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Do You Have Rosacea? We Have The Answers

Do you sometimes experience facial redness or sudden outbreaks of pimples for no apparent reason?

You may have Rosacea — one of the world’s most common chronic skin conditions.

Rosacea is a complex disease that is not fully understood. It has many potential causes and can be treated using a variety of approaches.

Its complexity means that finding a cure for rosacea can involve a lot of trial and error. It may take a long time to find an approach that eliminates your specific rosacea symptoms.

Rosacea Doctor has been created to make this process simpler.

We start by explaining the signs and symptoms of rosacea in an easy-to-understand way. This will include the common causes of rosacea and the lifestyle factors that can make rosacea worse.

Next, we’ll share the most effective rosacea treatments currently available. This includes:

  • Rosacea reducing diets
  • Nutritional supplements
  • Roacea medications
  • Rosacea creams
  • Rosacea natural treatments
  • Rosacea moisturisers, and much more!

The information we share will help you beat rosacea once and for all!

Ready to get started?

Continue reading to learn more about rosacea or click on one of our popular articles listed above.

What Is Rosacea?

Rosacea is a chronic skin condition which causes facial redness and flushing.

Most rosacea sufferers will also experience flareups, where symptoms become worse for several weeks. During a flareup, red, pus-filled bumps can appear on their skin — which is why rosacea is often confused with acne.

Rosacea mostly affects the centre of the face, including the cheeks, nose, and chin. However, it can also affect the eyes, chest, and other parts of the body.

In its early stages, rosacea looks like sunburn or rosy cheeks. However, as the disease progresses, a variety of additional symptoms can occur (more on the symptoms of rosacea below).

If rosacea is not treated, the symptoms will worsen and it can eventually cause:

  • Spider veins (broken blood vessels under the skin)
  • Thicker skin texture
  • Facial inflammation including bumpy or excessive tissue
  • Bloodshot or watery eyes
  • Facial inflammation

Anyone can get rosacea, however, it mostly affects adults between the ages of 30 to 60 with fair skin. Fortunately, rosacea is not a contagious disease, so you don’t have to worry about it spreading to other people!

There is currently no cure for rosacea. However, most people can manage their rosacea symptoms through a combination of the following:

  1. Identifying their flare-up triggers
  2. Making lifestyle adjustments
  3. Using skin care products
  4. Obtaining medical treatment

Awareness and early intervention are critical for beating rosacea. Understanding the causes of rosacea and the available treatments will help you enjoy great skin and a healthy lifestyle.

Where Rosacea Appears On The Face

Where Rosacea Appears On The Face

How Common Is Rosacea?

Rosacea affects about 415 million people globally, making it one of the world’s most common chronic skin conditions. Unfortunately, many of the people with rosacea don’t even know they have it. As a result, they don’t seek treatment and suffer from serious complications associated with rosacea.

What Are The Symptoms Of Rosacea?

The symptoms of rosacea are very mild initially. In most cases, rosacea sufferers think they have just developed a “healthy glow” because they have rosy cheeks.

Unfortunately, the symptoms worsen over time and most people will develop the nastier symptoms of rosacea once they have turned 30.

Understanding the symptoms of rosacea will help you take action early — which is absolutely critical when it comes to battling rosacea.

The earlier you make lifestyle adjustments, use a rosacea-friendly regime, and obtain medical treatment, the less permanent damage can be caused by the disease.

There are four rosacea subtypes which have unique symptoms (more that below). However, the general symptoms experienced by virtually all rosacea sufferers include:

