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The Best Rosacea Topical Treatments

The Best Rosacea Topical Treatments


Rosacea is a skin condition that affects more than sixteen million people in the United States. Most individuals who have rosacea are typically in their thirties and forties and have a fair complexion, however it can affect almost anyone. Some may just think their skin is flushed, but rosacea usually starts with some modest redness around the nose, cheeks, chin, and forehead. If these symptoms persist, a doctor should be consulted.

If rosacea is not treated, it can worsen and result in:

  • Permanent redness on the cheeks and nose
  • Redness always appearing following hot drinks, caffeinated beverages, alcohol, or exercise
  • Small blood vessels appearing on the nose
  • Excess skin tissue enlarging the nose
  • The appearance of ‘adult acne’, small pimples on the face

Rosacea is still somewhat of a mystery, although doctors do know it appears in phases. These phases will evolve from one to another as the condition worsens.

  • Pre-rosacea is the first phase and is often thought to be blushing, however it appears almost everywhere on the face. This redness is caused by the tiny blood vessels under the skin dilating and the redness will slowly spread as the condition worsens
  • Vascular rosacea is the next phase where the skin begins to feel warm and appear puffy. The blood vessels are swelling and leaking fluid and can now be seen through the skin. These blood vessels are called spider veins or telangiectasia. The skin is also more sensitive and becomes much oilier which can make applying skin products painful.
  • Inflammatory (papulopustular) rosacea occurs when the skin shows pus-filled pimples and small red bumps consistently. This is not acne and should be treated by a physician.
  • Late rosacea is the last stage and is the most advanced. This is when the condition intensifies and deeper redness and more veins appear, and the nose begins to enlarge. 

Rosacea is treated with both topical and oral antibiotics and if not treated, will certainly worsen. Other treatments include using laser to eradicate red blood vessels. Treatment is usually successful and though there is no known cure for rosacea, with the right treatment and daily use of sunscreen, symptoms can be controlled.

It is important to see a dermatologist if rosacea is suspected. Once a diagnosis is made, the dermatologist will prescribe a treatment plan.

There are several topical medications that are used to treat rosacea. These medications are applied directly on the affected areas and help reduce inflammation and redness. Dermatologists will often prescribe topical medications in combination with oral medications. Light-based and laser treatments may also help an individual manage their rosacea symptoms.

The best rosacea topical medications used to treat rosacea are are azelaic acid, metronidazole, and sodium sulfaceatmide/sulfur.

Azelaic Acid is dicarboxylic acid found in whole grains. Approved to treat rosacea in 2002, azelaic acid has anti-inflammatory and antibacterial properties and is very effective in treating the skin lesions often associated with rosacea. Treating rosacea with azelaic acid may have side effects including itching, burning, and mild swelling, but these are generally not severe.

Metronidazole is considered by many to be the best rosacea topical treatment. This product contains anti-inflammatory and microbial properties and is used to treat the inflamed lesions caused by rosacea. It is tolerated well by all skin types. When rosacea was first diagnosed, treatment included killing the demodex mites that inhabit rosacea patients’ skin.

Metronidazole is very effective in eradicating these mites which was the reason for its first use to treat rosacea, even though it is now known that demodex mites play no role in causing rosacea.

Metronidazole is still prescribed to treat rosacea because of its effectiveness in treating the overall condition. It is available as a gel, cream, and lotion and comes in various strengths. There are mild side effects including itching, stinging, and burning.

Sodium sulfacetamide/sulfur has been used for years to treat acne and is now considered an effective topical treatment for rosacea. One of the drawbacks of this treatment is the smell of the sulfur, although there has been progress in developing lotions, creams, and gels with fragrance to help disguise the sulfur odor.

This medication is effective in reducing the swelling and inflammation of rosacea skin lesions. The possible side effects of using sodium sulfacetamide/sulfur include stinging, swelling, redness, and other reactions, but are usually mild. If a patient is allergic to sulfur, they may not be able to use sodium sulfacetamide/sulfur a topical treatment for rosacea.

The most prominent features of rosacea are the flushing and redness and these are very successfully treated by laser therapy. This treatment is also extremely effective against the little red blood vessels that can appear beneath the skin. Laser therapy also works against the acne-like pimples that may appear with rosacea. Lasers used in the treatment of rosacea include the KTP laser, the ND:YAG laser, and the pulsed-dye laser.

There are several treatments that are successful in reducing the appearance of rosacea symptoms, but treatment must be started as soon as possible once rosacea appears. Although there is no known cure for rosacea, a dermatologist can diagnose and prescribe a course of treatment which can control the symptoms and appearance of rosacea.