Rosacea treatment and medication online: get long-term relief

Erythematotelangiectatic (vascular) rosacea is the most common type, affecting about half of the 16 million Americans who live with rosacea.³   

The most common symptom is persistent facial redness. Small blood vessels beneath the skin typically enlarge and become visible, with symptoms that tend to flare up and then subside. If left untreated, the redness usually worsens, affecting a larger skin area and potentially becoming permanent.   

It's not clear what exactly causes erythematotelangiectatic rosacea. Genetics, microorganisms, nerve and blood vessel dysfunction (neurovascular dysregulation), and environmental factors contribute to its development. Hot drinks, alcohol, cinnamaldehyde-containing foods, fatty foods, and spicy foods can all exacerbate the symptoms.   

Treatment involves personalized skincare routines, general strategies, and specific topical therapies. Rosacea is a chronic condition, so it's important to identify triggers, prioritize protection, and use gentle skin care, such as mild cleansers, moisturizers, and sunscreen. You can also use topical treatments, such as azelaic acid and metronidazole, to help reduce inflammatory symptoms, such as:  

• Temporary darkening of the face, which extends to the neck and chest.   

• Swollen and sensitive skin  

• Redness  

• Tendency to blush or flush more quickly than others.  

• Visible small blood vessels, commonly known as spider veins (telangiectasia)   

Papulopustular acne ("acne rosacea") typically appears as "whitehead" bumps, usually blemishes filled with pus and swollen and red bumps. These bumps are common on the chin, cheeks, and forehead and are often mistaken for acne.

You may notice flushing, redness, and blemishes on the neck, chest, and scalp. In more severe cases, you may suffer many blemishes that last a long time.  

To avoid flare-ups, it's essential to identify and avoid common triggers such as high temperatures, low temperatures, wind, stress, sunlight, spicy foods, certain medications, alcohol, hot beverages, certain hair products, and specific bacteria.

Prescription medications such as metronidazole, doxycycline (an oral antibiotic), and azelaic acid minocycline (an oral antibiotic), as well as lifestyle adjustments, may help manage common symptoms:   

• Persistent redness, facial flushing, small pus-filled bumps, and enlarged blood vessels   

• Small, red bumps resembling acne may appear, sometimes with pus.   

• Acne-like breakouts that usually manifest in areas with highly reddened skin and often come and go   

• Heightened skin sensitivity, burning or stinging sensation, and oily skin  

• Visible spider veins and raised patches of skin, also known as plaques.

Phymatous rosacea is a condition that causes scarring and thickening of the skin, especially around the nose (Rhinophyma). This results in a swollen, bumpy, and occasionally discolored appearance. It is believed to result from chronic inflammation and an overgrowth of oil glands (sebaceous glands) in the skin. Common symptoms include:   

• Excess skin tissue can cause the skin to thicken, especially on the nose, ears, forehead, and chin  

• More common in males than females  

• A bumpy texture, visibly broken vessels, oily skin, and large pores 

While this type of rosacea is rare, it is treatable and tends to occur more frequently in men than women.4 The exact cause is still unknown, but inflammation is believed to play a significant role. Risk factors include being male, age between 25 and 50, chronic inflammation, genetics, sunlight exposure, smoking, and specific occupational hazards.   

Treatment options include oral medications, lifestyle changes, and surgical procedures, and the goal is usually to improve facial disfigurement and slow down symptom progression.   

To help manage symptoms, follow a preventive skin care regimen, including wearing sunscreen with titanium dioxide or zinc oxide, using sulfate-free hypo-allergic and paraben moisturizers, and minimizing triggers that potentially cause flare-ups.

Ocular rosacea usually affects the eyes, resulting in a bloodshot or watery appearance, burning sensation, or irritation, sometimes leading to sensitivity, persistent dryness, and formation of cysts on the eyelids. The exact cause is unknown but often linked with skin rosacea. Common symptoms include:   

• Eye irritation and dryness   

• Watery or irritated eyes   

• Red swollen eyelids   

• Styes  

• Watery or bloodshot appearance  

• A burning or stinging sensation  

• A gritty feeling  

• Itching  

• Blurry vision   

• Sensitivity to light  

• Cysts on the eyelid   

• Decreased vision  

• Visibly broken blood vessels.  

