Rosacea treatment

What is rosacea?

Rosacea is a common, long-term skin condition that affects many adults in the UK. Its main symptoms are facial redness, persistent flushing, and visible blood vessels. In some cases, it can also cause acne-like bumps or pustules.

Rosacea typically affects the central face, including the forehead, nose, cheeks, and chin, and it can sometimes extend to the neck and chest. Affected skin often becomes sensitive, with many individuals experiencing burning or stinging sensations when applying water or skincare products.

Symptoms of rosacea vary between individuals. For some, rosacea may be persistent, while for others it may flare up in response to triggers such as heat, stress, or certain foods and drinks.

Although rosacea can affect people of all skin tones, it’s most commonly diagnosed in adults aged 30 to 60, particularly those with fair skin, as rosacea may be more difficult to detect on darker skin tones.

While rosacea has no known cure, early diagnosis and appropriate medical treatment can significantly reduce symptoms, prevent the condition's progression, and improve overall skin health and quality of life.

How do I know if I need rosacea treatment?

It may be difficult to know whether you need treatment for rosacea because it can sometimes be mistaken for acne, contact dermatitis, allergic reactions, or other skin conditions. However, rosacea has distinct features and common symptoms that a doctor will be able to recognise and diagnose as rosacea.

Common rosacea symptoms

Rosacea symptoms can vary, but the most common signs include:

• facial redness that does not go away, particularly on the cheeks, nose, forehead, and chin
• sensitive skin, including burning, stinging, or itching
• frequent flushing or blushing
• visible small blood vessels (telangiectasia)
• face feeling warm or hot and painful
• red, acne-like bumps or pustules
• yellow/orange patches on skin
• dry, rough, or thickened skin texture (in advanced cases)
• irritation of the eyes and eyelids (dryness, redness, or swelling)
• swelling or thickening of the skin around the nose (rhinophyma)

If you recognise any of these symptoms, medical treatment for rosacea may help you control flare-ups, prevent your rosacea from worsening, and protect your skin’s long-term health.

Different types of rosacea and their symptoms

There are 4 different types of rosacea, each has slightly different symptoms. It’s also common for someone to have 2 or more types of rosacea at once. The different types of rosacea include:

Erythematotelangiectatic rosacea (redness)

This is the most common form of rosacea and is characterised by:

• persistent facial redness, in the face (cheeks, nose, and forehead)
• flushing episodes
• visible blood vessels
• symptoms that flare up unpredictably and gradually worsen without treatment

Papulopustular rosacea (acne-like symptoms)

This form of rosacea is often mistaken for acne, and its symptoms can include:

• red bumps (papules)
• pus-filled spots (pustules)
• facial redness
• swollen or inflamed skin

Phymatous rosacea (thickening skin)

This form of rosacea develops gradually and is more common in men. It causes:

• thickened, bumpy skin, which commonly affects the nose and can lead to rhinophyma, a condition where the nose becomes enlarged and bulbous
• enlarged pores

Ocular rosacea (rosacea in the eyes)

This type of rosacea affects the eyes and eyelids, causing:

• eye irritation, redness (bloodshot eyes), or dryness
• eyes to be sensitive to light
• sore eyelids, inflamed eyelids, and sometimes styes
• crusts around the roots of eyelashes (blepharitis)

Rosacea can change over time, and those with rosacea can develop symptoms of more than 1 type. Identifying and monitoring the pattern of your symptoms is key to choosing the most effective treatment approach.

How does rosacea treatment work?

Rosacea is a long-term condition, so its treatments aim to manage symptoms and reduce the frequency of flare-ups, rather than provide a cure, as the cause of rosacea remains unknown.

Rosacea symptoms can be effectively treated with a range of medicated creams, gels, or antibiotic tablets, as well as clinical procedures. The right treatment approach for you will depend on your specific symptoms and their severity. Medical treatments for rosacea work in the following ways:

1. Creams or gels (topical treatments)

There are gels and creams to treat rosacea symptoms like inflammation, redness or pimples and pustules. Different rosacea types can be treated with different creams, for example, by:

• targeting redness or calming inflammation
• killing bacteria and facial mites that worsen rosacea
• working to shrink dilated blood vessels on the face

2. Oral medications

In more advanced or severe cases, especially with inflammation and bumps or pustules (ocular and papulopustular rosacea), oral medications such as antibiotics may be prescribed to reduce inflammation rather than targeting bacteria directly.

3. Laser or light therapies

These treatments can target facial redness and visible blood vessels by damaging them with heat, which causes them to fade. This can help improve the appearance of rosacea symptoms over time.

How effective is rosacea treatment?

Topical creams and gels can be highly effective at reducing redness and bumps in mild to moderate cases of rosacea. For example, studies show that after 12 weeks of using ivermectin cream (Soolantra), around 40% of people achieved clear or almost clear skin, compared to just 12 to 19% with a placebo.

Oral medications, such as doxycycline, are effective in targeting inflammation caused by rosacea. Research shows that low-dose doxycycline (40mg) showed an 80 to 100% clearance of inflammatory rosacea lesions.

