Rosacea: Treatments for Rosacea (Facial Redness)

How is rosacea treated?

The first step in rosacea treatment is to avoid any triggers that may exacerbate the condition. Common triggers of rosacea include; certain foods including liver, yogurt, cheese, and spicy/chilli foods, direct sunlight, extremes of weather, alcohol, hot drinks, stress, heavy physical exercise, and hot flushes/menopause.

Particular skin care regimes may also exacerbate rosacea, especially those containing alcohol (e.g. in toners), topical steroids (can help initially, but in the long-term will exacerbate rosacea), and any skin care that irritates the skin such as Retin-A/Stieva-A (tretinoin). Changing your skin care or avoidance of certain skin care chemicals may be advisable.

The use of non-irritating sunscreens is important. Physical sunscreens with titanium dioxide or zinc oxide tend to irritate skin less than chemical sunscreens. Titanium dioxide and zinc oxide do not enter the skin and are not absorbed by the body, as opposed to chemical sunscreens that are absorbed by the body and skin and increasing the potential for skin irritation and exacerbation of rosacea.

Using skin care with anti-inflammatory ingredients is appropriate in the treatment of rosacea. These include; aloe vera, arnica, calendula, chamomile, cucumber, provitamin B5, feverfew, green tea, licochalone, perilla leaf extract, red algae, red clover, thyme, willow herb, and zinc.

Mineral make-up does not tend to enter the skin, congest the skin and exacerbate rosacea. They may also contain some calming ingredients such as green tea extract.

More powerful anti-inflammatory agents (these require a prescription from a doctor) include metronidazole gel (Rozex) and clindamycin gel.  Both are antibiotics, but are used in this case for their anti-inflammatory properties. In the author’s opinion however,  metronidazole and clindamycin gels are not very effective in the treatment of rosacea.

Niacinamide and salicylic acid are also topical agents that have anti-inflammatory and anti-bacterial properties and have been shown to improve rosacea. Synergie’s Vitamin B serum contains Niacinamide and can help with rosacea.

Another good option for rosacea in is retinaldehyde. Retinaldehyde is a less irritating form of retinoid and
is better tolerated by those with sensitive skin. It is available in the Osmosis skin care and in the Osmosis serum Calm. Retinaldehyde has been shown to reduce endothelial growth
factors which can worsen redness in the skin. Again, topical
retinaldehyde should be introduced slowly to the skin to prevent it
from causing any irritation that could worsen the rosacea.

Topical steroids are not useful in the long-term with rosacea, as although they can decrease inflammation in the short-term, they tend to worsen redness and capillary formation in the long-term.

Oral antibiotics have also been used in the treatment of rosacea. Generally, they are used for inflammatory lesions i.e. papules and pustules (or acne-like lesions), rather than for background redness or capillaries. Tetracyclines are the main antibiotic used in rosacea and include minomycin and doxycycline. Macrolides are also used and examples of this group of antibiotics include clarithromycin and azithromycin, and tend to be more expensive than the tetracyclines. All antibiotics require a prescription from a doctor.

The treatment of redness and capillaries due to rosacea is often more rapidly corrected with laser treatments. In many cases, broken facial capillaries can only be properly treated by laser. Lasers for the treatment of rosacea include the Gemini Laser that has two wavelengths, 532nm and 1064nm. The 532nm is attracted in particular to oxyhaemoglobin (in blood) and is very effective in shutting down broken facial capillaries and reducing facial redness. The 1064nm has a deeper penetration, and although it is not attracted to oxyhaemoglobin as much as the 532nm it has the ability to shut down deeper vessels that may feed the facial capillaries. For more information on the Gemini laser, click here.

The Pulsed dye laser can also be used for the treatment of rosacea. It is also attracted to the oxyhaemoglobin, and can help to shut down the blood vessels that contribute to skin redness. Although it usually causes less swelling than the Gemini laser, the Pulsed dye laser can sometimes cause bruising on the surface of the skin that can last around 14 days. This can be avoided by reducing the energy level of the laser treatment.

To learn more about the best rosacea moisturisers for men, click here

What are the consequences of rosacea?

Rosacea is a problem that is uncommonly ‘cured’. Generally, people will be able to, with the appropriate therapies, reduce the effects of rosacea. Recurrence is common, and ongoing maintenance treatments may be necessary.

Left untreated, rosacea can damage the skin, and at times cause enlargement of the nose (rhinophyma), worsening of redness and facial capillaries, and thickening of the skin.

Rhinophyma is a particularly serious late stage complication of rosacea, that results in thickening of the nose skin and enlargement of the nose. It is best treated with a combination of the carbon dioxide and erbium lasers which help to ablate (remove) some of the excessive skin thickness that has formed.