  • Facial flushing
    This is the number one symptom amongst rosacea sufferers. Facial flushing causes a sudden burst of facial redness, accompanied by feelings of heat or warmth on the face. This symptom occurs intermittently and is one of the earliest rosacea symptoms.
  • Persistent facial redness
    Rosacea sufferers often look like they have a sunburn or blush that does not go away.
  • Skin thickening
    The skin on the face begins to become thicker from excess tissue. This mostly affects the nose and can cause a condition called rhinophyma in some severe cases.
  • Pimples, pustules, and facial bumps
    These acne-like symptoms appear as the disease worsens. They are more common when suffering from a rosacea flare-up. Sufferers often have solid red bumps, pimples, and larger pustules.
  • Burning or stinging
    You may experience some skin pain from time to time.
  • Facial swelling
    Rosacea is an inflammatory condition, so you may notice some swelling or puffiness in the face. The medical term for this type of swelling is edema.
  • Visible blood vessels
    The blood vessels beneath the skin of the face become engorged, which makes them more visible. In more serious cases, the blood vessels become permanently visible — a condition called telangiectasia.
  • Skin plaques
    Raised red patches of skin on the face.
  • Dry skin
    The skin on your face may become quite dry, rough, and irritated.
  • Eye irritation
    A variety of eye problems are linked to rosacea including dry eye, itchy eyes, swelling of the conjunctiva, swollen eyelids, and bloodshot eyes. Severe cases can cause damage to the cornea and problems with visual acuity. These symptoms are caused by a subtype of rosacea called ocular rosacea.

While the symptoms of rosacea mostly affect the face, they can also appear on the chest, neck, scalp, and ears.

The symptoms you experience will vary based on a number of factors, including the subtypes of rosacea that you have been diagnosed with.

Rosacea Subtypes

There are four rosacea sub-types, which have unique symptoms and treatment approaches. They are:

  1. Rosacea Subtype 1: Facial redness (Erythematotelangiectatic Rosacea)
    This is the primary form of rosacea, which all sufferers experience. Symptoms include facial redness, flushing, visible blood vessels, sensitive or burning skin, swollen skin, and dry or rough skin.
  2. Rosacea Subtype 2: Bumps and Pimples (Papulopustular Rosacea)
    This subtype causes persistent redness, acne-like breakouts, oily skin, bumps on the skin, pimples, pustules, broken blood vessels, and raised patches of skin.
  3. Rosacea Subtype 3: Enlargement of the Nose (Phymatous Rosacea)
    This form of rosacea causes the skin to become thicker, particularly around the nose. Other symptoms include large pores, visible blood broken vessels, and bumpy skin texture.
  4. Rosacea Subtype 4: Eye Irritation (Ocular Rosacea)
    This is a particularly dangerous form of rosacea as it can cause eye problems including corneal ulcers and styes. The symptoms include dry eye, eye pain, a burning or stinging sensation in the eyes, swollen eyelids, crusty eyelids, sensitivity to light, gritty-feeling eyes, and excessive tearing.

It’s common for rosacea sufferers to have multiple subtypes. Most people will have subtype one initially, then develop the other subtypes over time.

I’ll share a little more information on these subtypes, their symptoms, and the best available treatments below. But first, we’ll take a look at the causes of rosacea, risk factors, and how it is diagnosed.

What Causes Rosacea?

Researcher still don’t understand the precise cause of rosacea, however, they have developed several theories over the years. Here is a short summary of the potential causes of rosacea. We’ll go into more detail on the causes of rosacea in other articles.

Immune System Dysfunction

The immune system protects your body against infection. It is a complex system involving immune cells and molecules which can identify and attack any nasty viruses, bacteria, or pathogens they encounter.

One of the ways the immune system protects the body and attacks foreign cells is by using inflammation. Inflammation causes the blood vessels to dilate, which allows for additional flow of white blood cells, hormones, and nutrients which promote healing and attack foreign cells.

Some researchers believe that a dysfunctional immune system can result in chronic inflammation which affects the tissue of the face. They have even identified a specific anti-microbial molecule called Cathelicidins which may be responsible for several rosacea symptoms. Cathelicidins can cause pimples, enlarged blood vessels, and inflammatory bumps.

Neurovascular System Dysfunction

Researchers from the Charles Institute of Dermatology at the University College Dublin School of Medicine believe that rosacea may be related to the Neurovascular System.

Common rosacea triggers like sensitivity to UV light, alcohol consumption, exposure to heat/cold, ad spicy food are all related to stimulation of the sensory nervous system.

In fact, a nervous system condition called neurogenic inflammation has rosacea-like symptoms, including redness and swelling. Research is ongoing.

Demodex Mites and Microbes

Demodex Mites are microscopic creatures that live on human skin. They are a natural part of our “microbiome” which is a large community of organisms that live in, or on, our bodies.

