The Best Topical Treatment for Rosacea
Rosacea is a common condition that causes redness and inflammation in the skin. The exact cause of rosacea is unknown but the facial flushing and redness caused by rosacea flare ups can be very distressing. Rosacea can cause acne symptoms too, ranging from small red spots called papules to pus filled spots called pustules and even moderate to severe rosacea related acne where the skin becomes very inflamed, red and angry.
Treatment can help to keep rosacea under control and due to the fact that rosacea is a chronic skin condition, many treatments are topical, meaning that they’re applied to the areas of the skin directly affected by rosacea symptoms.
Topical treatments are often the first line of treatment for mild to moderate rosacea where there are not many papules and pustules present. However, your treatment options will depend on the severity of your condition and your doctor may prescribe a topical ointment, gel or cream or perhaps a course of oral antibiotics.
The Best Topical Treatment for Rosacea Prone Skin
The best prescription topical treatments for rosacea generally consist of a carrier ingredient such as glycerin plus an active ingredient and can vary in form, for example, water based gels vs oil based creams and ointments.
It’s important to remember, everyone’s skin is different and will react differently to different treatments. So what works for someone you know, might not work for you. But all is not lost, below is a list of some of the best treatments for rosacea so that you together with your doctor or dermatologist, you can experiment and figure out the most effective treatment for you and your skin.
Metronidazole Antibiotic Cream to Reduce Inflammation
Metronidazole is an antibiotic often prescribed orally for the treatment of skin infections and gum disease as well as bacterial vaginosis and pelvic inflammatory disease. It reduces bacterial growth in the place of infection which leads to a reduction in general inflammation.
This antibiotic is also one of the most commonly prescribed treatments for acne rosacea. It’s often used to treat rosacea symptoms in the form of a cream or gel. Metronidazole cream is often referred to by its brand name, Rosiced or Rozex. The gel is marketed under the brand names Acea, Anabact, Metrogel, Metrosa or Zyomet. It helps to reduce the inflammation and redness associated with rosacea.
Using metronidazole has possible side effects including developing a metallic taste in the mouth as well as diarrhoea and vomiting, but these are more common when taking it orally for conditions other than as a treatment for acne rosacea.
Take care not to drink alcohol while using any product containing metronidazole as it may lead to a worsening of any side effects plus heart palpitations and hot flushes.
Can Rozex Make Rosacea Worse?
Rozex is a cream that contains metronidazole and doesn’t usually cause a worsening of rosacea symptoms. But if you notice that your skin feels worse after using Rozex, speak to your doctor.
Azelaic Acid Cream and Gel to Help Treat Rosacea Symptoms
Azelaic acid is another one of the topical treatment plan options for rosacea. It kills the skin bacteria that cause inflammation and reduces the production of the skin protein keratin and protease activity that can contribute to rosacea.
Creams and gels that contain azelaic acid are sold under the brand names Dermaz 99, Crema Pella Perfetta, Azepur99, Azetec99, Azaclear, AzClear Action, Azelex, White Action cream, Finacea.
Azelaic acid is an effective best treatment for rosacea, but there are side effects that include skin itching, burning and tingling. High concentrations or prolonged treatment can cause skin peeling.
Ivermectin Cream as a Rosacea Treatment
Ivermectin is a medication used to treat parasitic infections. The precise mechanism of its effectiveness in rosacea treatment is not known but is thought to be connected to the control of the skin mite, Demodex.
In clinical trials, topical ivermectin was more effective in reducing rosacea symptoms than the standard treatment with metronidazole.
Possible side effects include an itching or burning sensation. Prolonged treatment can harm the nervous system so check with your prescribing doctor how long you may be able to safely use this product for.
Brimonidine Tartrate for Ocular Rosacea
Brimonidine tartrate is a medication prescribed for the regulation of pressure in the eye in patients with glaucoma and hypertension. It’s also effective against ocular (eye) rosacea symptoms. Brimonidine constricts, or narrows, the blood vessels in the eyes, causing a relaxation of the eye muscle and the drainage of excess fluid in the eye.
It’s prescribed in the form of eye drops or eye creams with the brand names Alphagan, Alphagan-P, Mirvaso Lumify.
Common side effects include itchiness and a dry mouth as well as skin inflammation at the site of application (a skin condition called contact dermatitis).
Another treatment or rosacea is a retinoid that's applied directly to the skin. Retinoids are compounds similar to vitamin A. They work by regulating skin cell turnover and are commonly prescribed as an intervention for rosacea that's associated with acne symptoms.
Synthetic retinoids have a much stronger effect than vitamin A but may also have stronger side effects, including hair loss, skin dryness and itching. Isotretinoin is the most potent retinoid and cannot be used during pregnancy.
