Prescription Medicine and Beauty Procedures To Deal with Rosacea

Prescription treatment to manage the pimples and redness of rosacea, and coverings to eliminate the ‘damaged’ facial capillaries, are sometimes what brings a rosacea affected person to the dermatologist’s workplace. I’ve handled rosacea for over 30 years in my dermatology follow. On this article, I’ll share with you the way I exploit prescription lotions, oral medicines, and beauty procedures to assist my rosacea sufferers. I’ve rosacea myself, so I’ve additionally been on the receiving finish of a lot of what I’ll focus on.

It’s vital to notice that this info is for instructional functions solely and represents my opinions.  In case you assume that one thing you learn right here could also be useful for you, it’s good to focus on it along with your treating dermatologist. 

This text is the fifth article in my rosacea sequence. You will discover the opposite articles on the finish of the put up together with these with basic info on the signs and indicators of rosacea, how I management rosacea with a easy skincare routine, and my holistic method to rosacea that features the most effective weight loss plan and life-style decisions for lowering physiologic irritation that may result in pores and skin irritation, together with rosacea. 

The most effective rosacea medicines that I exploit in my dermatology follow.  

I’ll break this down into: 1) topically utilized prescription rosacea lotions and cleansers, 2) medicated non-prescription lotions and cleansers, 3) oral prescription treatment for rosacea therapy.

Professional-tip: By no means rely on a prescription alone to manage this cussed, power, and at occasions unrelenting pores and skin downside.  Add prescriptions to a rosacea-healing skincare routine to realize sustainable management of your rosacea. – Dermatologist Dr. Bailey

One of many largest causes that persons are annoyed with prescription rosacea therapies that they get from their medical doctors is that the docs give them a prescription however do not take the additional time to show them tips on how to handle their delicate rosacea-prone pores and skin. I see rosacea sufferers utilizing the mistaken irritating skincare merchandise for rosacea, and no quantity of prescription medication can battle that.

Your skincare routine will make or break getting management of your rosacea. – Dr. Bailey

I all the time add prescription topical medicines right into a rosacea-healing skincare routine. I name this a Full Pores and skin Care Routine™ and it provides pores and skin all the pieces it wants within the 4 important skincare steps of:

1. CLEANSE,
2. CORRECT,
3. HYDRATE,
4. PROTECT.

That is particularly vital for rosacea which is a situation that’s simply triggered by harsh cleansers, insufficient moisturizer use and even the slightest quantity of UV publicity. My Full Pores and skin Care Routine for rosacea is present in my Rosacea Remedy Equipment. I will clarify how I add prescription merchandise to a routine reminiscent of this.

What are the most effective medicated prescription facial cleansers for rosacea?

Sodium sulfacetamide and sulfur antibiotic cleanser for rosacea therapy

There may be just about only one prescription facial cleanser that I’ve discovered helpful for rosacea and it is sodium sulfacetamide and sulfur. I’ve sufferers use it a few times a day. Whether it is used as soon as every day, I’ve them alternate it with a pH balanced cleanser reminiscent of my Extraordinarily Light Foaming Facial Cleanser that comes alone or within the Rosacea Remedy Equipment. As a result of it’s an antibiotic, I all the time like to make use of it when wanted then take a ‘drug vacation’ to forestall antibiotic resistance. I do that by making an attempt to get my affected person’s complexion converted to Calming Zinc Cleaning soap (fortified with 2% pyrithione zinc, which isn’t an antibiotic, and that works to discourage pores and skin microbes by a broad mechanism of motion that doesn’t create resistant microbes). 

Sodium sulfacetamide is a sulfa antibiotic. It really works in opposition to a broad vary of pores and skin micro organism. When sulfur is added, it really works even higher and has efficacy in opposition to micro organism, fungi/yeast and a few parasites (assume presumably Demodex mites within the case of rosacea). This antibiotic cannot be utilized by people who find themselves allergic to sulfa medication. The sulfur additionally smells and may be drying however I typically discover this cleanser is nicely tolerated. We do not know the reason for rosacea, nor why antibiotics like sodium sulfacetamide work to deal with rosacea, however they’re a mainstay of rosacea remedy, each for topical and oral therapy. 