There is some evidence to suggest that rosacea sufferers have an overabundance of Demodex mites, which may be triggering an immune system response. This immune system response could be responsible for rosacea symptoms.

Another study published in 2007 suggests that it might not be the mite causing rosacea, but a bacteria that the mites release. The bacteria, called Bacillus oleronius, may be responsible for kick starting the immune response that causes rosacea.

Fortunately, there are several effective for dealing with demodex mites and the bacteria they produce. This includes the use of antibiotics and specific skin care products.


Several studies have shown that genetics play a role in determining who is more likely to have rosacea. Researchers from the  University of California-San Francisco have already confirmed that there is a genetic component in subtype 1 (erythematotelangiectatic) rosacea.

Researchers from the Stanford University School of Medicine have also identified two genetic variants of rosacea. These variants are located in areas of the genome that are associated with autoimmune disease.

Rosacea Risk Factors

There are several risk factors which determine how likely it is that you will have rosacea. They include:

  • Gender
    Women between the ages of 30 and 60 are almost three times as likely to have rosacea compared to men. However, men are more likely to have severe rosacea.
  • Family history
    There is a genetic factor to rosacea, so having family members with rosacea increases your risk of also having it.
  • Ethnicity
    Rosacea has been found to be prevalent amongst people from countries and regions like Scotland, England, Norway, Ireland, and Scandinavia.
  • Caucasians
    Rosacea is more common amongst caucasians. However, people from any race can suffer from rosacea.
  • Fair Skin
    If you have fair skin, you are more likely to develop rosacea.
  • Sun Damage
    Prolonged sun exposure can damage can cause blood vessels and skin on the  face. This can sometimes increase the risk of rosacea.
  • Acne
    People who have experienced severe acne in the past and more likely to have rosacea.

How Is Rosacea Diagnosed?

There is no conclusive test which determines if you have rosacea. Doctors must examine your skin and ask questions about your symptoms to determine if a patient has rosacea. Some specialists will also take skin samples to look at the level of inflammation that is occurring.

The Global Rosacea Consensus (ROSCO) Panel has developed a classification system which helps doctors confirm a diagnosis. The presence of one “diagnostic phenotypes” or two “major phenotypes” is sufficient to confirm rosacea (Phenotypes are essentially observable symptoms).

Diagnostic Phenotypes

  • Centrofacial erythema in a characteristic pattern (the skin in the centre of the face is redder than normal and the patient experiences flareups)
  • Phymatous changes (thickened skin, enlarged pores and irregular surface nodularities)

Major Phenotypes

  • Pimples, papules and pustules
  • Flushing
  • Telangiectasia (visible broken veins)
  • Ocular rosacea (a range of symptoms affecting the eyes

Minor Phenotypes

  • Burning or stinging skin
  • Oedema (facial swelling)
  • Dry appearance

My Diagnosis Experience

Speaking from personal experience, none of the doctors I saw even mentioned the likelihood of rosacea — even though I had several rosacea symptoms (including a variety of eye problems).

It was only when I saw a new ophthalmologist that he mentioned that I had rosacea. That allowed me to finally obtain the necessary treatments and make lifestyle changes which saw an improvement in my symptoms.

The moral of this short story is — don’t expect your doctor to diagnose your condition. Keep track of your symptoms and see a dermatologist if you believe you have rosacea. They are best equipped to make a correct diagnosis.

Why Rosacea Is Often Misdiagnosed

One of the challenges of dealing with rosacea is that it is often misdiagnosed. You may mistakenly believe that it is simply Acne Vulgaris or one of these other conditions:

