Rosacea Treatment Options

The Four Types of Rosacea

Experts have divided rosacea into four subtypes based on the general appearance of each. These subtypes overlap, however, so individuals with rosacea commonly have symptoms of more than one subtype at the same time. Your treatment options depend on the symptoms you have.

Figure 1. Current Treatment Options

Subtype I
FACIAL REDNESS
Approximately 83% of rosacea patients experience what is called erythematotelangiectatic rosacea.

Symptoms: Long-lasting flushing and redness (erythema), sometimes with enlarged blood vessels (telangiectasias) visible just under the skin; burning and stinging may occur.

Treatment: Initial treatment is typically a topical medication (medication applied directly to the skin). Treatment with lasers or special lights can sometimes help reduce redness and eliminate visible blood vessels.

Subtype II
BUMPS AND PIMPLE-LIKE BLEMISHES
Approximately 63% of rosacea patients experience papulopustular rosacea.

Symptoms: Long-lasting redness with bumps (papules) or pimple-like blemishes (pustules).

Treatment: Oral medications (taken by mouth) are often prescribed for short-term use; they are often combined with a topical medication.

Subtype III
SKIN THICKENING
About 15% of rosacea patients (mostly men) suffer from phymatous rosacea.

Symptoms: Skin thickening, enlargement, and deformity, especially of the nose and chin.

Treatment: Topical or oral medications can slow progression, but laser treatment or surgery may be required to reshape affected areas of the face.

Subtype IV
EYE IRRITATION
As many as 50% of rosacea patients have ocular (eye-related) rosacea.

Symptoms: Watery or bloodshot eyes; gritty feeling, dryness, itching, burning or stinging, blurred vision, or sensitivity to light. In rare cases, rosacea involving the eye can result in damage to vision if not treated.

Treatment: Treatment with oral medications is often effective.

Treatment Challenges

People with mild rosacea may be prescribed medications that are applied directly to the skin (topicals). These drugs are generally considered safe for long-term use; however, they do have some drawbacks:

They are not capable of treating more severe cases of rosacea
They are generally ineffective at reducing redness or eliminating blood vessels visible under the skin
Their effect may be temporary (many patients relapse 1 to 6 months after stopping treatment)
They may cause skin irritation
They do not treat ocular rosacea

Oral antibiotic medications are effective in reducing many of the symptoms of rosacea, particularly the papules (bumps) and pustules (pimple-like blemishes) that can appear during a severe flare. They are also effective for treating ocular rosacea. They work well for most people because they are potent inflammation fighters, but these drugs also have drawbacks. Most of the drawbacks relate to the fact that they are antibiotic drugs—meaning that they kill bacteria (germs) that normally live in or on your body, even though these bacteria are probably not responsible for rosacea.

Major drawbacks include:

Side effects—Stomach upset and increased tendency to sunburn are common; other, more infrequent side effects are possible depending on the medication.
Changes in normal bacteria—Antibiotics can kill beneficial bacteria and leave the skin and body vulnerable to more harmful microorganisms that can then multiply (yeast infections, for example).
Antibiotic resistance—Resistance occurs when bacteria develop defenses against antibiotics. When bacteria become resistant, the antibiotics doctors rely upon to treat certain infections may no longer work.

Lasers or special lights can be effective in treating redness and enlarged blood vessels. However, multiple courses are usually required and these treatments may not be covered by insurance.

Advances in Treatment

A new oral therapy is being developed primarily for patients with rosacea that is mainly characterized by papules and pustules. This medication is active against inflammation, but has fewer of the drawbacks associated with current oral medications.

Talk to your doctor about advances in treating rosacea.

Subtype I FACIAL REDNESS Approximately 83% of rosacea patients experience what is called erythematotelangiectatic rosacea.
Symptoms: Long-lasting flushing and redness (erythema), sometimes with enlarged blood vessels (telangiectasias) visible just under the skin; burning and stinging may occur.	Treatment: Initial treatment is typically a topical medication (medication applied directly to the skin). Treatment with lasers or special lights can sometimes help reduce redness and eliminate visible blood vessels.
Subtype II BUMPS AND PIMPLE-LIKE BLEMISHES Approximately 63% of rosacea patients experience papulopustular rosacea.
Symptoms: Long-lasting redness with bumps (papules) or pimple-like blemishes (pustules).	Treatment: Oral medications (taken by mouth) are often prescribed for short-term use; they are often combined with a topical medication.
Subtype III SKIN THICKENING About 15% of rosacea patients (mostly men) suffer from phymatous rosacea.
Symptoms: Skin thickening, enlargement, and deformity, especially of the nose and chin.	Treatment: Topical or oral medications can slow progression, but laser treatment or surgery may be required to reshape affected areas of the face.
Subtype IV EYE IRRITATION As many as 50% of rosacea patients have ocular (eye-related) rosacea.
Symptoms: Watery or bloodshot eyes; gritty feeling, dryness, itching, burning or stinging, blurred vision, or sensitivity to light. In rare cases, rosacea involving the eye can result in damage to vision if not treated.	Treatment: Treatment with oral medications is often effective.