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Topical treatments for rosacea

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Because rosacea is a skin disease, many treatments are topical and applied to the areas were the rosacea symptoms are. Topical treatments should be the first line of treatment of mild rosacea when there are not many papules and pustules.

Topical remedies consist of a carrier such as glycerin and an active ingredient and vary in form, for example, gel or cream. Here's some of the best products for rosacea

Metronidasole for rosacea

Metronidazole is an antibiotic often prescribed for treatment of skin infections, gum disease as well as bacterial vagina inflammation and pelvic inflammatory disease. It reduces bacterial growth in the place of infection which leads to a reduction in general inflammation.

Metronidazole is one of the most effective anti-rosacea treatments. It is often used to treat rosacea symptoms in the form of cream or gel. Metronidazole cream is called by the brand names Rosiced or Rozex. The gel is marketed under the brand names Acea, Anabact, Metrogel, Metrosa, Rozex or Zyomet.

Using metronidasole has possible side effects including metallic taste in the mouth as well as diarrhea and vomiting.

Do not take alcohol while using any product containing metronidazole as it may not only cause strong side effects but lead to hot flashes and heart-pounding and headaches.

Can Rozex make rosacea worse?

Rozex is a cream that contains metronidazole. Rozex does not usually cause worsening of rosacea symptoms. But if you notice that your condition is getting worse after Rozex application, contact your doctor.

Azelaic acid cream or gel

Azelaic acid has several effects beneficial for reduction of rosacea symptoms. In high concentrations, it kills bacteria that cause inflammation. It also reduces the production of the skin protein keratin and protease activity.

Creams and gels that contain azelaic acid sold under the brand names Dermaz 99, Crema Pella Perfetta, Azepur99, Azetec99, Azaclear, AzClear Action, Azelex, White Action cream, Finacea.

Azelaic acid is effective, but there are side effects that include skin itching, burning, or tingling. High concentration or prolonged treatment can cause skin peeling.

Ivermectin cream for rosacea

Ivermectin is a medication used to treat parasitic infections. The precise mechanism of its effectiveness in rosacea treatment is not known but probably connected to the control of skin mite, Demodex. In clinical trials, ivermectin was more effective in reducing rosacea symptoms than the standard treatment with metronidazole.

Possible side effects include itching and burning sensation. Prolonged treatment can harm the nervous system.

Brimonidine tartrate for rosacea

Brimonidine is a medication prescribed for the regulation of eye blood pressure such as glaucoma and hypertension. It is also effective against ocular rosacea symptoms. Brimonidine constricts eye blood vessels, relaxation of the eye muscle and excess liquid drainage.

It is prescribed in the form of eye drops or eye creams with brand names Alphagan, Alphagan-P, Mirvaso Lumify.

Common side effects include itchiness and a dry mouth as well as skin inflammation on site of application (contact dermatitis).

Retinoids for rosacea

Retinoids are compounds similar to vitamin A. They work by regulating skin cells turnover. Retinoids are prescribed and effective for several skin conditions such as severe acne and rosacea.

Synthetic retinoids have a much stronger effect than vitamin A but may have strong side effects, including hair loss, skin dryness, and itching. Isotretinoin is the most potent retinoid that cannot be used during pregnancy.

Accutane for rosacea

Accutane (or Roaccutane) is a pill that contains isotretinoin, a retinoid. Accutane is prescribed for severe acne and rosacea treatment. Isotretinoin is the most potent retinoid that regulates skin cells turnover and decreasing sebum production.

However, Accutane has a high concentration of the compound and can cause side effects. If you suspect that Accutane makes rosacea worse in your case, contact your doctor who can prescribe a formulation with a lower dose of isotretinoin.

Sodium sulfacetamide-sulfur

This is a combination of two compounds sulfacetamide and sulfur. Sulfacetamide is a sulfonamide, a group of compounds that were used before the invention of modern antibiotics. Like antibiotics, it reduces bacterial growth, therefore, reducing skin inflammation. Sulfur is an even older anti-infection compound which also removes excessive dead skin cells e.g., has a keratolytic effect.

Sodium sulfacetamide-sulfur is effective against several skin inflammation compounds such as pustular acne and rosacea. Side effects are mild, mostly possible irritation on the site of application.

Benzoyl peroxide for rosacea

Benzoyl peroxide is a skin-clearing agent. It kills bacteria and reduces inflammation. It has been used in skin treatment for several decades and 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 in application places. Higher concentration causes side effects more frequently.

Afrin for rosacea

Afrin is a topical decongestant that reduces runny nose symptoms and is manufactured in the form of a spray. It is FDA approved for use in rosacea as it constricts the face blood vessels that are the cause of rosacea.

