Rosacea flare-ups are caused by certain triggers that can be environmental, chemical, or emotional. Sun exposure, spicy food, and blushing can all lead to prolonged facial redness but triggers vary between individuals. While finding these triggers and avoiding them is an essential part of managing rosacea, medications are usually prescribed as well to get flare-ups under control. A rosacea cream is the most commonly used treatment along with laser and light therapy and sometimes systemic medications. In most cases of mild to moderate rosacea, a topical is the first-line treatment and is usually effective at getting a flare-up under control without the need to resort to a systemic medication.

What is Rosacea?

Rosacea is a chronic condition that causes redness and acne on the face. In severe cases it may also cause thickening of the skin on the nose and reddening of the eyes. It is an incurable condition that an individual is predisposed to and most often presents after age 30. The diagnosis of rosacea relies on clinical observation of symptoms as there is no test available that will determine the cause.

Types of Rosacea

There are four subtypes of rosacea and each can require different treatment. In many cases a patient will have characteristics of multiple rosacea subtypes.

Erythematotelangiectatic Rosacea (ETR) involves facial redness and telangiectasias

Papulopustular Rosacea (PPR) involves redness as well as facial bumps or acne.

Phymatous Rosacea involves thickening of the skin on the nose leading to enlargement.

Ocular Rosacea involves reddening around the eyes. This can include burning in the eyes, swelling, and damage to the cornea.

Topical Medications for Treating Rosacea

The treatment for ETR and PPR starts with regular application of topical rosacea cream. Azelaic acid is commonly prescribed topical cream that reduces inflammatory lesions and erythema.

The results of treatment with a rosacea cream may not always be noticed immediately. Sometimes it can take weeks before a patient notices an improvement in their rosacea symptoms. It is important to stay compliant with regular treatment in combination with managing exposure to triggers. Exposure to a trigger that causes a flare-up can prolong the amount of time a medication needs to be used to get the condition under control.

Types of Topical Medications for Rosacea

These medications can be made in multiple strengths in a rosacea cream or gel. Combinations of ingredients are also possible in one cream through a compounding pharmacy.

Metronidazole: This is one of the more commonly prescribed topical antibiotics for treating rosacea. Because it is both effective and inexpensive, metronidazole is considered a first-line treatment for many rosacea patients. Recent evidence has shown however that topical azelaic acid is significantly more effective than metronidazole at treating rosacea.

Azelaic Acid: This ingredient is an anti-inflammatory that primarily reduces erythema and inflammatory lesions. Azelaic acid can also reduce the activation of the immune system that may cause rosacea symptoms.

Niacinamide (B3): A vitamin that has been shown to effectively treat inflammatory skin conditions like acne and rosacea when applied topically or taken orally. It mainly works by improving barrier function in the skin.

Clindamycin, Erythromycin: These antibiotics may be used in topical creams or gels instead of metronidazole.

Benzoyl Peroxide: This antimicrobial is effective at treating acne and may be combined with clindamycin, erythromycin, or another antibiotic into one cream.

Sodium Sulfacetamide: Known as a sulfa antibiotic, this medication is made more effective when combined with sulfur. Sulfur targets demodex mites, which can contribute to some types of rosacea.

Tretinoin: Also called retinoic acid, tretinoin is a powerful medication used to treat acne, rosacea, aged skin, and more. Retinoids like tretinoin can increase skin cell renewal and reduce signs of skin damage that results from rosacea flare-ups.

Oxymetazoline Hydrochloride: This medication was recently approved by the FDA as a topical cream for rosacea. It is a vasoconstrictor that can reduce facial redness.

What is the Best Rosacea Cream?

The best rosacea cream is one that includes multiple effective ingredients in one formulation. Rosacea has multiple symptoms that present in the skin, and some ingredients are good at treating only particular symptoms. When ingredients are combined in a compounded rosacea cream, they can work together to improve multiple aspects of the condition faster. A compounded acne-rosacea cream from Park Compounding Pharmacy includes azelaic acid, niacinamide, and retinoic acid in one effective cream.

How to Apply Topical Rosacea Cream

Topical rosacea medication should be applied before sunscreen or makeup. The face should first be cleaned with a mild cleanser and then patted dry (not rubbed). After the skin is dry, then medication can be applied to the face. This will ensure that the active ingredients are able to penetrate the skin. Applying sunscreen after the rosacea cream is necessary as exposure to UV-rays is a trigger for many patients. Some skincare ingredients can make the skin more sensitive to the sun, leading to further skin damage if proper sun protection is not used.

Severe Types of Rosacea – Oral Antibiotics

For certain types of rosacea, a cream may not be enough. Phymatous rosacea, where there is thickening of the skin around the nose, often requires oral medication to get it under control first. This can then be followed with topical treatments once the more severe symptoms have improved. Systemic oral medications for treating rosacea include doxycycline, tetracycline, and isotretinoin.

Long-Term Management of Rosacea

It is important for rosacea patients to remember that their condition is not due to poor hygiene or something that is their fault, but is something they are predisposed to. Since there is no cure for rosacea, management of flare-ups by identifying triggers is necessary. With the use of effective topical medications in combination with avoidance of triggers, rosacea symptoms can be brought under control.