Most of my rosacea sufferers use Inexperienced Tea Antioxidant Pores and skin Remedy. In my follow, all prescription go away on merchandise are utilized after the Inexperienced Tea. 

Metronidazole cream and gel prescription for rosacea

Metronidazole is a prescription antibiotic that has been used topically to deal with rosacea for many years. It’s nicely tolerated. Relying on the power and the precise product it’s utilized a few times a day. 

Topical antibiotic foams and cream prescriptions for rosacea

There are different antibiotics used topically to deal with rosacea together with clindamycin, erythromycin and minocycline. Clindamycin has additionally been mixed with benzoyl peroxide and used for rosacea. These merchandise are available lotions, lotions, gels and options. They’re merchandise used to deal with different situations like zits and they also get tried on rosacea when medical doctors and sufferers are annoyed.

I take into account the gathering of topical antibiotics variations on a theme, I attempt to match the product to the affected person’s preferences for the way it feels on their pores and skin, what their insurance coverage covers and the way nicely it really works for his or her distinctive case of rosacea. As soon as the pores and skin is evident, I prefer to get them off antibiotics for a ‘drug vacation’ in order that we do not unbalance their pores and skin microbiome or create resistant micro organism.

We do not absolutely perceive why antimicrobial therapy works for rosacea. Philosophically and scientifically, I choose to do the antimicrobial inhabitants discount with non-antibiotic elements reminiscent of pyrithione zinc and benzoyl peroxide to keep away from creating antibiotic resistant microbes – Dr. Bailey

Different medicated prescription face lotions for rosacea

Azelaic Acid

Azelaic acid lotions, foams and gels (sometimes within the 15 to twenty% vary) are used to deal with rosacea, particularly pustular rosacea. Most of my rosacea sufferers don’t love these merchandise as a result of they’ll make the pores and skin sting or itch. Curiously, azelaic acid is a molecule made by the frequent pores and skin germ Malassezia furfur that may trigger ‘fungal’ zits (a misnomer as a result of Malassezia is a yeast). This molecule can also modify pigment manufacturing and azelaic acid may be helpful for pigment pores and skin issues reminiscent of melasma. You will note it in pores and skin brightening merchandise. Once more, over time, I’ve not been massively impressed by azelaic acid and most of my rosacea sufferers discover it causes their pores and skin to sting whereas doing little to enhance their rosacea. That stated, everybody’s pores and skin is totally different and you’ll find individuals who discover it useful for his or her rosacea. 

Ivermectin Cream

Ivermectin cream is a recreation changer in rosacea therapy. It is the primary actually good new prescription medication that is come alongside for this irritating pores and skin downside through the course of my 42 years in medication. At present, the one model of ivermectin cream is Soolantra, and it is costly.

What’s ivermectin and why does it assist rosacea

Ivermectin is a standard and anti-parasitic medication created within the Seventies. It has been utilized in people and animals to kill parasites reminiscent of worms. There may be nothing new or horny about ivermectin however the concept of making use of it to the face to kill Demodex mites is good – and worthwhile for the pharmaceutical firm that makes it.

Demodex mites are recognized to overpopulate the pores and skin of rosacea sufferers. Lowering their numbers usually improves rosacea. – Dr. Bailey

Demodex mites play an as but to be absolutely elucidated position within the flushing, redness and pimple misadventures of rosacea. Discouraging mite abundance helps rosacea. However the mites come again. Yep, they’re again inside a month which means mite inhabitants management therapy is ongoing – and costly.

Rosacea medicated cream different to ivermectin

I’ve used permethrin cream (a scabies therapy cream) to manage facial Demodex mites in my follow for in all probability 25+ years. This cream is economical and I discover that it really works nicely. My little trick is ‘off label’ which means that it’s not FDA accepted and I share it solely for instructional functions as a subject of dialogue between you and your physician. 

