Rosacea Treatment: What Works Best?

Medically reviewed by: Ted Schiff, MD

Rosacea can be embarrassing, even demoralizing. In a survey from the National Rosacea Society, 90% of patients said rosacea had lowered their self-esteem and self-confidence, and many people reported feeling frustrated, anxious, and depressed. Getting your rosacea symptoms under control lets you face the world with clearer, smoother skin and a more even complexion — but how do you know which rosacea treatment will work best? 

It all starts with identifying the type of rosacea you have. Even then, whether you have mild rosacea or severe rosacea, finding the best rosacea treatment for you might take some trial and error. But since different rosacea types respond to different treatments, you and your dermatologist will have a better sense of where to begin. 

The four types of rosacea

Here’s a quick look at the four main types of rosacea. Keep in mind, you may have more than one type.

• Erythematotelangiectatic rosacea makes parts of your face red and causes tiny spider veins to form. Your face may swell, sting or burn, and your skin is probably rough and dry.
• Papulopustular rosacea is sometimes mistaken for acne because it causes pus-filled blemishes (pustules) and swollen, red bumps. Other symptoms include red, oily, sensitive skin; spider veins, raised patches of skin (called plaques) and stinging or burning. You may have symptoms on your scalp, neck or chest as well as your face.
• Phymatous rosacea, sometimes called nose rosacea, is rare. It causes thick, oily, bumpy skin, broken blood vessels and enlarged pores. Phymatous rosacea can affect the ears, chin and forehead, but it most often affects the nose and can lead to a disfiguring condition called rhinophyma, in which the skin on the nose thickens, making the nose large and bulbous.
• Ocular rosacea affects the eyes and makes them look watery and bloodshot. It can be painful, causing irritation, burning, dryness and sensitivity.

Treatment for rosacea

Your dermatologist will likely choose from these treatment options. If you may have more than one type of rosacea, your dermatologist may mix and match.

Erythematotelangiectatic rosacea treatment

To treat redness and inflammation, doctors prescribe the topical drugs brimonidine and oxymetazoline. They work by narrowing visible blood vessels. If they don’t help enough, laser treatment for rosacea can ease symptoms by reducing or destroying the vessels.

Papulopustular rosacea treatment

Papulopustular rosacea can be treated with brimonidine and oxymetazoline, topical medicines that work by narrowing visible blood vessels. They are also used to treat erythematotelangiectatic rosacea. 

To treat pustules, your dermatologist might prescribe other topical drugs, including metronidazole (an antibiotic with anti-inflammatory effects), azelaic acid (a naturally occurring acid) and ivermectin. Ivermectin has anti-inflammatory effects and also kills the Demodex mite, which lives on the skin and may lead to rosacea symptoms in some people.

If your rosacea is severe, your dermatologist may add a low dose of an oral antibiotic (usually doxycycline) to limit redness and reduce blemishes. 

Once papulopustular rosacea is under control, the doctor may prescribe oral isotretinoin to prevent relapses. It’s a retinoid that decreases sebum production; it’s also used to treat nodular acne.

Phymatous rosacea treatment

Rosacea on the nose is often treated with oral isotretinoin (a retinoid that decreases sebum production) or laser therapy.

If the rosacea leads to rhinophyma, treating it early with oral isotretinoin can prevent it from getting worse. If rhinophyma has progressed, your doctor may recommend reshaping your nose to make it less bulbous. Ways to do this include laser surgery, electrosurgery and dermabrasion. Your doctor will decide which method is best for you based on the stage of the disease and the amount of inflammation.

Ocular rosacea treatment

When ocular rosacea causes inflammation of the eyelid, topical drugs may relieve it. They include metronidazole (an antibiotic with anti-inflammatory effects) and ivermectin (an anti-parasitic that also fights inflammation). You might also be prescribed Cyclosporine eye drops to increase tear production if your eyes are dry. 

People with ocular rosacea may benefit from taking omega-3 fatty acid supplements — the same fish oil supplements some people take for heart health —  to calm inflammation and ease dry eye symptoms.

Article Written By: Jessica Brown, a health and science writer/editor based in Nanuet, New York. She has written for Prevention magazine, jnj.com, BCRF.org, and many other outlets.