Accutane form a Dermatologist
Accutane (or Roaccutane) is a pill that contains isotretinoin, a potent retinoid, and is prescribed for severe acne. It can also be prescribed as one of the last ways to treat rosacea. Isotretinoin is the most potent retinoid that regulates skin cell turnover and decreases sebum production.
However, Accutane has a high concentration of retinoids and can cause side effects. If you suspect that Accutane may be causing side effects as listed above, speak to your doctor who can prescribe a formulation with a lower dose of isotretinoin. Rosacea can be distressing but the right type of treatment is one that doesn't add to your upset with harsh side effects.
Sodium Sulfacetamide-Sulphur to Manage Symptoms of Rosacea
This is a combination of two compounds sulfacetamide and sulphur. Sulfacetamide is a sulfonamide, a group of compounds that were used before the invention of modern antibiotics. Like antibiotics, they reduce bacterial growth, therefore, reducing skin inflammation. Sulphur is an even older anti-infection compound which also removes excessive dead skin cells from the pores. As such, rosacea may reduce by using these compounds together.
Sodium sulfacetamide-sulphur is effective against several skin inflammation conditions such as pustular acne and rosacea. Side effects are mild, mostly possible irritation at the site of application.
Benzoyl Peroxide to Reduce Rosacea Redness
Benzoyl peroxide is a skin-clearing agent. It kills bacteria and reduces inflammation. It has been used in skin treatments for several decades and has shown its efficacy in clinical trials. Benzoyl peroxide is typically applied to the affected areas in gel, cream, or liquid form.
Common side effects of topical medications that contain benzoyl peroxide include peeling, itching and dryness of the skin where it’s been applied. Higher concentrations lead to more intense side effects so always start with a low dose.
Afrin Medication to Constrict Blood Vessels
Afrin is a topical decongestant that reduces runny nose symptoms and is manufactured in the form of a spray. It’s approved for use in rosacea as it constricts the facial blood vessels that are the cause of the redness of rosacea.
The spray should be used according to the instructions and only in the nose and on the areas of skin experiencing rosacea symptoms. Prolonged use may damage the lining of the nose.
Permethrin May Work for Rosacea
Permethrin cream is a medication used against insects such as lice, mosquitoes and mites. Side effects include rashes and irritation where it’s been used on the skin. There are several studies where permethrin was concluded to be effective against mild rosacea.
Facial Oils For Rosacea
As well as prescribed topical treatment for rosacea, there are some facial oils that are available from salons, beauty brands and even supermarkets, that may help.
Facial oils to help manage the symptoms of rosacea include:
Ozonated Olive Oil
Sönd Concentrated Ozonated Olive Oil can be effective for rosacea prone skin. Ozone therapy with olive oil helps to reduce the effects of inflammation on the skin. This is in part due to the reduction of chemicals that promote inflammation called cytokines and the activation of different cytokines that have a positive, anti-inflammatory effect.
Ozonated olive oil can also help to reduce the bacteria on the skin that can lead to swelling and inflammation since it has an antimicrobial effect too. This allows for a faster healing of the skin.
Hemp oil doesn't contain THC, the hallucinogenic compound found in other cannabis derived products. It’s widely used in cosmetics, to smooth the skin and reduce fine wrinkles. There is also evidence that hemp oil can be used as a treatment for rosacea on the face.
Oil from coconuts contains lauric acid that can soothe irritated skin and has been used in the topical treatment of rosacea in folk medicine for generations. It doesn’t have pro-inflammatory properties, so there is no reason for it to irritate rosacea, especially if also taken internally.
Tea Tree Oil
Tea tree oil has been traditionally used for treating many skin conditions such as acne. It has anti-inflammatory properties so can be beneficial for rosacea. If a product has a high concentration of tea tree oil it may be too intense for rosacea treatment. So when using a new product do try on a small patch of skin to make sure there are no adverse effects.
Bio Oil is a trademarked formulation that is used to alleviate skin problems such as stretch marks and scars, including acne scars. Essentially, it’s a mineral oil as a base with retinol and essential plant oils dissolved in it. Mineral oil is a known occlusive which means that it protects the skin.
There is no systematic research on Bio Oil efficiency in treating rosacea. It may be helpful in some cases, but there are cheaper oils with fewer ingredients - and fewer components lessen the chance of triggering rosacea.
Fish oil rich in omega-3 fatty acids is one of the compounds that relieve rosacea symptoms. There are randomised controlled scientific studies proving that regularly taking fish oil, for example, in the form of capsules, relieves symptoms of even advanced rosacea.
The Use of Natural Treatments for Rosacea
At Sönd, we advocate for a natural, holistic approach to skincare first. We completely understand the need for medicated topical treatments for rosacea, but here’s some natural alternatives that may also help.
Aloe vera is one of the most efficient natural emollients - compounds that soothe and smooth the skin, and is recommended as a natural treatment for rosacea due to its naturally soothing properties.