  • Periorificial dermatitis or periocular dermatitis
    A very common condition which causes  tender small red papules around the nostrils, eyes, and mouth.
  • Steroid rosacea
    A rosacea-like condition which occurs when using or withdrawing from topical steroids.
  • Demodicosis
    Demodicosis is a skin rash caused by sensitivity to the Demodex mite.
  • Keratosis pilaris rubra faciei
    An uncommon skin condition which occurs in children and often improves with age.
  • Skin ageing
    As you age, you develop a redder face with more blemishes, which can be confused with rosacea.
  • Rosacea fulminans
    A rare disorder which affects women between the ages of 15 and 45. It causes the onset of pustules, cysts, papules, and reddening of the skin.
  • Seborrhoeic dermatitis
    This is a chronic condition that causes red, scaly, itchy, greasy, and inflamed skin.
  • Irritant contact dermatitis
    Irritant contact dermatitis occurs when the skin has been injured by chemicals, over-exposure to water, friction or environmental factors. Symptoms include red, scaly skin, itching, swelling, and cracking.
  • Systemic lupus erythematosus
    Lupus is a complex autoimmune condition which has a wide variety of symptoms. One of those symptoms is a rash on the cheeks and nose, which can be confused for rosacea.
  • Dermatomyositis
    This is a very rare inflammatory disease which can cause a skin rash which may be confused for  rosacea.

It’s important to track your symptoms and speak with a doctor to have your condition correctly assessed.

Effective Rosacea Treatments

There are many potentially effective treatments for rosacea. However, you may need to try a variety of treatments in order to discover what works best for you.

The following is a short summary of the rosacea treatments which have been shown to work. I’ll be posting additional articles which go into much more detail on each treatment approach shortly.

1. Avoid Triggers Which Cause Flushing

Common Rosacea Triggers Image

Common rosacea triggers

All rosacea sufferers will experience flushing every now and then. Flushing causes the skin on the face to redden dramatically and increases the likeliness of other rosacea symptoms occurring.

Personally, whenever I experience flushing, pustules are more likely to appear in the next couple of days. My skin also becomes puffier and my ocular rosacea symptoms may worsen.

The best approach for reducing the frequency and severity of flushing events is to understand the triggers that cause it.

There are many types of triggers, including:

  • Foods
    Many foods can potentially* cause a flareup. They include avocados, broad-leaf beans and pods, cheese, chocolate, citrus fruits, tomatoes, bananas, eggplant, foods high in histamine (including lima, navy or peas), liver, red plums, raisins, figs, sour cream, soy sauce, spicy and thermally hot foods, spinach, vanilla, vinegar, yeast extract, and yogurt.
  • Beverages
    Beverages containing alcohol or caffeine cause flareups in some people. Drinks that are too hot or cold can also worsen rosacea symptoms.
  • Emotional factors
    High levels of stress or anxiety can sometimes worsens rosacea.
  • Skin care products
    Products that contain alcohol, hydro-alcoholic substances, perfumes, or acetone substances. Substances that cause redness or dry out the skin.
  • Temperature extremes
    Spending time in hot environments like hot baths, saunas, or showers can cause a flareup.
  • Weather
    Excessive sun exposure and hot, cold, or windy weather can cause a flareup.
  • Medications
    Drugs which dilate blood vessels, called vasodilators, will worsen rosacea. Topical  steroids can also have an impact.
  • Medical conditions
    Conditions that also cause flushing (like menopause) can worsen rosacea.
  • Physical exertion
    Exercising or working at a high intensity is a common cause of rosacea flareups.

* Every individual will react to these foods differently. They may not cause a flareup at all.

A survey performed by the National Rosacea Society found that the most common flushing triggers were:


Percent Affected

Sun exposure


Emotional stress


Hot weather




Heavy exercise


Alcohol consumption


Hot baths


Cold weather


Spicy foods




Indoor heat


Certain skin-care products


Heated beverages


Certain cosmetics




Medical conditions


Certain fruits


Marinated meats


Certain vegetables


Dairy products


Other factors


However, it is important to remember that each rosacea sufferer has a unique set of triggers which cause their flare-ups.

Some people will find that alcohol immediately creates a severe flushing event, while others can tolerate alcohol well.

To beat rosacea, you will need to identify the triggers which affect you the most. Once you have done so, you can either eliminate each trigger or reduce its impact. Click To Tweet

To begin with, consider making the following lifestyle adjustments:

  • Avoid excessive sun exposure
  • Reduce stress levels if possible
  • Avoid exposing your face to heat, humidity and cold or windy weather
  • Exercise at a moderate intensity
  • Limit alcohol/caffeine intake and drink plenty of water
  • Avoid irritating skin care products
  • Get more sleep (reduces inflammation)
  • Eat a healthy diet
  • Keep track of the food you eat to see if anything is trigger a rosacea flareup
  • Be gentle on your skin

I’ll be going into each of these steps in more detail and share more information on common rosacea triggers in later posts.