The spray should be used according to the instructions, e.g., in the nose and on places of rosacea symptoms. Prolonged use may damage nose lining.

Permethrin for rosacea

Permethrin is a medication used against insects such as lice and mosquitoes and mites. The compound is used in the form of cream. Side effects include rash and irritation at the area of use. There are several studies where permethrin was concluded to be effective against rosacea in a mild form.

How to get rid of demodex mites in rosacea

Demodex mites are inhabitants of sebum oil glands on the skin including the face. Some rosacea sufferers have Demodex on their skin but rosacea symptoms are usually not caused by them unless there was a sudden demodex infestation.

If you want to get rid of Demodex, it’s important to use treatments that will not exacerbate your rosacea. Wash face with a mild cleanser twice daily. Use diluted tea tree oil on face and eyelids. Change your bedding frequently. Wash it in hot water and use a tumble drier. Avoid oil-based makeup, change it frequently and do not exceed its “best before date”.

In cases of severe Demodex proliferation, the doctor can prescribe products containing metronidazole or ivermectin.

Oils that help rosacea

Does hemp oil help rosacea?

Hemp oil is produced by hemp plants that were bred for technical purposes and don’t contain THC, the hallucinogenic compound. Hemp oil is widely used in cosmetics, to smooth the skin and reduce fine wrinkles.

Cosmetic industry and sellers of hemp-derived products report that hemp oil alleviates symptoms of rosacea. However, there is no scientific evidence that confirms these claims so far. On the other hand, there are no reports that hemp oil makes rosacea worse.

Is coconut oil food for rosacea?

Oil from coconuts contains lauric acid that can soothe irritated skin and it has been used in the topical treatment of rosacea. It doesn’t have proinflammatory properties, so there is no reason for it to irritate rosacea, especially if taken internally.

Is tea tree oil good for rosacea?

Tea tree oil is 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. When using a new product do try on a small patch of skin to make sure there are no adverse effects.

Does bio oil help rosacea?

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.

Does fish oil help 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.

Natural ingredients for rosacea

While it is possible to combine some of the plant remedies, you need to make sure that they don’t clash due to the active ingredients interactions.

Will aloe vera help rosacea?

Aloe vera is one of the most efficient natural emollients, e.g., compounds that soothe and smooth the skin and is recommended as a rosacea remedy.

Can aloe vera make rosacea worse? Unlikely on its own. However, it can be listed as just one ingredient in the commercial formulation. Several other compounds in the same preparation can cause rosacea.

If you suspect that a particular cream or lotion causes rosacea, you should stop using it immediately.

Is green tea good for rosacea?

Green tea is rich in antioxidants that are good in preventing and reducing inflammation. The compounds derived from this type of tea are shown to diminish the symptoms of rosacea. Green tea should be used as a topical agent, for example as part of topical applications or in compresses of cold tea in the places of rosacea outbreaks.

Does burdock help rosacea?

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 burdock effect on rosacea. There are no known side effects so it is worth trying.

Is chamomile oil good for rosacea?

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.

Can feverfew help with rosacea?

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 mitigation of rosacea symptoms and has no known side-effects.

Is turmeric good for rosacea?

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.

Is licorice good for rosacea?

Licorice root contains compounds that work as anti-irritants and sensitivity regulators. A study has shown that a skincare regime that included licorice-derived compounds have improved rosacea symptoms in a significant number of participants.

Use oatmeal masks for rosacea

Oatmeal is a traditional humectant and emollient frequently used for inflammatory skin conditions, including rosacea. There are no known side effects and is safe to use. Use oatmeal as a mask on the places of rosacea symptoms.

Can wild chrysanthemum help with rosacea?

Extract from wild chrysanthemum has anti-inflammatory and UV protection properties. It also improves the mechanical elasticity of blood vessels. In a clinical trial where the participants with moderate rosacea applied a cream with wild chrysanthemum extract, they have had a reduction in rosacea symptoms. Thus wild chrysanthemum is a promising natural remedy for rosacea treatment.

Can quassia help with rosacea?

Quassia is a tree from South America with antiparasitic properties. It is 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 gel improves rosacea symptoms such as spider veins, papules, and pustules.

Is moringa beneficial for rosacea skin?

Moringa is a small tree native to tropical regions of South Asia. It is used for water purification and traditional herbal medicine. Moringa extract has antioxidant and UV-protection properties effective in the protection of skin cells. There is no clinical trials yet that prove moringa effectiveness against rosacea but preliminary studies look promising.

