Patient information from BMJ

Rosacea: what treatments work?

Last published:Jan 18, 2023

Rosacea is a skin condition that mostly affects the face. The main symptom is redness. In many people the condition comes and goes, and attacks are 'triggered' by certain things, including changes in the weather.

Rosacea can’t usually be cured. But treatments can help keep it under control. You can use our information to talk to your doctor about the best treatments for you.

What treatments work?

Rosacea is a skin condition that mostly affects the cheeks, chin, nose, and forehead. But it can also affect parts of the upper body.

Rosacea causes different symptoms in different people, including:

• occasional flushing (redness)

• permanent redness

• visible small blood vessels (sometimes called 'spider veins')

• spots

• rough or swollen skin, and

• raised lumps (nodules) on the skin.

For more background information on rosacea, see our leaflet: Rosacea: what is it?

Rosacea is a complex condition that we don’t know enough about. Treatment can be hard to get right, and you might need to try several treatments before you find something that works.

The results of treatments can vary a lot. Some people find that treatment helps a lot, while some people find that nothing they try makes much difference. We don’t yet know why this is.

Staging rosacea

Treatment for rosacea depends on:

• which type or types you have (doctors call these 'subtypes'), and

• how severe your symptoms are - which is the same as saying what 'stage' they are at.

Like dividing rosacea into subtypes, staging is another way of guiding doctors towards the best treatments for individual people.

Doctors divide rosacea into four stages, which basically describe what stage the redness has reached:

• Stage 1 is flushing that comes and goes.

• Stage 2 is when the redness doesn’t go away.

• Stage 3 is when you get spots as well as redness.

• Stage 4 is when you can see swollen spider veins.

Treatments for redness and swelling

The main first treatment for most types of rosacea is antibiotic cream. Antibiotics are usually used to kill bacteria. But they are used to treat rosacea because they also reduce redness and swelling.

People with more severe symptoms might also need to take antibiotics as pills, or to use other prescription creams that can reduce inflammation.

Once your treatment starts to work, you should use it for as long as you need to, or for as long as your doctor advises.

If you find that the treatment isn’t working, talk to your doctor about trying something else.

If your treatment has worked well your doctor might suggest reducing the dose or stopping for a while. You might find that your symptoms stay away for a long while before you need treatment again. But some people need to start treatment again quickly.

Side effects of antibiotics

Like all medicines, antibiotics can cause side effects in some people. The creams shouldn’t cause you any problems. But the tablets can cause things like diarrhoea, bloating, and loss of appetite.

If you have side effects that bother you, talk to your doctor. You might be able to try a different treatment or reduce your dose.

If antibiotics don’t work for you, you might be able to try a drug treatment called isotretinoin, which is usually used to treat severe acne. But taking isotretinoin pills can sometimes cause serious side effects, including aggression and muscle problems.

You should never take isotretinoin if you are pregnant or planning to become pregnant.

Treatments for other symptoms

Antibiotics can work well to reduce redness and simple swelling. But for more severe symptoms there are other things you can try.

For spider veins your doctor might suggest medicines that work by reducing the swelling in the veins in the face.

Or, if your symptoms are severe or they bother you a lot, you could try laser therapy. This works by using a laser to damage the veins so that they shrink to the point where you can’t see them any more.

Extra treatments that can help for ocular rosacea include:

• regular cleaning of your eyes, and

• using eye drops that contain 'artificial tears'. This helps if your eyes become inflamed because they get too dry.

For thickened skin and nodules (phymatous rosacea) there are some procedures designed to remove excess swollen tissue without scarring, such as:

• surgery

• laser treatment, and

• electrosurgery.

These treatments might seem extreme. And some people decide that they don’t want surgical procedures.

If your symptoms bother you a lot but you are unsure about surgery, talk to your doctor about these procedures. He or she should explain exactly how the treatments work.

Preventing attacks of rosacea

If you have rosacea symptoms that come and go, it’s a good idea to find out what triggers the attacks. We know what the general triggers are, but they’re not always the same for everyone.

So you could try keeping a diary to track things that might cause you problems. For example, note in your diary the day that you do things like eating spicy foods, and drinking alcohol or hot drinks.

One of the main triggers for rosacea attacks seems to be sun exposure, so you could try things such as:

• using sunscreen on your face every day

• avoiding the midday sun, and

• wearing a wide-brimmed hat in the sun.

Some cosmetic products can trigger symptoms in some people. You might want to note whether this affects you, and change the soaps and cosmetics you use, depending on what seems to cause you problems.

What will happen?

It’s not possible to say what will happen to you as an individual. Rosacea symptoms vary greatly from person to person.

Some people have symptoms so mild that they choose to have no treatment other than doing their best to avoid things that trigger attacks.

Other people have severe symptoms that affect their confidence and self-esteem to the point that they decide to have a surgical procedure.

Treatments work better for some people than for others. Some people find that their symptoms clear up very well with treatment, while others struggle to find anything that works.

If your symptoms make you unhappy and you would like more help from people who understand how you feel, you might be able to find an organisation that provides support and information to people with conditions that make them look different.

For example, in the UK, the charity Changing Faces (changingfaces.org.uk) has been helping people for many years.

Your doctor might be able to help you find a group in your area, or you could search online.