2. Develop A Rosacea Friendly Skincare Regime

Rosacea Skincare Routine

Rosacea makes your skin much more very sensitive to certain chemicals and compounds.

If you use the wrong kind of soap or moisturiser it can quickly cause your rosacea symptoms to dramatically worsen.

The best approach for looking after your rosacea affected skin is to follow these 10 simple tips:

  1. Use gentle cleansers and moisturisers
  2. Cleanse twice a day
  3. Avoid products that dry the skin (witch hazel, alcohol, menthol, eucalyptus oil etc)
  4. Avoid products with perfumes and unnecessary ingredients
  5. Use lukewarm water when washing your face
  6. Always apply moisturiser
  7. Use a high-quality sunscreen to limit UVA/UBA exposure
  8. Be very gentle with your skin when cleaning
  9. Choose makeup carefully (test products before using them, avoid chemicals)
  10. Don’t have facials (chemical peels, microdermabrasion treatments)

I’ll be going into more detail on how to care for your skin in other posts.

3. Protect Your Face

As mentioned a moment ago, protecting your skin from the sun is important. I’m mentioning this fact again, because it is an important part of reducing rosacea symptoms.

Rosacea sufferers with fair skin are particularly vulnerable and should always use sunscreen if they will be outdoors for an extended period. This will prevent damage from harmful ultraviolet A and ultraviolet B rays, which dramatically worsens rosacea symptoms.

Use a product with SPF 30 or higher. Sunscreen should be applied on top of any topical rosacea products you are using, but beneath any cosmetics.

You can also take other steps to protect your skin from the sun, like wearing a hat, staying inside during the hottest part of the day, and cover your face with scarf to protect yourself on windy days.

4. Natural Remedies For Rosacea

There are a wide variety of natural rosacea treatments which have proven to be effective. These treatments are a great option for anyone wishing to avoid commercial skin care products which may contain chemicals.

Sometimes a combination of natural remedies will be required to beat rosacea. Unfortunately, people with severe rosacea may find that natural remedies alone are not effective at treating their condition.

The most effective natural treatment options for rosacea include:

  • Green tea cream
  • Chrysanthellum indicum cream
  • Aloe vera gel
  • Burdock
  • Coconut oil
  • Apple cider vinegar
  • Feverfew
  • Comfrey
  • Oatmeal
  • Raw honey
  • Niacinamide cream
  • Licorice
  • Tumeric
  • Lavender
  • Chamomile
  • Tea tree oil
  • Camphor

I will be publishing a comprehensive guide on natural remedies for rosacea in coming weeks. Subscribe to receive a notification.

5. Topical Treatments For Rosacea

People with mild to moderate rosacea can often benefit from topical treatments.

Topical treatments like brimonidine (Mirvaso) and oxymetazoline (Rhofade) reduce facial redness by constricting blood vessels. These treatments are effective fairly quickly, but need to be used regularly to maintain long-lasting improvements.

Other products are designed to control pimples and pustules caused by Papulopustular Rosacea. These products typically use one of three active ingredients:

It can take a few weeks for products containing Azelaic acid or Metronidazole to create a noticeable improvement. Products containing Ivermectin tend to take even longer.

Most rosacea sufferers find that they need to experiment with different topical treatments to find something that works for them. I will share much more detail on topical treatments for rosacea in the blog. Subscribe to stay updated.

6. Oral Antibiotics For Rosacea

If your skincare regime, natural remedies and lifestyle changes are not effective, you may need to ask a doctor about antibiotics.

Antibiotics work by reducing inflammation in the body, which relieves rosacea symptoms.   They are particularly

The antibiotics commonly used for rosacea include minocycline, doxycycline, erythromycin, clarithromycin and clindamycin.

In the United States and Europe, most patients will be prescribed 40 mg of doxycycline per day initially. The dose is usually kept low so the patient does not build up a resistance to it.

It is important to note that there are some side affects associated with antibiotic use. In the case of doxycycline, patients may experience photosensitivity, which means they are more vulnerable to UV exposure. Long term use of antibiotics can also affect gut health.