Moringa is also recommended for women experiencing menopausal symptoms.

Is pomegranate good for rosaccea?

Pomegranate has a rich history symbolising prosperity and fertility. Extract from pomegranate has shown antioxidant and anti-hyperpigmentation properties. It is one of the ingredients recommended for natural skincare as a topical application. Drinking pomegranate juice is also beneficial for skin conditions.

Use bearberry for rosacea

Bearberry is a dwarf shrub that grows in Arctic regions andis used in traditional medicine. A compound found in bearberry, arbutin, prevents skin pigmentation. It is used in skin lightening products and a promising compound as a topical treatment for rosacea.

Inorganic compounds for rosacea

Milk of magnesia for rosacea

Milk of magnesia is magnesium hydroxide. It’s 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.

Milk of magnesia is used as a mask. It is applied to the face and other body parts that have rosacea symptoms and regularly used for several weeks.

Can lactic acid help rosacea?

Lactic acid is an organic acid found in sour milk products. It is 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.

Is glycolic acid safe for rosacea?

Glycolic acid is one of the organic acids widely used in cosmetics. It is a humectant e.g., a compound that attracts and retains water on the skin. Commercial formulations that contain glycolic acid are usually safe for rosacea.

Topical products to avoid during rosacea

Selsun blue

Selsun Blue is a medicated shampoo used for seborrheic dermatitis. Its main ingredient is salicylic acid, a powerful drying agent. Salicylic acid should not be used to treat rosacea skin. As a harsh treatment, it will most likely make rosacea worse.

Charcoal will dry skin making rosacea worse

Charcoal has a powerful drying effect on the skin. People with rosacea have dry, prone to irritation skin. Therefore, charcoal will not help and most likely will make the condition worse.

Sudocrem will worsen rosacea Symptoms by drying skin

The main ingredient of Sudocrem cream is zinc oxide that has drying properties. The problem with rosacea skin that it has too little moisture. Using Sudocrem will most likely worsen the symptoms.

Ingredients to avoid during dosacea

Avoid witch hazel for rosacea

Witch hazel is a popular and efficient remedy for acne. However, it has an opposite effect on rosacea as witch hazel containing solutions often irritate rosacea skin.

Do not use comfrey for rosacea

Comfrey is a popular natural remedy for skin abrasions and inflammatory conditions. However, it is highly toxic, especially to the liver, which leads to the prohibition of comfrey consumption. There are clinical trials that show the effectiveness of comfrey-derived compounds in rosacea treatment. But it’s important to understand, that these remedies had the alkaloids removed before use. Therefore, it’s better not to use raw and untreated comfrey for rosacea treatment.

Salicylic acid

Salicylic acid is commonly used to treat acne. However, it has a strong drying effect. Salicylic is detrimental for mature skin in general and especially for rosacea as itcan make rosacea worse.

Apple cider vinegar

Apple cider vinegar is a product of fermentation of apple juice. Some studies show its efficiency as an antimicrobial and immunostimulating agent. However, no reports are investigating if apple cider vinegar helps rosacea. It will certainly not do any harm taken internally with sufficient dilution as a part of a healthy diet. Applying it to the skin is dangerous because it can have adverse effects.

Steroid hormones

Steroid hormones increase inflammation exacerbating rosacea symptoms. You need to avoid steroid hormones in medication such as nasal sprays. You should absolutely avoid taking hormonal supplements for increasing muscle mass.

Cortisone

Cortisone is a steroid hormone. Rosacea is triggered by steroid hormones in any form. Therefore, cortisone - containing cream is bad for rosacea.

Sources:

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.

https://www.nice.org.uk/advice/esnm68/chapter/Key-points-from-the-evidence

https://www.ncbi.nlm.nih.gov/pubmed/28837365

https://www.drugs.com/npp/comfrey.html

https://www.ncbi.nlm.nih.gov/pubmed/30077837

https://www.ncbi.nlm.nih.gov/pubmed/?term=pomegranate+rosacea

https://onlinelibrary.wiley.com/doi/full/10.1111/j.1529-8019.2007.00147.x


Hannah de Gruchy BSc(Hons)

About Author

Hannah de Gruchy is a freelancer writer who specialises in health and wellness. She has a keen interest in the biology of skin and loves using her words to help separate the real science of skincare from the pseudoscience of some skincare brands. Hannah has a degree in Human Biology and many years’ experience working in laboratories around London. Using this experience, Hannah enjoys turning complex science into interesting, engaging and easy to digest pieces to read. In her spare time, Hannah runs, practices yoga and loves cooking plant based foods.

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