What are the treatments for rosacea?

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What are the treatments for rosacea?

There is no permanent cure for rosacea. There is nothing you can do to prevent rosacea from starting. However, treatments can ease symptoms. The treatments used may vary, depending on what symptoms develop. Treatment may need to be adjusted over time depending on the response to treatments, and the unpredictable course of the condition.

General measures

Avoid strong sunlight to the face. Sunlight is thought to make symptoms worse. Use a sun-block cream on the face with a high protection factor (15 or higher and with UVA and UVB protection). It is difficult to say what is 'strong sunlight' and so many doctors would advise that you apply sun-block every day before you go out, whatever the level of sunshine. A wide brimmed hat will also help to protect your face from the sun.

Treatment for facial flushing

There is no medicine that can prevent flushing. However, some people find that certain things aggravate the skin and make the flushing worse. The most common things reported are: extremes of temperature (in particular excessive heat), alcoholic drinks, strenuous exercise, stressful situations, sunlight, spicy food, hot drinks. If any of these seem to make the flushing worse then avoiding them is sensible.

Some medicines used for other conditions may also trigger flushing. For example, calcium-channel blockers. If you suspect a medicine is making the flushing worse, then discuss this with your doctor. An alternative medicine may be available.

Treatment for persistent facial redness (erythema) and telangiectasia (tiny blood vessels)

There is little evidence that medication has any effect to clear erythema or telangiectasia. However, a treatment listed below (for spots) may be advised to prevent spots from developing if you have persistent erythema.

Also, people with erythema often have sensitive skin which can make things worse. Therefore, it is best to avoid using anything that may sensitise the skin. For example, cleansers containing acetone or alcohol, abrasive or exfoliant preparations, oil-based or waterproof make-up, perfumed sun-blocks or those containing insect repellents.

Camouflage creams can help to cover and conceal erythema and telangiectasia.

Another option for telangiectasia is laser therapy. Very briefly, a fine laser can destroy tiny blood vessels under the skin.

Treatment for spots and cysts (papules and pustules)

Certain antibiotics are the usual treatment. They usually work well, but it is not clear why they work as there is no proven germ that causes rosacea. Some antibiotics reduce inflammation in the skin as well as kill germs and this may be why they work for rosacea. A topical (rub on) antibiotic called metronidazole is the common treatment if you have just a few small spots. If you have many spots or cysts then antibiotic tablets called tetracyclines or erythromycin are commonly used.

Some improvement may occur after 2-3 weeks of treatment. However, it commonly takes a 6-12 week course of antibiotics to clear spots and cysts. One reason why antibiotic treatment fails is that some people give up on treatment after a few weeks without completing the full course.

When a course of treatment is finished, the spots or cysts commonly return at some point. Therefore, in many cases, repeated courses of treatment are needed from time to time. As an alternative, once the spots have cleared, some people take a regular 'maintenance' dose of topical metronidazole long-term to prevent the spots and cysts from returning.

Topical azelaic acid is an alternative to topical antibiotics to treat mild to moderate spots.

Treatment for eye problems

Eye symptoms, if they occur, are often mild and may not need any treatment.

·	If dryness of the eyes is a problem then regular use of artificial tears will help. (See separate leaflet called 'Dry Eyes' for details.)

·	If eyelid inflammation (blepharitis) is a problem then regular eyelid hygiene will help. This is described in detail in a separate leaflet called 'Blepharitis'.

·	If eye symptoms become troublesome, a course of antibiotic tablets (as described above) will usually settle the symptoms.

·	If a more serious eye problem occurs then you will need to be referred to an eye specialist for treatment. For example, steroid drops may be advised by a specialist to treat inflammation of the cornea (an uncommon complication of rosacea).

Treatment for rhinophyma

Rhinophyma (an unsightly bumpy nose) is an uncommon symptom of rosacea. If it occurs, surgical or laser treatment usually works well.

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Dovonex : This medication is a form of vitamin D. It is used on the skin to treat psoriasis.

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Lamisil : This medication is an antifungal used on the skin to treat skin infections such as athlete's foot, jock itch or ringworm.

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