Patients typically receive antibiotics until they reach the point where symptom control can be achieved with topical therapies alone.

I’ll be sharing more details on using oral antibiotics to treat rosacea in later posts.

7. Laser and light therapies for rosacea

There are a variety of laser and light therapies which target different aspects of rosacea.

These treatments work by using heat from wavelengths of light to collapse the tiny red blood vessels on the face. This removes redness and improves the appearance of the skin. The most common laser and light therapies for rosacea include:

  • Erbium YAG laser
    Erbium YAG laser treatments are used to minimise the appearance of visible blood vessels. They can also remove excess tissue around the nose that has occurred as a result of Phymatous Rosacea.
  • Pulsed-dye lasers
    This includes Cynosure, V Beam, and V-Star laser treatments. This therapy uses light to penetrate vascular lesions (visible blood vessels). Dye can be used to make the laser beams different colours, which reduces facial redness and inflammation.
  • CO2 lasers
    Also called ablative lasers, these lasers are used to remove excess rosacea-inflamed tissue or the nose and other parts of your face.
  • Intense pulsed light therapy (IPL)
    IPL uses several wavelengths of light at once to get rid of unwanted pigment or redness on the skin.

8. Surgery

Surgery can be used to treat Type 3 Rosacea (Rhinophyma), which causes the nose to increase in size. A plastic surgeon will cut away excess tissue surgically or with a carbon dioxide laser.

Treating Rosacea Subtypes

Here is some more information on the different rosacea subtypes and how they should be treated.

How To Treat Erythematotelangiectatic Rosacea (Rosacea Subtype 1)

This is by far the most common form of rosacea. It is very rare for someone to have rosacea but not have the symptoms of ETR. As mentioned earlier, those symptoms include:

  • Facial redness at the centre of the face
  • Flushing
  • Swollen facial skin
  • Broken blood vessels
  • Dry, rough, or scaly skin

It’s important to remember that you may not see all of these symptoms at once. They may come and go over time. It’s also common for some people to only experience one or two of these symptoms.

The earlier you obtain treatment, the less likely it is that you will have all five symptoms.

The main goal when treating subtype 1 rosacea is to reduce the sensitivity of your skin and limit the number of flushing events that you have.

People with mild subtype 1 rosacea may be able to manage the condition with simple lifestyle adjustments including:

  • Avoiding sun exposure
  • Using SPF 20+ sunblock
  • Eating a healthy diet and avoid foods that cause flareups
  • Only exercising at a moderate intensity
  • Avoid extreme hot or cold environments
  • Using mild skincare products designed for people with rosacea
  • Avoiding triggers like caffeine, alcohol, and harsh facial cleansers

However, people with more severe symptoms may need to also use:

  • Medications
    Creams containing Brimonidine, Retinoids, or Calcineurin can be effective at reducing the symptoms of ETR rosacea.
  • Laser and Intense Pulsed Light (IPL)
    These treatments can reduce the appearance of broken blood vessels which are often associated with ETR.
  • Near Infrared Lasers
    This type of therapy can be used to treat larger lesions which cover more of the face.

How To Treat Papulopustular Rosacea (Rosacea Subtype 2)

Papulopustular rosacea causes acne-like symptoms including pimples and pustules.

It’s common for rosacea sufferers with this form of the condition to feel embarrassed about the condition of their skin. This can negatively impact their confidence levels and mental health. Fortunately, papulopustular rosacea can respond well to treatment.

Papulopustular rosacea is also often referred to as “Acne Rosacea”.

The symptoms of papulopustular rosacea include:

  • Facial redness
  • Red bumps
  • Hot, itchy, or sensitive skin
  • Patches of skin that are raised and irritated
  • Acne-like breakouts with pimples and pustules
  • Oily skin
  • Visible broken blood vessels on the face

Papulopustular rosacea has the same types of triggers as ETR rosacea (Rosacea Subtype 1) including weather triggers (sun/wind exposure), temperature triggers, (hot/cold temperatures), lifestyle triggers (stress, intenseness exercise), and food triggers (chilli, caffeine, hot foods, alcohol).