Factors contributing to this type of rosacea include inflammation, bacteria, genetics, mites, plus other underlying conditions. Triggers that worsen the symptoms include exposure to sun, heat, wind, certain foods, strenuous activities, and emotional stress.  

Diagnosis is based on clinical symptoms, mainly if the individual already has skin rosacea. However, it can be hard to diagnose without skin symptoms since it's sometimes mistaken for conditions like blepharitis.   

There is no cure for ocular rosacea; however, medications such as oral antibiotics, tetracycline or macrolides, antiseptics, and steroids can help control symptoms. If other treatments are ineffective, your doctor might prescribe topical cyclosporine.   

Conservative management techniques include eyelid hygiene, warm compresses, and artificial tears. Avoid wearing contact lenses.   

Prescription topical creams and gels can help you manage rosacea symptoms, such as flushing, redness, and pimples. Examples of topical treatments include:  

• Mirvaso: This gel is only used in adult patients. It effectively reduces blood flow by narrowing small blood vessels, reducing the redness caused by rosacea.   

• Rhofade: Like Mirvaso, this cream also helps treat the redness caused by rosacea. It narrows small blood vessels near the surface of your skin, ultimately reducing the redness.  

• Metrogel (metronidazole): This antibiotic reduces skin inflammation. It comes in gel, cream, or lotion, and it's often prescribed chiefly as the initial topical treatment for rosacea due to its affordability compared to other options.  

• Azelex and finacea: These two creams contain azelaic acid and effectively reduce skin inflammation and the occurrence of rosacea pimples.  

• Soolantra (ivermectin): This anti-parasite-based medication cream effectively reduces inflammation and eliminates Demodex mites.  

• Sodium sulfacetamide/sulfur: This antibiotic reduces skin inflammation and is available in gel, cream, and cleaner forms.  

If you have rosacea pimples, your doctor may prescribe additional treatment options beyond topical creams and gels, such as doxycycline (a short course of low-dose antibiotics) to help improve your symptoms. Here are other oral medications that doctors prescribe;  

• Doxycycline: Doxycycline fights acne-causing bacteria, reduces inflammation, and improves skin lesions and redness. Due to its side effects, you should regularly follow up with your doctor while taking this medication. It should be used under medical supervision and with proper sun protection. It's usually prescribed briefly and can be complemented with skincare and topical treatments to manage rosacea long-term.  

• Tetracycline antibiotics are a family of antibiotics that stop the growth and spread of bacteria in the body. Thus, they reduce inflammation and redness associated with rosacea and help improve the appearance of small bumps and pimples on the skin. They have anti-inflammatory properties that help in treating rosacea symptoms. These antibiotics include minocycline and doxycycline.  

• Minocycline: Minocycline, too, has anti-inflammatory properties that work by inhibiting the production of inflammatory substances and reducing the number of Demodex mites in the skin. It is taken orally, and the dosage should be followed as instructed by your doctor. Some common side effects include diarrhea, vomiting, dizziness, and skin sensitivity to sunlight.   

• Erythromycin: Erythromycin is an antibiotic commonly used to treat skin infections and rosacea, especially in children. While generally considered safe for children, it may cause mild side effects such as nausea, diarrhea, stomach upset, and vomiting. Call your doctor if you experience any allergic reactions. 

Rosacea is a complex skin condition with no known exact cause. It may involve factors such as blood vessel abnormalities, the immune system, genetics, Demodex mites, environmental triggers, and gut bacteria imbalances.   

While triggers can worsen symptoms, they are not the direct cause of rosacea. Consulting a dermatologist is crucial for accurate diagnosis and personalized treatment. Ongoing research may provide more insights into its future development.  

Rosacea has various signs, including persistent facial redness, small bumps and pimples, burning or stinging sensation, dry, flaky skin, and visible blood vessels. Not everyone experiences all these symptoms, and severity varies from person to person.

It may also affect other areas other than the face. Consult your doctor for a proper diagnosis and treatment plan to prevent worsening and alleviate symptoms.