Rosacea Treatment Options

Topical treatments are the first-line approach for managing mild to moderate rosacea. These medications are applied directly to the skin to reduce inflammation, redness, and breakouts.

• Metronidazole is one of the most commonly prescribed topicals for rosacea and is available in gel, cream, and lotion forms. It helps calm inflammation and can be used over long periods with a low risk of side effects. Extensive clinical data supports its use.
• Azelaic acid is another well-established topical agent that helps unclog pores, smooth the skin, and reduce redness. It may be slightly irritating for some patients at first, but this typically improves with continued use.
• Ivermectin is a more recent addition to topical rosacea therapy. It is particularly effective in reducing inflammatory bumps and may also target microscopic Demodex skin mites that are sometimes associated with rosacea flares.
• For persistent facial redness, medications like brimonidine or oxymetazoline can be used. These agents work by constricting the small blood vessels in the skin to temporarily reduce redness. These topicals usually take effect within hours and can be used as needed, though their effects are temporary and may wear off after several hours. In more complex cases, topical therapies may be combined—such as brimonidine gel plus traditional agents (e.g., metronidazole or azelaic acid)—or used alongside systemic agents like oral tetracyclines or isotretinoin.

Oral medications are typically used for patients with more severe symptoms or when topical treatments alone are not enough.

• Low-dose doxycycline is one of the most common oral therapies for rosacea. At sub-antibiotic doses, it reduces inflammation without causing widespread antibacterial resistance. This makes it a safe long-term option for many patients.
• Oral antibiotics may also be used for short-term control of flares or more extensive papulopustular rosacea. In cases that do not respond to standard treatment, or in patients with phymatous rosacea—characterized by skin thickening, especially around the nose—oral isotretinoin may be recommended. This medication is typically reserved for severe cases due to its potential side effects and need for close monitoring.
• In select patients with frequent flushing or prominent vascular symptoms, medications such as beta-blockers or other vascular-modifying agents may be considered. These are not standard treatments but may be useful in specific cases where vascular symptoms are prominent and persistent.

These are powerful tools for addressing persistent redness, visible blood vessels, and thickened skin. Vascular laser including Excel V laser a commonly used option. This laser technology works by targeting the dilated blood vessels under the skin, effectively reducing facial redness and broken capillaries. Treatment typically involves a series of sessions spaced a few weeks apart. While some improvement is usually seen after the first treatment, most patients require multiple sessions for optimal results. These treatments can also be helpful in maintaining long-term control of symptoms and reducing the need for medication.

For patients with thickened skin or advanced phymatous rosacea (rhinophyma of the nose) more specialized laser devices or surgical methods may be used to remove excess tissue and restore a more natural appearance. In some cases, light-based therapies such as LED treatments or photodynamic therapy may also be used to reduce inflammation and improve skin texture.

At Palo Alto Dermatology Institute, rosacea care is customized for each patient. Because rosacea can present in different ways and progress over time, treatment plans are designed to address both current symptoms and long-term management. In many cases, combination therapy provides the best results. A patient might use a topical treatment daily to reduce inflammation, take a short course of oral medication to calm a flare, and undergo periodic laser treatments to manage persistent redness and visible vessels.

Alongside medical and procedural treatments, skin care and trigger management play a critical role in rosacea control. Patients are encouraged to use gentle cleansers, avoid harsh exfoliants, and apply daily sunscreen to protect the skin from UV-related flares. Identifying and avoiding common triggers—such as spicy foods, alcohol, hot beverages, stress, and extreme temperatures—can help minimize symptom recurrence and improve treatment success.

Ocular rosacea is relatively common, affecting up to 58% to 72% of individuals with cutaneous rosacea at some point during their disease course. In many cases, eye symptoms may precede skin changes or occur independently, making diagnosis more challenging.

Ocular rosacea is a subtype of rosacea that affects the eyes, causing symptoms such as dryness, redness, burning, itching, and in some cases, blurred vision or sensitivity to light. Treatment focuses on reducing inflammation and improving eye comfort.

Common approaches include warm compresses, gentle eyelid hygiene with diluted baby shampoo or lid scrubs, and lubricating eye drops to relieve dryness. In more persistent cases, oral antibiotics such as doxycycline may be prescribed to reduce inflammation and improve symptoms. For severe cases, referral to an ophthalmologist may be necessary to prevent complications such as corneal damage.