doctor tomorrow. Metrogel in cream seemed to work for a few days was very excited but now rebound the other direction to extreme redness and pain, not to mention looking like a science project gone wrong.

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maddogmckee said on 11 November 2012

Hi I have just signed up, can anyone give me any advice on what to use, docs were hopeless, Tony.....

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ArturJ said on 03 September 2012

After trying many expensive creams I have finally found the solution for my rosacea on this page. The cream first suggested by gailforce has really worked for me. No idea why and how but it has and that’s all I care about.

Yes it did take 2-3 months and yes I’ve never been a fan of tea tree oil smell but my skin looks and feels a lot better. On top of that it’s not as ridiculously expensive as other creams - at the moment it’s about £30 for 100ml. I hope it can help you as well.

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AnnalisaCM said on 22 May 2012

I bumped into this thread months ago, when I was really beginning to lose hope of ever ridding of rosacea. Like many here, I’d suffered for years, since 2008, aged 31. At first it was light but it got worse and worse.

I’d had it for almost a year when I went to Italy to see my dad. I was lucky - he’s a GP there and knew straight away what it was. He prescribed me tetracycline which started to work within a week. Relieved to know what I had and to have something that worked, I took this to my first practice back in the UK, where I was prescribed the same thing. It helped and I was on it for 4 years but it didn’t cure me as I’d still have occasional outbreaks.

I moved again, changed practice and a doctor suggested I tried something else, on the advice by my dentist, as tetracycline can stain teeth and in any case, it should not be taken for years. I was given a topical cream but it was too weak and had the opposite effect. I experienced my worst outbreak, lasting months. The acne on my face was fierce and extensive; some pustules would even bleed if I bent down. There was nothing I could do to hide it so going out or to work was tough. It was then that I had enough and I insisted on isotretinoin, which I had researched.

Sadly, I agree my problem was handled badly. You can’t help but feel that less hassle and cheaper options come first. I suffered severely for more than 4 years; options such as Isotretinoin were never mentioned. I read other poor souls have suffered a lot longer.

I was eventually seen by a dermatologist in my second practice (a year on, I hadn’t been told the practice had one). It wasn’t too difficult, looking the way I looked - as soon as she saw me, she referred me to the hospital. But did it have to come to this?

For me, it's early days but it's working wonders already and finally I can start to hope for a better quality of life. Would I be receiving better treatment if I hadn’t persisted in better care? I genuinely don’t know...

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Sueshep said on 22 April 2012

I would like to thank gailforce who wrote on the 4th of Feb, for the recommendation to use proskin rosacea. I had been suffering from what I can only describe as a very sore face for the last 6 months to a year.. somebody mentioned that it may be rosacea although menopause was also an issue, so I did a little research on the web and in the process read this article. I didn't want to get involve with analysing the problem I just needed relieve as every moisturiser including pure coconut oil made it feel worse... almost like my face was on fire! Having used this cream within 2 days my face felt soft again... and the redness was much calmer. 3 weeks later I'm loving my face and feeling so much better about myself! I recommend you give it a try if you have a chance... and the best thing is that its not overpriced! Thank you ! :)

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lovestodance said on 13 March 2012

can anyone suggest how i may get relief from my burning and very painful rosacea on my cheeks and bridge of my nose, and on my chin?

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boatenigma said on 04 February 2012

Had acne rosacea for forty years but was miss diagnosed as facial eczema, properly diagnosed six years ago tried metro gel but caused acute scaling of skin at side of nose then tried finacea cream (azealic acid) with radical success...totally works on my face, been on it for five years now with no reduction in effect.
Have to apply very thin layer using a very small amount or it can cause spots at periphery of application area. Can sting for first few months but totally goes away eventually. Very important to wash hands afterwards, even a tiny trace will make eyes sting from contact with fingers.

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gailforce said on 04 February 2012

I too have had rosacea for years and Azeuic Acid gel and Clyndamycin gel but nothing worked. Eventually got sick and tired of the whole doctor and dermatologist thing and bought an alternative remedy for it. Now this may not work for everyone but my guess is it is worth a try. It has worked for my rosacea. Rosacea can be a result of tiny demodex mites that populate our skin. We (rosacea) sufferers have more of these than normal people and their is a train of thought that these mites cause an allergic reaction on our skin. I then read forums where people who tried tea tree oil were getting success but they also said it was drying to their skin. So I added tea tree oil to a basic moisturiser I had but it didn't work. I was scared to put in too much in case it affected the base cream. I then discovered a cream on the internet called proskin rosacea. It contains natural ingredients such as calendula and coconut oil but most importantly for me is it contains tea tree oil. I gave this a try and well it has worked. It didn't work overnight and it took about a month in total but my rosacea is away.

