Diagnosis and Treatment
The diagnosis for rosacea is based on recognition of its signs and symptoms by a doctor. There is no lab test for this condition.
Although there is no cure for rosacea, a number of treatment options are available to help control it. Treatment for rosacea is typically a long-term process. It can take one to two years to bring the disorder under control, and lifelong treatment is often necessary. However, in some cases the condition resolves quickly and goes into permanent remission.
The first line of treatment for rosacea is learning to avoid its triggers. Keep a diary of your rosacea flare-ups to help you determine which of the following triggers affect you most:
- Extreme temperatures and temperature changes, including moving from inside to outside
- Strenuous exercise
- Heat from sunlight
- Severe sunburn
- Stress and anxiety
- Fragranced soaps and soap-based cleansers
- Certain food and drinks, including caffeine, spicy foods and foods containing histamines, such as cheese, fermented soy products, vinegar, alcohol and other fermented foods
- Certain medications and topical irritants, such as blood-pressure drugs, microdermabrasion, chemical peels, high doses of isotretinoin, benzoyl peroxide, tretinoin, topical steroids and demodex mites (tiny mites found in the hair follicles)
Several approaches can relieve rosacea symptoms. Some of the treatments, like laser and light therapy, act by reducing skin thickness and the size of visible blood vessels. For more serious cases of rosacea, one involving papules or pustules, more aggressive anti-inflammatory or antibiotic treatment might be recommended. These treatments will reduce redness by dampening the reaction of your immune system or by killing invading bacteria.
Topical treatments (creams, gels, ointments)
Antibiotic/steroid combinations are used to treat rosacea that affects the eyes. These medications target bacteria and reduce inflammation and immune system activity. To use, apply one or two drops to affected eyes every one or two hours for several days. Following this, apply one or two drops three or four times daily. You should not use this type of drug if you have a viral or fungal infection of the eye, or if you have tuberculosis. These medications may increase pressure within the eyeball; this should be checked regularly if you use these products for more than 10 days.
Laser and light therapies can treat skin thickening on the nose and face, redness, and the dilated blood vessels associated with rosacea. Lasers selectively target excessive tissue and blood vessel lesions while reducing damage to surrounding skin. A health professional will administer laser treatments. Your condition may be resolved after one treatment, but may require several visits, separated by three to eight weeks. Common side effects include bruising and fluid accumulation around the site of treatment.
Metronidazole is a topical anti-inflammatory cream used to treat papules, pustules and erythema of rosacea. The medication is applied to the affected area after washing once in the morning and once in the evening. Metronidazole can irritate the eyes, so apply the cream carefully to the face and avoid the eye area. Tell your doctor if you have a history of blood disorders. Reported side effects include skin sensitivity, burning and itching.
Mild skin cleansers gently remove oil and dirt from the skin without increasing irritation. Although cleansers are not a specific treatment for rosacea, they are included here because good skin hygiene is important for rosacea. To use, cleanse affected and unaffected areas each morning and evening before applying topical medications.
Antibiotics (e.g., tetracyclines, including minocycline and doxycycline) are prescription medications that can improve rosacea. Some antibiotics are approved for rosacea, while others are approved only for use against acne but may be effective in treating rosacea. To use, take the antibiotic pills as prescribed, usually twice a day for at least six months. Prepare for long-term treatment; effects will be evident after one month, but treatment may continue for at least eight months. Side effects include an upset stomach.
Other medications officially approved for treating other conditions and diseases have been tried in rosacea with variable success. Some medications are approved for rosacea in other countries, but not in Canada. These prescription medications are included here for information only: erythromycin/benzoyl peroxide/tretinoin combination products, beta blockers (e.g., labetalol, propranolol, atenolol), clonidine, isotretinoin, and azelaic acid.
As research continues into rosacea, researchers may be developing new drugs to treat it.
*All information on medical treatments on this site is provided as an overview only. For a complete and up-to-date list of side effects, warnings and precautions, read the product’s package insert and consult your doctor or a pharmacist.
**If you are considering an alternative or complementary therapy, discuss it with your doctor first, and always be sure to keep your doctor up to date about any vitamins, supplements, or other forms of alternative treatment you are taking. Like any medication, alternative therapies can interact with other medications/treatments and, in some cases, have side effects of their own. Remember that “natural” does not necessarily mean “safe.”