Treatment options for rosacea 

Treatment
Pros
Cons

Self-help measures

Avoid triggers such as direct sunlight, and keep your eyelids clean, use camouflage make-up, and take care of your skin 

  • Can prevent mild flushing, visible blood vessels and thickened skin
  • Can improve confidence and prevent embarrassment
  • Not always practical or easy
  • May not prevent moderate or severe symptoms 
  • You need to learn how to apply the make-up
Topical metronidazole

Metronidazole gel or cream that is applied directly to the skin

  • Can be effective for mild to moderate spots
  • Less irritation to the skin than azelaic acid 
  • Required for several weeks or more 
  • You need to avoid strong sunlight and UV light
  • May be less effective than azelaic acid
Topical azelaic acid

Azelaic acid gel that is applied directly to the skin

  • Can be effective for mild to moderate spots
  • Doesn't make skin sensitive to sunlight
  • May be more effective than metronidazole
  • Required for several weeks or more 
  • More likely to cause side effects than metronidazole
  • Can cause mild burning, stinging, dryness and itchiness
Ivermectin cream

A new medicine for rosacea papules and pustules that's applied directly to the skin once a day

  • Can be effective for mild to moderate spots
  • Doesn't make skin sensitive to sunlight
  • May be more effective than metronidazole
  • Side effects are uncommon
  • May take a few weeks to have an effect
  • Not available on the NHS everywhere
  • May only be recommended if other topical treatments don't work
  • Can cause mild burning, stinging, dryness and itchiness
Oral antibiotics

Antibiotics, such as tetracycline or erythromycin, taken as tablets or capsules

  • Can be effective for moderate to severe spots
  • Useful if affected area is widespread and creams are difficult to use
  • Can be effective for inflammation of the eyelids (blepharitis)
  • Can be taken at a low dose, which acts as an anti-inflammatory
  • Required for several weeks or more
  • Can make the contraceptive pill less effective, so alternative contraception should be used
  • Can cause sickness, diarrhoea and mild stomach pains
Isotretinoin

A very powerful medication often used to treat severe acne

  • Can be effective in treating severe spots caused by rosacea
  • May help improve facial redness and flushing
  • Can only be prescribed by a dermatologist
  • High risk of causing serious birth defects, so women must use reliable contraception
  • Can cause inflammation and dryness of lips, nosebleeds, headaches, inflammation of the eyelids and eyes, skin rashes, muscle, joint and bone pain, and blood in urine
  • Has to be used with caution because of potential mood changes
Brimonidine tartrate

A gel that stops the blood vessels in the face widening (dilating)

  • Can be effective in reducing facial redness
  • Usually starts to work after about 30 minutes and the effect can last around 12 hours
  • Common side effects include itchiness and a burning sensation where the gel is applied
  • Less common side effects can include a dry mouth, headaches, pins and needles, and dry skin
  • A rebound effect, where redness gets worse, has been reported
Laser or IPL treatment

Where lasers are aimed at the blood vessels in the face to shrink them

  • Can be effective in reducing facial redness and visible blood vessels
  • Side effects are usually mild and last only a few days
  • Can cause bruising, swelling, redness or blisters
  • May be painful
  • You may need to avoid sun during and after treatment
  • Not available on the NHS in many areas of the country
Surgery

Surgery to reshape the nose

  • Can help improve appearance of thickened skin (rhinophyma) on the nose
  • Only for severe cases of rosacea
  • Not always available on the NHS