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hrh1977 said on 19 January 2012

I was diagnosed nearly 3yrs ago shortly after the birth of my daughter, but had been suffering in silence for about 5yrs. Due 2 breast feeding I was limited in treatment available. After weaning complete( 9months of trying creams, pills, none worked.) My doctor referred my 2 the dermatologist. I was put on isotretinoin 30 mg everyday. Within a couple of months my face had cleared up , redness was much better & I thought 'wow' .. unfortunately as soon as they lowered my dose my symptoms started 2 return. 18months since I started with dermatologist & I'm almost back 2 square 1. As I have quite a severe case of rosacea ,face, neck, ears & chest, I'm wondering what alternative therapies may help , if anyone has any experience or knowledge I would be grateful 2 hear from u, I am desperate 4 help & can't really afford 2 go private

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T Walker said on 03 November 2011

I agree with the comments written above. Just over a year ago a GP told me I had 'acne rosacea' and prescribed oxytetracycline and benzoyl peroxide. The oxytetracycline, to be fair, worked very well in terms of the pimples, but the benzoyl peroxide was way too harsh for my skin so I stopped using it - it made my face redder, so putting it on was completely counter intuitive. After 2-3 months the oxytetracycline stopped being as effective, so I went back to the doctors and saw a different GP, he didn't mention rosacea but prescribed erythromycin and retin-A gel. He told me to get a good water-based moisturiser as it might dry my skin, but didn't mention the sensitivity to sunlight that would go with it. Of course, as soon as we got a sunny spell my face got burnt. I looked at the retin-A guidance and it actually said 'do not use if you have rosacea' - so I went back to my doctors and saw a different GP, he told me to stick with it even after I queried the retin-A guidance notes. He didn't mention rosacea. After a few more months I went back to the doctors, saw a 4th GP who did mention rosacea, he prescribed lymecycline and azeliac acid. I didn't even bother with the azeliac acid, my skin is already damaged so why put an acid or peroxide on it? Anyway, the lymecycline really didn't work, it dehydrated my skin and caused some humungous spots. I was at the end of my tether. Fortunately I moved house and went to a 5th GP at a different practice, I explained my past year of antibiotics and creams/gels, and she has referred me to a dermatologist in January. I'm not holding out much hope, and think I may end up going private for treatment anyway. I don't really want to drop the nuclear bomb (roaccutane), and would prefer something more natural in terms of treatment, but what I'd really like is a proper diagnosis of what I've got, and for a GP to take it seriously! All the GPs at my first practice were dismissive of it, and prescribed anti-biotics far too quickly!

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T Walker said on 03 November 2011

I agree with the comments written above. Just over a year ago a GP told me I had 'acne rosacea' and prescribed oxytetracycline and benzoyl peroxide. The oxytetracycline, to be fair, worked very well in terms of the pimples, but the benzoyl peroxide was way too harsh for my skin so I stopped using it - it made my face redder, so putting it on was completely counter intuitive. After 2-3 months the oxytetracycline stopped being as effective, so I went back to the doctors and saw a different GP, he didn't mention rosacea but prescribed erythromycin and retin-A gel. He told me to get a good water-based moisturiser as it might dry my skin, but didn't mention the sensitivity to sunlight that would go with it. Of course, as soon as we got a sunny spell my face got burnt. I looked at the retin-A guidance and it actually said 'do not use if you have rosacea' - so I went back to my doctors and saw a different GP, he told me to stick with it even after I queried the retin-A guidance notes. He didn't mention rosacea. After a few more months I went back to the doctors, saw a 4th GP who did mention rosacea, he prescribed lymecycline and azeliac acid. I didn't even bother with the azeliac acid, my skin is already damaged so why put an acid or peroxide on it? Anyway, the lymecycline really didn't work, it dehydrated my skin and caused some humungous spots. I was at the end of my tether. Fortunately I moved house and went to a 5th GP at a different practice, I explained my past year of antibiotics and creams/gels, and she has referred me to a dermatologist in January. I'm not holding out much hope, and think I may end up going private for treatment anyway. I don't really want to drop the nuclear bomb (roaccutane), and would prefer something more natural in terms of treatment, but what I'd really like is a proper diagnosis of what I've got, and for a GP to take it seriously! All the GPs at my first practice were dismissive of it, and prescribed anti-biotics far too quickly!

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OrganisedPauper said on 13 September 2011

Frankly NHS treatment for Rosacea is totally inadequate. It is shocking that there is virtually nothing available until you are so deformed that you are embarrassed to be seen in public. The creams and gels do not work. As a woman the thought that it's looking likely that I am going to end up with a large, lumpy, purple or red nose before anything can be done is just not good enough, never mind doing nothing at all for telangiectasia.

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Mary de v said on 11 May 2011

I have been suffering with Rosacea for about 4 years now and have been given by my GP
Roeex get, Clindamycin 1% topical gel, Azeuic Acid gel, isotrationan gel and Doxycycline 100mg. Yes all the above for the four years and nothing worked. I requested to go to a dermatologist and did so but was given some creams which also did not do anything. My skin became so bad that I felt that I could not go out in public and now needed to do something other than the what the NHS could offer me and took myself off to a private dermatologist and after a blood test I started a course of Isotretinoin ( Roaciatine - Roche) Within 5 days I had seen a result. My skin became carm and lost its readness and was nolonger tight and ichy. I have been on 20mg per day for the last two months and day by day my skin has improved. I have clear, carm, normal colour skin without breakouts and the scars which were starting to form have seemed to blended and not visible. I only wich I had taken myself off the the private dermatologist sooner and got this treatable condition sorted out sooner. I am due to keep taking the Isotretinoin for all in all 6 to 8 months and with hope I will be able to stop or go on a maintance course. My skin is not dry but my eyes are dry but nothing a few drops would not sort out. My hair does not seem to get greasy and I only need to wash it about every 10 days. My advise is visit a private dermatologist and get it sorted withing 5 days and don,t wast any more time with creams which don,t work. 4 years messing around with creams and pills from my GP compared to 5 days on the Isotretinoin and getting a result and keeping on getting better.

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Find and choose services for Rosacea