Rosacea is a common chronic skin disorder that affects a whopping 415 million worldwide. It causes redness and bumps on the face, which are most commonly seen on the central cheeks but it can impact the eyes, forehead, nose, and chin, too, says Papri Sarkar, M.D., a dermatologist in Boston, Massachusetts. "Symptoms of rosacea can include flushing, redness of the central face, dilated blood vessels, acne-like lesions, swollen and red eyes, and bumpiness and thickness of the skin (especially the nose)," she explains. "There are often triggers to flushing and redness, including heat, extreme cold, UV radiation, and certain foods (i.e. spicy food) and beverages."
Luckily, there have been some major advancements in the treatment of rosacea, especially in the last several decades, the largest being the development of lasers in the 1960s. "For redness and dilated blood vessels, lasers are the gold standard treatment," says Dr. Sarkar. "Until recently, there were no other treatments for this, and even now, the other treatments are temporary." Lasers treat the physical aspects of redness, as well as the dilated blood vessels. But since there are four types of rosacea, not all treatments work equally for every patient. Here are some of the very best, according to dermatologists.
Rhofade is a topical cream, and the first of its kind, approved for persistent facial erythema associated with rosacea in adults, making it one of the most popular treatments for rosacea. "Rhofade (oxymetazoline hydrochloride) cream, 1%, is FDA-approved for the topical treatment of persistent facial erythema (redness) associated with rosacea in adults," shares Dendy Engelman, M.D., a dermatologist at New York City's Manhattan Dermatology and Cosmetic Surgery. "In two clinical trials, once-daily application of Rhofade was proven to reduce persistent facial erythema associated with rosacea through 12 hours." Patients can expect to notice an improvement in the redness and flushing associated with rosacea when using Rhofade daily.
Also known as mesobotox, this treatment was developed in 2000 and involves a tightening of the skin to help improve flushing and redness. "I systematically inject tiny micro-aliquots of dilute botox in a grid pattern all over the face superficially so it doesn't target the muscles which are deeper," says Dr. Sarkar. "This avoids a 'frozen' appearance and leads to smoother looking, tighter skin which doesn't flush or blush as easily." While many dermatologists attest to its effectiveness, microbotox is expensive and temporary. Additionally, your doctor must be very skilled and experienced in how to administer it via this method to prevent undesirable results, notes Dr. Sarkar.
Laser treatments, such as V-Beam, address facial redness by directly targeting and destroying extra blood vessels in the skin, explains Joshua Zeichner, M.D., director of Cosmetic and Clinical Research in Dermatology at Mount Sinai Hospital in New York City. "The laser emits a beam of light that is selectively absorbed by the color red, the pigment found in red blood cells," he says. "The laser treatment is uncomfortable, and can lead to worsening of redness, swelling, and some bruising in the few days after the treatment." Multiple treatments are needed, usually spaced every four to six weeks.
Oral antibiotics, such as doxycycline, can be useful, especially for ocular rosacea, which occurs around the eye area. And for more severe cases, Eva M. Volf, M.D., a dermatologist in Swampscott, Massachusetts, often prescribes Accutane, which was first developed as an acne drug, in low doses. "It acts by reducing inflammation and oil production, but may be drying for patients," she says. "It is also important to know that Accutane also causes severe birth defects and cannot be used by anyone who is either pregnant or planning to become pregnant."
If a patient has predominantly acne-like breakouts (papulopustular rosacea), Dr. Volf often uses combination therapies that include metronidazole cream, a topical antibiotic to clear inflammatory lesions. She also adds Finacea foam 15% (or 10% azelaic acid) another anti-inflammatory cream. "This is a good option for patients who are pregnant, as it is safe in pregnancy," she says. "Soolantra cream, an antimicrobial agent that kills Demodex mites on the skin, has also been a major game changer in rosacea." Sometimes, she even adds sodium sulfacetamide cleanser to the treatment list to help prevent the formation of new lesions. The downside to the sodium sulfacetamide, however, is that it has an unpleasant odor, she adds.