Rosacea Treatment Options That Can Help With Redness and Bumps

Rosacea may begin with a mild blush or flush. But over time, depending on the type of rosacea you have, this skin condition can worsen and become far more bothersome. Besides redness, rosacea can cause swelling, acne-like breakouts, bumps with pus (pustules) or without (papules), thickened skin, eye irritation, and even a change in the shape and size of your nose.

"Given the many different ways that rosacea can affect the skin, I would encourage patients with rosacea to discuss their care with a dermatologist to develop a personalized treatment plan," said John Barbieri, MD, director of Advanced Acne Therapeutics Clinic and associate professor in dermatology at Harvard Medical School.

While there's no cure for rosacea, prompt attention and therapy can prevent some long-term complications. Here are some options to consider when searching for the best rosacea treatment.

Topical Treatments

When helping patients select a rosacea treatment, Richard Torbeck, MD, director of cancer surgery and Mohs surgeon at Mount Sinai Health System, first gauges which aspects of the condition are the most distressing.

If redness ranks high, Dr. Torbeck targets that, often beginning with a non-invasive treatment. One option is metronidazole; while it's technically an antibiotic, doctors believe that for rosacea, it works to decrease inflammation and irritation.

For more intense cases of redness, a cream or gel called oxymetazoline may constrict blood vessels and decrease blood flow, said Robyn Gmyrek, MD, a board-certified dermatologist at Union Square Laser Dermatology in New York City. A similar product is brimonidine gel. Both reduce redness for about 12 hours.

For rosacea cases that involve papules or pustules (the two most common types of inflammatory acne), a healthcare professional may recommend twice-daily applications of a gel, foam, or cream containing azelaic acid. These products also fight bacteria. Plus, they decrease levels of a compound called keratin—a fibrous protein that provides structure to hair, skin, and nails but can block pores if you produce too much of it.

Finally, a cream called ivermectin is sometimes prescribed. This drug effectively kills microscopic skin mites called Demodex folliculorum, which are thought to contribute to some cases of rosacea, Dr. Gmyrek explained. Ivermectin (called Soolantra) also helps decrease inflammation.

Oral Medications

Because rosacea can be caused or aggravated by bacteria—some of which may live within the mites—Dr. Gmyrek said oral antibiotics are sometimes used to address flare-ups. A healthcare professional may prescribe a course of drugs such as tetracycline, minocycline, doxycycline, or erythromycin to bring your rosacea symptoms under control.

However, taking antibiotics at high doses for long periods can contribute to antibiotic resistance when illnesses become unresponsive to these germ killers. You might soon switch to a lower dose of doxycycline, which acts more as an anti-inflammatory than an antibiotic, Dr. Torbeck said (and is described in a 2015 study).

With less-intense formulations, "you're not building resistance or getting the complications you get with long-term antibiotic use," including the unintentional disruption of beneficial bacteria, Dr. Torbeck said. But you receive relief from the eye problems related to rosacea and the prevention of new papules and pustules.

Laser and Light Therapies

Other treatments for rosacea can be administered in a dermatologist's office. One popular treatment for rosacea is a vascular laser. Heat and energy from the laser's beam target a compound called hemoglobin in your blood vessels; small vessels then collapse, decreasing the appearance of redness, Dr. Torbeck explained.

Treatments using other forms of focused light—including intense pulsed light, which works by similar mechanisms—can also reduce redness. Though both are effective for many people with rosacea, they're not permanent, Dr. Torbeck noted. Repeated treatments are necessary to address new blood vessels as they form.

Besides banishing redness, laser or light therapy can also temporarily reduce the thickening of the skin, including the type that frequently distorts the shape of the nose, Dr. Gmyrek said.

Eye Care

When patients have rosacea symptoms in their eyes, Dr. Torbeck recommends they see an ophthalmologist at least once per year. Treatment can include prescription eye drops and oral antibiotics in these cases too. Laser treatments may also open glands in the eyes that become blocked in rosacea, according to a 2018 study published in Cornea.

In the meantime, you can take steps to ease discomfort and irritation, such as washing your eyelids with diluted baby shampoo and placing warm compresses over them.

Lifestyle Modifications

If you're looking at options for natural rosacea treatment, know that there are many powerful steps you can take that don't involve drugs. Making notes about your triggers—which often include spicy foods, exercise, stress, and hot liquids—can help you learn what worsens your rosacea, Dr. Gmyrek said. Also important to note, sun exposure and hair spray are two common rosacea triggers you may not have known about.

From there, you can alter your habits to avoid these triggers when possible. When it's not feasible or recommended—for instance, in the case of an otherwise health-promoting trigger such as exercise—you can time your other treatments to reduce a trigger's impact. For example, wash your face and apply one of your prescription creams soon after you stop sweating, Dr. Torbeck suggested.

Finally, using gentle, non-irritating skin products can ease your symptoms. Steer clear of strong fragrances, scrubs, toners, and astringents. Instead, look for mild cleaners and moisturizers specifically formulated for sensitive or rosacea-prone skin.

Over-the-Counter Treatments

While many therapies require a prescription, you can buy some types of rosacea treatment over the counter. This includes one of the most critical tools for keeping your skin healthy: sun protection.

"A mineral sunscreen is the first and last line of defense and prevention," said Carolyn Jacob, MD, medical director of Chicago Cosmetic Surgery and Dermatology.

In addition, creams and washes containing sulfa—and even some with azelaic acid—are also available at the drugstore, Dr. Gmyrek said. Topical antioxidants may also prevent cell damage and ease redness, Dr. Jacob explained.

A Quick Review

There are many ways to treat rosacea—from home remedies to light or laser therapy and prescription medications. If you've tried some rosacea treatments on your own and aren't seeing the results you want, it might be time to talk with a dermatologist who can help with a personalized treatment plan for you.