Treatment of Rosacea

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Pustules (pus-filled pimples) and papules (red pimples)

A topical (applied to the skin) antibiotic, metronidazole is commonly given as a gel or cream for the treatment of mild rosacea. You may see a slight improvement within the first month but it usually takes about two months to see a more definite improvement. Apply a thin layer of the gel or cream once or twice a day to the affected area(s), according to the label and patient information leaflet that is provided with your medicine. You will need to use it for two to three months or longer depending on the type of preparation used and the severity of the rosacea. If you are given topical metronidazole and you use a moisturiser, apply the moisturiser after the medication has dried. The moisturiser will also help to soothe the skin.

Topical metronidazole preparations sometimes cause irritant dermatitis, so the skin becomes more inflamed and itchy. If this happens, you should see your doctor, you may need to change to another treatment.

If you donâ€™t understand how to use your medicines, talk to your GP, your local pharmacist (chemist) or ring NHS Direct on 0845 4647.

Antibiotic tablets or capsules, taken by mouth (orally), are used if your skin does not respond to topical metronidazole or if you have a more severe form of the condition. You may be given antibiotic tablets or capsules in addition to a topical treatment. The antibiotics normally used are oxytetracycline or tetracycline or erythromycin. Doxycycline is sometimes used if oxytetracycline or tetracycline are considered not suitable for you e.g. if you have kidney failure. Oral antibiotics clear the spots on the face and prevent eye complications and rhinophyma (enlargement of the nose) before they develop.

Oral antibiotics usually work well, but it is not clear why they work, as a bacteria that causes rosacea has not been found. Some antibiotics reduce inflammation in the skin as well as kill germs and this may contribute to the way they work. Some improvement may be noticed after two to three weeks of treatment but you would normally have to take a course of between six and twelve weeks for them to work well.

The exact dose and when you should take it depends on the individual antibiotic. This is usually once or twice a day, depending on the antibiotic used. Read the label and patient information leaflet, provided with your medicine, carefully and always follow the instructions. Unless you experience some severe side effects and feel it necessary to stop treatment, complete the full course of antibiotics even if you think that the rosacea has cleared up. If you do not, the treatment may fail.

If you think you are experiencing particular side effects or donâ€™t understand how to use your medicines, talk to your GP, your local pharmacist (chemist) or ring NHS Direct on 0845 4647. See your GP before you run out of tablets, to discuss any further steps needed for your treatment.

These steps may include:

Extending the length of the course.
A smaller maintenance dose after you have completed the course to take over a long period of months or even longer, to keep rosacea from recurring.
A repeat course of antibiotics at a later date to keep the condition under control.
Referral to a dermatologist (skin specialist)

Isotretinoin belongs to a group of medicines known as retinoids, which are chemically related to vitamin A. It works by reducing the production of the skin's natural oil (sebum) and reducing the horny protein (keratin) in the outer layers of the skin. It can only be prescribed by, or under the supervision of, a consultant dermatologist and is reserved as an alternative when other treatments have failed. It has some potentially serious side effects such as liver damage and bowel inflammation. It may also cause abnormalities in the unborn child so effective contraception must be used during treatment and for at least a month before and after. The consultant dermatologist or doctor under his supervision will need to carry out a full clinical assessment and will explain benefits and harms to you about this medicine before it is prescribed.

Eye problems

If you develop eyelid inflammation (blepharitis) or any eye discomfort or stickiness, you should see your GP for the most appropriate treatment. Regular eyelid hygiene is the most important part of treatment and prevention of blepharitis. Eye problems are unlikely to occur in patients taking antibiotic tablets for rosacea.

Redness and flushing

Medicines used to treat pustules do not clear the redness or reduce the appearance of dilated blood vessels below the skin. Clonidine is sometimes used as a non-hormonal treatment for facial flushing during and around the menopause and so may help to reduce flushing attacks in rosacea during this period. However, there is little evidence to support its usefulness in the treatment of flushing in rosacea.

Over the counter medicines

Over the counter medicines are not effective for the treatment of rosacea and sometimes they may even make it worse.

For example, topical corticosteroid creams (such as hydrocortisone) would initially appear to help because they reduce inflammation but, when you stop using them, you could experience a severe flare up as they can mask the other symptoms.

However, discuss your condition with your pharmacist as they can provide advice on the use of moisturisers, sunscreens and soaps.

Cosmetic options

Your GP can prescribe camouflage creams to mask disfigurement of the skin. The British Red Cross offers a Cosmetic Camouflage Service, available nationally, to assist with the use of these creams, using simple cosmetic camouflage techniques.

Laser treatment for telangiectasia

Lasers use light energy, which is absorbed by the haemoglobin in blood and converted to heat, which causes the dilated red veins to shrink.

Surgery for rhinophyma

Rhinophyma can be treated surgically. The nose can be planed and shaped under anaesthetic. The nose is then dressed and forms a new layer of skin. A carbon dioxide laser can also be used to shrink the rhinophyma tissue.