How to treat rosacea?

In a Nutshell

  • Common skin condition that mainly affects the face
  • Treatment is a combination of self-care (to avoid triggers) and supportive care to address the flares
  • Advanced procedures like intense pulsed light (IPL) treatment and laser can improve cosmetic appearance in severe cases

What is Rosacea and who is at risk?

Rosacea is a common inflammatory skin condition that primarily affects face. It is characterized by redness or blushing of face (especially around nose, cheeks, chin, & forehead) in the early stages. When condition is advanced, affected individuals develop other cosmetic issues such as:

- Burning/ stinging pain

- Prominence of small blood vessels on the skin

- Appearance of spots on the face (such as pustules, papules)

Rosacea is more prevalent among females and white-skinned individuals. According to latest estimates, about 1 in 20 Americans (about 14 million) are living with rosacea. The symptoms can be controlled with treatment but may relapse with certain triggers.

Treatment Regimen:

So far there are no curative treatments. Current management regimen is a combination of supportive care (to control symptoms) and self-help measures (to identify and avoid triggers).

Use over-the-counter medicines to alleviate symptoms:

- Your doctor may suggest creams or ointments to alleviate symptoms of active rosacea or to reduce the appearance of spots. This include topical agents like benzoyl peroxide, tretinoin, and azelaic acid to reduce the ongoing inflammation of skin and to be applied at least once a day (ideally before bedtime).

- Some extreme conditions may require oral antibiotics to clear the more severe spots

- Very severe cases that does not respond to topic or oral medications require treatment options like Accutane (or Isotretinoin), but due to risk of complications, it is given with extreme caution to women of childbearing age. Generally a course of 3 months is advised at first to see the response to therapy, after which duration may be extended for another 6-8 weeks.

Advanced Procedures for more severe illness: To improve the cosmetic appearance of lesions/ spots, there are some advanced procedures that directly aim at shrinking the visible blood vessels on the skin. The duration and frequency of these treatments vary according to the severity of condition. For example:

- Intense pulsed light (IPL) treatment

- Laser therapy

Protect your skin when outdoors:

- Protect your skin from harmful sun rays by using sun-protection or sunscreen (SPF-30)

- Avoid humid condition, heat, and hot weathers if possible

- Use mild skincare products if you have sensitive skin

Identify and avoid Triggers:

- Avoid cheese and spicy foods

- Avoid alcoholic beverages

- Avoid hot and caffeinated beverages (tea, chocolate, coffee)

- Stress and strenuous exercise also make symptoms bad in some individuals

Nuances/ Safety

Speak to a healthcare professional if you are experiencing symptoms of ocular rosacea. This condition is characterized by:

- Painful eyes

- Impaired vision

- Redness or extreme irritation of eyes

- Blepharitis (a condition marked by inflammation of eyelids)

Some susceptible individuals also develop inflammation of cornea.

Strength of Evidence: A

The treatment modalities presented in the article are recommended by American Academy of Dermatology and The National Health Service based on the best practices.

Our Ruling

Rosacea is a common skin condition that affect millions in US. Treatment for mild symptoms is mainly supportive and self-care, but if you are experiencing severe symptoms, speak to a healthcare professional as there are a number of cosmetic procedures that can significantly improve the appearance of your skin.

Our Sources:

  1. https://www.aad.org/public/diseases/rosacea/treatment/redness
  2. https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/rosacea
  3. https://www.medicinenet.com/rosacea/article.htm
  4. https://www.nhs.uk/conditions/rosacea/
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How we grade evidence?

Learn more about it here.