Treating Mild To Moderate Papulopustular Rosacea

Moderate papulopustular rosacea can respond very well to optical treatments.

In some cases, a good skin care regime combined with natural remedies is all that is required to read this subtype. However, if this approach is not working, topical medications should be used.

The most commonly used topical medications for papulopustular rosacea are:

Azelaic Acid

Azelaic acid is a natural organic compound found in wheat, rye, and barley. It has an antibacterial, keratolytic (thins the skin), comedolytic (inhibits blemishes) and antioxidant effect, which is fantastic for combatting papulopustular rosacea.

Most products containing azelaic acid are a 20% strength lotion or a 15% strength gel. Common brand names include Azeclear, Finacea, and Paula’s Choice.

Many studies have confirmed that products containing azelaic acid are effective for treating papulopustular rosacea. However, it will take many weeks before the results are seen. In most cases, patients will use the products for 10 weeks or more before seeing a substantial improvement.


Metronidazole has antibiotic and antiprotozoal properties, which means it can combat both bacterial and protozoal infections. It is also anti-inflammatory, which is very useful for treating rosacea affected skin.

Metronidazole tends to be weaker in effect that Azelaic acid. This makes it useful for people who find that Azelaic acid is too harsh on their skin.

Although there is very limited scientific evidence that metronidazole works, millions of people around the world use it every day and have great results.

There are many different products containing metronidazole, including 0.75% and 1% cream, gels, and lotions.

Many people find that metronidazole is less harsh on the skin. However, other fid that it is much less effective than azelaic acid. You may need to try several products before deciding on the one you will use long-term.

There are side effects associated with using these topical creams, including stinging, burning, and dry skin. However, they are usually mild symptoms which go away over time.

There are other medications which may be useful, but they have not tested as thoroughly as metronidazole or azelaic acid. They include:

  • Ivermectin
    A common ingredient in flea treatments, it has anti-inflammatory and anti-parasitic properties. It is usually applied using a 1% cream.
  • Sulfacetamide
    Sulfacetamide is a sulfonamide antibiotic that is often used to treat skin and eye infections. It is available in many forms including lotions, foams, cleansers, and creams. There is some evidence suggesting that suncreams containing sulfacetamide may be a great option for people suffering from papulopustular rosacea.
  • Antimicrobials
    Antimicrobials like benzoyl peroxide and clindamycin kill microorganisms. There is some evidence suggesting they may be useful for treating papulopustular rosacea.
  • Retinoids
    Retinoids have an anti-inflammatory capacity and can repair the skin. This is very useful if you significant skin damage and lesions from papulopustular rosacea. However, some people find that retinoids are irritating to their skin.
  • Permathrin
    Permathrin is an anti-parasitic that may be useful for attacking demodex mites and microbes. However, very little research has been performed at this point.

Treating Moderate To Severe Papulopustular Rosacea

Topical treatments may not be effective if you have more severe symptoms. You may require antibiotics or laser therapies.

The most effective antibiotics for treating rosacea are Tetracyclines including tetracycline, doxycycline, and minocycline. These medications have an anti-inflammatory effect which reduces rosace symptoms. They have been thoroughly studied, so we know they are safe and effective.

Tetracycline can usually prescribed in doses anywhere between 250 to 1000 mg per day.

Doctors will only use higher doses for a short period to relieve the severity of a patient’s symptoms. At that point, topical therapies (azelaic acid or metronidazole) and lifestyle changes are all that are needed.

Most doctors will prescribe 50 to 100 mg or doxycycline or 250 to 500 mg of tetracycline. They will be taken twice daily for between 1 and 3 months.

At the end of this period, they will evaluate the condition of your skin to determine if your inflammation is under control.

There is growing concern that large doses reduce the effectiveness of antibiotics as the body becomes resistant to their effects.

As a result, several studies have tested if small dose antibiotic treatments can be effective for treating rosacea. One study found that as little as 100 mg may be effective.

Smaller doses can be used over a longer period, which means patients can use antibiotics for many months or years.

Other antibiotics which may be effective include  clarithromycin, azithromycin, metronidazole, and erythromycin. However, very few studies have checked how effective they are at treating rosacea in the longer term.

