The symptoms of rosacea can be treated in a number of ways. These are described below.
Facial flushing
Making lifestyle changes, such as avoiding possible triggers or wearing sunscreen, can be a good way of controlling the symptoms of facial flushing (when your skin turns red).
See Rosacea – prevention for more information about lifestyle changes and avoiding triggers.
Creams and gels
A number of treatments are effective in treating the spots and pimples caused by rosacea. Your GP can recommend a cream or gel as the first treatment option.
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 any side effects, although it may irritate your skin. 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 to 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, the antibiotics are used for their ability to reduce inflammation of the skin rather than for their ability to kill bacteria.
As with the 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 take oral antibiotics once or twice a day for several months or longer.
The two antibiotics that are most commonly used to treat rosacea are:
- tetracyclines
- erythromycin
Tetracyclines
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 the effects of sunlight, so avoid exposure to direct sunlight.
Tetracyclines can interact with a number of medications, including:
- warfarin, an anticoagulant (blood-thinning medicine) that is used to stop your blood clotting
- antacids, which are taken to treat indigestion and heartburn
Tell you GP if you are taking any other medicines. They can advise you about whether your dosage needs to be changed.
Some tetracyclines should be taken on an empty stomach because food and milk may prevent the medicine from being properly absorbed by your body. Ask your GP if you are not sure how to take your medicine.
A rare, but potentially serious, side effect of tetracyclines is that they can cause an increase in the pressure of the fluid that surrounds your brain. This is known as benign intracranial hypertension. The symptoms of benign intracranial hypertension include:
- a severe headache
- a disturbance in your vision
If you have these symptoms, stop taking tetracyclines and contact your GP.
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) that is used to stop your blood clotting
- statins, which are taken to lower your cholesterol levels
Tell your GP if you are taking any other medicines. They can tell you whether your dosage needs to be revised.
Isotretinoin
Isotretinoin is a medicine that is often used to treat severe acne. However, it is also occasionally used to treat rosacea. As isotretinoin is a very strong form of medication, it can only be prescribed by a dermatologist (an expert in treating skin conditions) and not your GP.
Isotretinoin can cause a number of 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.
Visible blood vessels (telangiectasia)
The symptoms of visible blood vessels associated with rosacea are known as telangiectasia. Treatment for telangiectasia will usually require a referral to a dermatologist and is unlikely to be available on the NHS, so you may need to pay for it.
Laser treatment is one of the most widely used treatments for telangiectasia. Lasers are narrow beams of light that are aimed at the visible blood vessels on your face. The heat from the lasers damages the dilated (widened) red veins and causes them to shrink so they are no longer as visible.
Laser treatment can cause some pain, but most people do not need to have 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 usuall y only last a few days and are rarely permanent. An infection will require treatment with antibiotics.
Persistent redness
It may be possible to disguise patches of persistent red skin using specially designed 'camouflage' make-up. The British Red Cross 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.
Thickened skin (rhinophyma)
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 that is carried out by choice (elective) and is 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.
See the Health A-Z topics about Cosmetic surgery and Plastic surgery for more information.
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
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 can be used to treat dry eyes (see the Health A-Z topic about Dry eye syndrome – treatment for more information).
- 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 (see the Health A-Z topic about Blepharitis – treatment for more information).
- Antibiotics such as tetracyclines (see above).