Green tea is rich in antioxidants that are good at preventing and reducing inflammation. The compounds derived from this type of tea are shown to diminish the symptoms of rosacea. Green tea can be used as a topical treatment for rosacea, in the form of a compress of cold tea applied to the skin affected by rosacea.
Simply soak a clean piece of gauze in cool green tea and gently apply to the affected area. Leave the gauze pressed onto the skin for 20 minutes and repeat daily.
Consuming burdock is a home remedy recommended for people with rosacea because it has a positive effect on the gut bacteria. There is a connection between gut health and rosacea, but there are no clinical trials so far that confirm this as yet. There are no known side effects so it is worth trying.
Chamomile is one of the most popular herbal remedies due to its proven anti-inflammatory effect. Compresses and salves with chamomile flowers can improve rosacea symptoms, and there are no known side effects.
Feverfew is a plant from the same family as Chamomile and has similar flowers. Feverfew flowers have an anti-inflammatory effect that has been confirmed in several clinical studies. It is shown to be effective in the reduction of rosacea symptoms and has no known side-effects.
Turmeric is a spice widely used in Middle Eastern cooking. Turmeric and its constituents constrict capillaries and have antioxidant, anti-inflammatory and wound-healing properties. It is one of the most promising anti-rosacea compounds. Clinical trials show that taking a course of pills that contain turmeric reduces rosacea symptoms such as facial redness.
Liquorice root contains compounds that work as anti-irritants and sensitivity regulators. A study has shown that a skincare regime that included liquorice-derived compounds have improved rosacea symptoms in a significant number of participants.
Oatmeal is a traditional humectant and emollient frequently used for inflammatory skin conditions, including rosacea. There are no known side effects and it is safe to use. Use oatmeal as a mask to help soothe rosacea symptoms.
Extract from wild chrysanthemum has anti-inflammatory and UV protection properties. It also improves the elasticity of blood vessels. In a clinical trial where the participants with moderate rosacea applied a cream with wild chrysanthemum extract, they noticed a reduction in rosacea symptoms. Thus wild chrysanthemum is a promising natural remedy for rosacea treatment.
Quassia is a tree from South America with anti-parasitic properties. It’s used in traditional medicine to treat lice infestation and to improve digestion. A clinical trial has shown that applying quassia extract in the form of a gel improves rosacea symptoms such as spider veins, papules, and pustules.
Moringa is a small tree native to tropical regions of South Asia. It’s used for water purification and traditional herbal medicine. Moringa extract has antioxidant and UV protection properties. There are no clinical trials yet that prove moringa effectiveness against rosacea but preliminary studies look promising.
Pomegranate has a rich history symbolising prosperity and fertility. Extract of pomegranate has shown antioxidant and anti-hyperpigmentation properties. It’s one of the ingredients recommended for natural skincare as a topical application. Drinking pomegranate juice is also beneficial for skin conditions.
Bearberry is a dwarf shrub that grows in Arctic regions and is used in traditional medicine. A compound found in bearberry, arbutin, prevents skin pigmentation. It’s used in skin lightening products and is a promising compound as a topical treatment for rosacea.
Other Alternative Topical Treatment for Rosacea
Diagnosis and treatment of rosacea by a certified doctor or dermatologist is essential. But there are skincare products that can help you support your skin, alongside other treatments.
Milk of Magnesia
Milk of magnesia is a solution of magnesium hydroxide and is often used to treat heartburn and as a food additive. There is no research to confirm its effect on rosacea, but there are reports that it can help without causing adverse effects. Use milk of magnesia as a mask and apply it to the face and other body parts that experience rosacea symptoms.
Lactic acid is an organic acid found in sour milk products. It’s used in cosmetics as a humectant - a compound that attracts and retains moisture in the skin. Rosacea is characterised by dry, inflamed skin so humectants such as lactic acid are often used to relieve the symptoms of rosacea.
Glycolic acid is one of the organic acids widely used in cosmetics and beauty products to help keep the pores clear. It’s also a humectant and is usually safe for rosacea.
Living with Rosacea
Having rosacea can be upsetting and frustrating. But with our help, you can get your skin under control. Finding a treatment plan and avoiding triggers such as UV light, spicy foods, caffeine and alcohol can help you love your skin again.
https://www.nhs.uk/medicines/metronidazole/ Liu, R. H.; Smith, M. K.; Basta, S. A.; Farmer, E. R. (2006). "Azelaic acid in the treatment of papulopustular rosacea – A systematic review of randomized controlled trials". Arch. Dermatol. 142 (8): 1047–1052. doi:10.1001/archderm.142.8.1047. PMID 16924055.
This article is not meant to treat or diagnose. Please visit your doctor for advice about any health concerns you may have.