Brimonidine Gel for rosacea

Brimonidine is a drugs that causes capillaries to constrict to cut back facial flushing. The model identify is Mirvaso. It really works to relieve redness in as little as half-hour and the outcomes can last as long as 6 hours. It solely works when used and doesn’t enhance rosacea over the long term. I take into account it helpful when the flushing must be managed for an occasion.

Usually, research past 1 yr of use will not be revealed. Nevertheless, one case report of an individual who used it for two years was revealed and refractory facial redness was an unlucky aspect impact. It is sensible to me as a result of this class of medicines, known as alpha blockers, is thought to do this.

A brand new associated medication known as oxymetazoline hydrochloride has been accepted. It really works the identical approach. it as Afrin nasal decongestant spray. Mainly, it is a variation on brimonidine and I anticipate the identical problems with refractory vascular congestion and redness. For my part, I solely use alpha blockers for the event actually vital days the place facial flushing should be managed. 

Benzoyl peroxide cream for rosacea

Benzoyl peroxide cream may be useful for papulopustular rosacea on complexions that aren’t delicate. Most individuals with rosacea have pores and skin that’s far too delicate to tolerate benzoyl peroxide. That stated, I’ve had sufferers use it whom I by no means thought would tolerate benzoyl peroxide and but had glorious response. Why it really works in rosacea is a thriller. Benzoyl peroxide has a broad mechanism of motion in opposition to microbes. I additionally assume it could have some efficacy in opposition to Demodex mites, however that has but to be studied. 

Clotrimazole cream for rosacea

I usually use clotrimazole cream or ketoconazole cream for my rosacea sufferers which have each rosacea and facial dandruff., This can be a frequent pores and skin downside mixture; facial redness, flaking, sensitivity and pimples which might be troublesome to deal with. Clotrimazole is an antifungal and anti-yeast treatment. The concept is that the Pityrosporum yeast (aka Malassezia) overgrows its regular stage on the pores and skin and performs a job in inflicting facial seborrheic dermatitis, which in flip will increase facial redness and sensitivity. Clotrimazole helps to deal with the yeast.

I’ve my sufferers apply clotrimazole cream after the Inexperienced Tea Antioxidant Pores and skin Remedy. The clotrimazole cream is available in a moisturizing base that will make the necessity for added moisturizer pointless. I sometimes use it twice a day for a month then as wanted to manage flaking and sensitivity. Yeast and fungi can develop resistance to clotrimazole a lot the best way micro organism grow to be proof against antibiotics. Because of this, Calming Zinc cleaning soap is my choice for addressing Pityrosporum on a long-term foundation. 

Can you employ prescription cortisone cream on rosacea?

Solely below your physician’s supervision might this be acceptable! And, it’s important to make use of solely non-halogenated topical cortisone steroid lotions (reminiscent of over-the-counter hydrocortisone cream) on the face. I exploit them as a final resort for brief time period management of facial irritation. For my part, any physician prescribing cortisone cream for somebody’s face must know what ‘non-halogenated cortisone’ means and why it is vital on the face! 

Cortisone cream, particularly halogenated corticosteroids, will irritate rosacea. They result in perioral dermatitis, a situation that’s no enjoyable. Steroid lotions may skinny your pores and skin and injury your eyes.  Your dermatologist will know what this implies and must be the one to prescribe and supervise any cortisone use in your face. 

How lengthy does it take medicated prescription lotions to work for rosacea?

It varies. You might start seeing enchancment in as little as every week. That stated, I give any therapy technique 2 month to actually declare itself efficient or ineffective. I prefer to see a medicated cream enhance pores and skin and assist preserve enchancment over all of the ups and downs that rosacea flare ups can create. 

Over my profession, my favourite oral antibiotics to deal with rosacea are tetracycline and doxycycline. Low dose doxycycline is now the most effective different for my part for long run use. This dose is taken into account ‘sub antimicrobial’ and is assumed to work by way of doxycycline’s anti-inflammatory mechanisms. Thus, it is an antibiotic that is not working as an antibiotic. 