The use of oral metronidazole is more common in Europe, where doctors often prescribe 200 mg capsules, taken twice a day. This form of antibiotic has a severe reaction to alcohol.

Some people will find that antibiotics are ineffective at treating their severe rosacea. When this occurs, doctors will usually prescribe oral isotretinoin. It will usually be taken at low doses for several months, as high doses carry some severe side effects.

Laser And Pulsed Light Therapies

Intense pulsed light and pulsed dye lasers can be used to improve the improve the colour and texture of the skin. They work by heating the skin to remove unwanted cells or to collapse blood vessels. These types of treatments are effective at alleviating the symptoms of severe papulopustular rosacea, as opposed to the root cause.

How To Treat Phymatous Rosacea (Subtype 3 Rosacea)

Phymatous Rosacea causes unusual growths on the face, particular the nose, cheeks, chin, and ears. The symptoms include:

  • Bumpy red skin
  • Thickened skin, particularly around the nose and nostrils

Because this form of rosacea leads to more obvious symptoms, it is usually treated more aggressively. Doctors will often resort to laser therapies or surgery to treat more severe cases.

Some researchers believe that low doses of isotretinoin can be useful in the early stages of phymatous rosacea. This drug reduces the number of skin cells accumulating on the face. It is usually taken for several months.

More advanced cases where thick skin has accumulated on the nose and other parts of the face will require surgery to debulk or reshape the face.

In most cases doctors will use infrared lasers or carbon dioxide lasers initially. Other debunking surgical techniques which can be used include dermabrasion, cryosurgery, scalpel excision, and electrosurgery.

How To Treat Ocular Rosacea (Subtype 4 Rosacea)

Ocular rosacea is affects the eyes. It’s important to seek medical treatment for this form of rosacea as it has several potentially dangerous complications which may affect your  eyesight, The symptoms of ocular rosacea include:

  • Dry eyes
  • Burning or stinging in the eyes
  • Itchy eyes
  • Grittiness or feeling of having a foreign body in the eye or eyes
  • Blurred vision
  • Sensitivity to light (photophobia)
  • Red eyes
  • Dilated small blood vessels on the white part of the eye
  • Red and swollen eyelids
  • Excessive tearing

The severity of these symptoms may not match the severity of rosacea on your skin. So, it is possible to have severe ocular rosacea even when the condition of your skin looks relatively good.

The symptoms of ocular rosacea can be worsened by several lifestyle choices and environmental  factors, including:

  • Excessive screen time
  • Alcohol consumption
  • Extreme temperatures
  • Excessive sunlight exposure
  • Windy environments
  • Strong emotional responses, stress, or anxiety
  • Hot baths, showers, or saunas

Ocular rosacea is a complex topic and one I’ll be discussing in other articles. Subscribe to remain updated!

Where To Now?

As you can see, Rosacea is a complex topic!

This website was created to make rosacea easier to understand. I’ll  share dozens of helpful tips and tricks for beating rosacea and give the up-to-date information from leading medical websites.

From here you could read:

Do Moisturizers Reduce Rosacea?

When to use a Dermatologist

Male Makeup for Rosacea

Why Did I Create This Website?

Like most people eventually diagnosed with Rosacea, I didn't know what was wrong with my skin for several years. I developed rosy cheeks at the age of 28, then pimples started appearing when I was 30.

I thought it was adult acne and began applying a variety of acne creams. My skin continued to worsen and I thought my diet must have been to blame. I saw my local GP for other illnesses during this time and they never mentioned Rosacea.

A couple of years later, I experienced an eye infection that sent me to an eye specialist. It was only then that I learned that the issues with my skin were caused by rosacea and my eye problems were ocular rosacea.

Over the next 5 years I tried many treatment approaches, including antibiotics, supplements, special diets, and creams. After many failures, I finally reached a point where I was happy with my skin again!

So, I have created this website to share some information about my journey and the approaches that I have found to be effective. I will also be writing about new developments in rosacea research and lifestyle adaptations that reduce the symptoms of rosacea.

My goal is to help other rosacea sufferers learn more about their condition and find find effective approaches that improve the quality of their skin. I also hope to bring rosacea sufferers together to share information on the approaches that work for them.

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