What to know about rosacea medication

Rosacea is an inflammatory skin condition that can cause several symptoms, such as skin color changes (erythema), acne-like breakouts, and skin thickening.

Some people can also get rosacea in the eyes, which can cause inflamed eyelids. Several treatment options, such as prescription medications, can help you manage rosacea symptoms.

Speaking with a healthcare professional about your symptoms can help identify the most suitable treatment option.

Treatment for erythema

The most common symptom of rosacea is erythema, similar to temporary warmth, redness, or deepening of skin color (flushing) of the skin, except it lasts a bit longer. If you have a light skin tone, it can appear red. For those with a dark skin tone, it may appear purple or dark brown. Without treatment, erythema can become permanent.

There are two medications for erythema: Brimonidine (Mirvaso) and oxymetazoline hydrochloride (Rhofade). Doctors prescribe both medications for people whose erythema is persistent.

Brimonidine (Mirvaso) 

Mirvaso is a topical gel that you apply once per day, which works by causing the blood vessels in the face to become narrow.

You can apply a pea-sized drop of Mirvaso to each of the five regions of the face, spreading them out to form a smooth layer. You should avoid the eyes and lips but apply the gel to the following areas:

• central forehead
• both cheeks
• chin
• nose

Some reported side effects of Mirvaso include:

• increased warmth, redness, or deepening of skin color (flushing)
• excessive whitening of the skin
• headaches

Oxymetazoline (Rhofade)

Oxymetazoline (Rhofade) is a topical cream that you apply to the face once per day. This medication is also an alpha-adrenergic agonist, which causes blood vessels to become smaller.

The dosage is a pea-sized amount of cream that you apply from the specialized Rhofade pump. Then, you spread it across the entire face. Avoid the eyes and lips, but cover the rest of the face, including cheeks, forehead, nose, and chin.

Side effects of Rhofade in studies included itching, dermatitis, worsening of rosacea lesions, pain, and erythema.

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Treatment for ocular rosacea

Warm compresses for the eye and cleansing with a gentle eye cleanser are first-line treatments for ocular rosacea. A doctor might also recommend artificial tears that are safe and appropriate for ocular rosacea. You may also use steroid eye drops, such as prednisolone acetate (Omnipred).

Treatment for rosacea breakouts

Several medication options are available for skin breakouts resulting from rosacea, such as:

Azelaic acid (Finacea)

Azelaic acid is available as a gel or a foam. Apply the gel or foam to the face twice per day, morning and evening, after cleansing the skin. If symptoms don’t improve within 12 weeks, consider speaking with a doctor about alternative treatment options.

Several side effects may occur from using azelaic acid, such as:

• pain
• itching
• dryness
• erythema.
• hypopigmentation, a decreased amount of melanin in the skin, for those with a darker skin tone

Metronidazole (Flagyl)

Metronidazole works to treat the red or pus-filled bumps that sometimes occur with rosacea. Apply the gel to the areas with bumps once per day after cleansing the skin.

Common side effects may include:

• dryness
• itching
• scaling
• stinging
• burning

Doxycycline (Oracea)

Doxycycline works to treat rosacea bumps. A 40 milligram (mg) capsule should typically be taken once per day an hour before eating. In studies, Oracea’s most common side effects were diarrhea and a minor nose and throat infection called nasopharyngitis. 

Isotretinoin (Accutane)

Isotretinoin treats severe acne. Doctors may prescribe it off label for rosacea bumps. It comes with a Food and Drug Administration (FDA) boxed warning that the medication can cause developmental issues for a fetus if you use it while pregnant. Accutane is taken twice per day with food at a dosage that depends on your body weight. Treatment is typically for 15–20 weeks.

Side effects may include the following:

• muscle pain
• a sore throat
• dry skin
• headaches
• back pain

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Treatment for skin thickening

In some instances, rosacea may cause firm, round bumps or thickening on the face. The medical term for this is phyma or rhinophyma, when it affects the nose. 

Isotretinoin (Accutane) can prevent phyma from worsening, but only surgery can remove skin that has already become thick. If phyma affects the eyelids or nose, it can affect your eyesight or breathing.

Alternative treatment options

You can prevent rosacea flare-ups by adopting a rosacea-friendly skin care routine, getting protection from the sun, and learning your rosacea triggers.

Consider the following tips:

• cleanse your skin twice a day with a gentle, soap-free cleanser
• use a moisturizer every day
• wear a broad-spectrum sunscreen designed for sensitive skin
• avoid skin care products with irritating ingredients like alcohol, fragrance, and sodium lauryl sulfate

Knowing your rosacea triggers can also help to prevent flare-ups. Consider keeping a journal to track symptoms and what things may cause them. Some common rosacea triggers are:

• sunlight
• stress
• heat
• alcohol (if you drink)
• spicy foods
• wind and cold
• medications

When should you speak with a doctor? 

If you’re unsure whether you have rosacea, receiving a diagnosis and beginning treatment can be useful. This can help you manage the condition and prevent some symptoms like erythema from becoming permanent. 

If rosacea affects your eyes, your doctor might refer you to a specialist doctor who performs medical and surgical interventions for eye conditions (ophthalmologist). Treating ocular rosacea can prevent discomfort, styes, and other symptoms that might affect your vision.

Phyma, or skin thickening from rosacea, does not get better on its own. A doctor can prescribe treatment or recommend surgery to help manage this symptom. 

Summary

Prescription treatments for rosacea can help reduce skin color changes, get rid of acne-like bumps, and prevent skin thickening.

You can work with a doctor to find the right prescription medication for your symptoms. Knowing your triggers and avoiding them can also help prevent rosacea flares.

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