I am nonetheless not a fan of long run antibiotic utilization and take a look at onerous to keep away from it by constructing a holistic method to rosacea that features a Full Pores and skin Care Routine with my Rosacea Remedy Equipment and life-style and weight loss plan decisions to suppress total irritation which may drive rosacea. (See the articles under the place I describe each my skincare and life-style suggestions for rosacea.)

There are different antibiotics that you will note promoted for rosacea. Minocycline is one. I don’t use minocycline due to its distinctive and severe uncomfortable side effects like liver irritation, autoimmune syndrome/arthritis and grey pores and skin discoloration.  I additionally hardly ever use erythromycin resulting from its drug interactions. 

In sufferers with very extreme rosacea, I’ll take into account a brief course of Accutane if we have tried all the pieces and their rosacea is extreme and nonetheless making them depressing, although this can be a final resort. 

What are the most effective beauty procedures to deal with rosacea in my follow?

Intense Pulsed Mild for rosacea

Intense pulsed gentle therapies are the most important advance we’ve had for rosacea therapy over your complete course of my medical profession. In my expertise it each improves the beauty look of the pores and skin’s ‘damaged’ capillaries and quiets down an individual’s propensity for flare ups of their rosacea. 

How does IPL work for rosacea?

Robust gentle of many wavelengths within the seen spectrum are flashed into the pores and skin and goal hemoglobin within the capillaries and melanin within the pores and skin and create warmth. We are able to tune the laser to focus extra particularly on the hemoglobin to considerably selectively goal the capillaries. When heated, the capillaries sometimes collapse and go away. However melanin remains to be all the time heated and so individuals with darker pores and skin tones or tans will not be good candidates for IPL. In my workplace the therapies are carried out as an preliminary sequence of 5 after which upkeep therapies are needed yearly.  IPL therapies have made a giant enchancment in my very own rosacea and I’m a giant fan.

Electrocautery for telangiectasias of rosacea

Selective ‘damaged’ capillaries may be cauterized with electrocautery to enhance the beauty look of the pores and skin. Low voltage electrical energy is utilized to the pores and skin straight over seen capillaries with a needle-small probe the thermally injury the vessel. The capillary must be traced at about 2mm increments till sufficient of it has been heated such that it disappears. It is a easy, however uncomfortable process that is economical and works instantly. 

Laser therapy of rosacea

A variety of lasers have been used to deal with the massive, plentiful and flush-prone facial capillaries of rosacea. We dermatologists have our favorites and use what we now have. Lasers reminiscent of Neodymium-doped, yttrium–aluminium–garnet (Nd-YAG) laser, 532 nm Potassium-Titanil-Phosphate (KTP), 595 nm PDL, IPL and twin wavelength long-pulsed 775 nm alexandrite/1,064 nm neodymium:yttrium-aluminum (LPAN) goal hemoglobin to take away capillaries. What’s most vital is that your dermatologist will get good outcomes with the laser they’ve. 

The underside line with prescription medical therapies and beauty procedures for rosacea:

There are quite a lot of choices for this power and irritating pores and skin downside. Each prescription and process has execs and cons that have to be weighed thoughtfully as a result of uncomfortable side effects are all the time a chance. That is why I like to make use of skincare and a holistic method to manage rosacea after which add within the riskier therapies after we actually need them. My Rosacea Remedy Pores and skin Care Equipment is the inspiration routine I exploit for all of my rosacea sufferers. 

To study extra about rosacea, there are 5 posts on this Rosacea Sequence:

What’s Zits Rosacea?

What Are the Pores and skin Signs of Zits Rosacea?

Rosacea Pores and skin Care Ideas from My Dermatology Follow

Zits Rosacea; Dermatologist’s Pure Therapy of Rosacea

Prescription Medicines and Beauty Procedures to Deal with Zits Rosacea (this put up)

Cited Scholarly Articles

1. Sarac G. A comparability of the efficacy and tolerability of topical brokers utilized in facial Demodex therapy. J Cosmet Dermatol. 2019 Dec;18(6):1784-1787. doi: 10.1111/jocd.12986. Epub 2019 Could 8. PMID: 31066486.

2. Sulphur for rosacea: Are we reinventing the wheel? JAAD, 66 (4),Complement 1, AB33, April 2012

3. Del Rosso JQ, Baum EW. Complete medical administration of rosacea: an interim examine report and literature assessment. J Clin Aesthet Dermatol. 2008;1(1):20-25.

4. Zhang H, Tang Ok, Wang Y, Fang R, Solar Q. Rosacea Therapy: Overview and Replace. Dermatol Ther (Heidelb). 2021;11(1):13-24. doi:10.1007/s13555-020-00461-0

5. Liu RH, Smith MK, Basta SA, Farmer ER. Azelaic Acid within the Therapy of Papulopustular Rosacea: A Systematic Overview of Randomized Managed Trials. Arch Dermatol. 2006;142(8):1047–1052. doi:10.1001/archderm.142.8.1047

6. Rubenstein RM, Malerich SA. Malassezia (pityrosporum) folliculitis. J Clin Aesthet Dermatol. 2014;7(3):37-41.

7. Del Rosso JQ. Azelaic Acid Topical Formulations: Differentiation of 15% Gel and 15% Foam. J Clin Aesthet Dermatol. 2017;10(3):37-40.

8. Del Rosso JQ. Topical Ivermectin: Information Supporting Twin Modes of Motion in Rosacea. J Clin Aesthet Dermatol. 2017;10(9):39-42.

9. van Zuuren, E.J., Arents, B.W.M., van der Linden, M.M.D. et al. Rosacea: New Ideas in Classification and Therapy. Am J Clin Dermatol 22, 457–465 (2021). https://doi.org/10.1007/s40257-021-00595-7

10. Anderson MS, Nadkarni A, Cardwell LA, Alinia H, Feldman SR. Highlight on brimonidine topical gel 0.33% for facial erythema of rosacea: security, efficacy, and affected person acceptability. Affected person Desire Adherence. 2017;11:1143-1150. Printed 2017 Jul 6. doi:10.2147/PPA.S115708

11. Lowe Erin MSIV, Lim Scott DO, Paradoxical Erythema Response of Lengthy-term Topical Brimonidine, JDD 15(6):763-765 (2016)

12. Jackson JM, Knuckles M, Minni JP, Johnson SM, Belasco KT. The position of brimonidine tartrate gel within the therapy of rosacea. Clin Cosmet Investig Dermatol. 2015;8:529-538. Printed 2015 Oct 23. doi:10.2147/CCID.S58920

13. ElAhmed Husein Huesein, Steinhoff Martin, Analysis of the efficacy of subantimicrobial dose doxycycline in rosacea: a scientific assessment of scientific trials and meta-analysis, JDDG, 19(1): 7-17 Jan 21

14. Engin B, Özkoca D, Kutlubay Z, Serdaroğlu S. Standard and Novel Therapy Modalities in Rosacea. Clin Cosmet Investig Dermatol. 2020;13:179-186. Printed 2020 Feb 20. doi:10.2147/CCID.S194074

15. Rivero AL, Whitfeld M. An replace on the therapy of rosacea. Aust Prescr. 2018;41(1):20-24. doi:10.18773/austprescr.2018.004

16. Crump A, Ōmura S. Ivermectin, ‘marvel drug’ from Japan: the human use perspective. Proc Jpn Acad Ser B Phys Biol Sci. 2011;87(2):13-28. doi:10.2183/pjab.87.13

Writer: Dr. Cynthia Bailey M.D. is a Board Licensed dermatologist training dermatology since 1987. She has carried out nicely over 200,000 pores and skin exams throughout her profession and authors the longest working doctor written pores and skin well being weblog on the earth.