Laser treatments or light therapy for rosacea can effectively reduce redness and visible blood vessels. Many people see a noticeable improvement after a few sessions, but it can be a long process.

Most people will experience a significant reduction in symptoms with the right treatment plan. However, overall effectiveness also depends on:

• the severity of your symptoms
• how well you manage your triggers (such as alcohol and heat exposure)
• how consistent you are with your treatment

There are effective treatments for all types and symptoms of rosacea. Depending on the type of rosacea you have and your symptoms, your healthcare provider can help you find the right treatment approach to improve your symptoms and help you feel more comfortable in your skin.

How long does rosacea treatment take to work?

The time it takes to see improvement in rosacea symptoms following treatment can vary from person to person, but generally:

• topical treatments show noticeable results within 4 to 8 weeks
• oral antibiotics may start reducing inflammation in 2 to 4 weeks, but full effects are often seen by 6 to 12 weeks, depending on the treatment duration
• laser or light therapies usually require multiple sessions, but gradual improvement may be seen over a few months

Consistent use is essential to get the best results from most treatments.

Can rosacea come back after treatment?

Yes, none of these treatments can completely get rid of rosacea, as there is no known cure. However, treatments can help you effectively manage symptoms and improve the condition, but flare-ups may still occur, especially if triggers are not avoided.

What rosacea treatments are there?

There are various treatments available for rosacea. The most appropriate option for you will depend on the type of rosacea you have and the severity of your symptoms. Following a consultation, the main treatment options may include:

Topical treatments (creams and gels)

These rosacea treatments are applied directly to the skin and work to target redness, calm inflammation, and reduce acne-like bumps.

How do these treatments work?

They work by targeting bacteria and mites on the skin that worsen rosacea and by calming inflammation.

How effective is this treatment?

Topical treatments are popular and can be very effective. For example, around 40% of people using topical treatments, like ivermectin cream, see clear or almost clear skin after 12 weeks.

How long do these treatments take to work?

Topical treatments usually show results in 4 to 8 weeks.

How to use these treatments:

Apply directly to affected areas once a day, making sure skin is clean and dry.

Rosacea treatments available at ZAVA

At ZAVA, we can provide the following topical rosacea treatments:

• Mirvaso gel (brimonidine)
• Finacea gel (azelaic acid)
• Metronidazole gel
• Soolantra (ivermectin) cream

Oral medications (antibiotic tablets)

Tablets containing a low dose of antibiotics (like doxycycline) may be prescribed to treat rosacea in more moderate to severe cases, especially where inflammation is present.

How do these treatments work?

They work by reducing inflammation and fighting the growth of bacteria that contribute to rosacea flare-ups.

How effective is this treatment?

Oral medications, such as doxycycline, are effective treatments for rosacea. In one study, doxycycline reduced rosacea bumps and lesions twice as much as a placebo, by 11.8 compared to 5.9 in 16 weeks.

How long do these treatments take to work?

Depending on the length of the course prescribed, oral rosacea medications can start to show improvements in 2 to 4 weeks, but full results may take up to 16 weeks to show.

How to use these treatments

You will usually take 1 capsule a day and swallow it whole with water.

Oral rosacea treatments available at ZAVA

Oral medications, like antibiotics for rosacea, are not available at ZAVA. You will need to see your GP about this treatment approach. However, we can offer several topical treatment options.

Laser or light therapy for rosacea

These therapies are only offered in person at specialist skin clinics or by a dermatologist. ZAVA does not provide this type of treatment for rosacea.

How do these treatments work?

They work by targeting persistent redness and visible blood vessels by damaging them with heat, which causes them to fade over time.

How effective is this treatment?

Laser and light therapies can be very effective at reducing visible symptoms of rosacea, such as persistent redness and broken blood vessels. These treatments are often most beneficial when used as part of a stepwise approach: a step-by-step treatment plan in combination with treatments for other rosacea symptoms.

It’s important to first reduce inflammation with topical or oral treatments, as using laser or light therapy too early, when the skin is inflamed, can lead to discomfort.

How long do these treatments take to work?

Results are gradual over several sessions, which can take weeks or months.

What’s the best treatment for rosacea?

The “best” or most effective rosacea treatment for you will depend on your specific symptoms. For example, for inflammation, the usual starting treatment is ivermectin cream (Soolantra) as it often works well for many people. Often, a combination of treatments can provide the best results.

For people with more persistent or severe rosacea, combining treatment options, like a topical cream with an oral antibiotic, and in some cases, following this with laser or light therapy, can help manage multiple symptoms more effectively. This approach is especially useful when a single treatment has not provided enough relief or in cases of stubborn and severe rosacea.

In one study, people whose rosacea had not responded to initial treatments saw up to 71% fewer bumps and a 54% reduction in redness after following a combined treatment plan of laser therapy and oral medication. This highlights how combining therapies can deliver significant improvements when a single treatment is not enough.

Otherwise, the best rosacea treatment for you may ultimately depend on your preferences, medical history, and how your skin responds. Our doctors can help you choose the right treatment based on your needs, so you can get trusted rosacea treatments delivered discreetly and quickly.

How to buy rosacea treatment

There are several ways to buy or access treatment for rosacea, depending on the type of treatment you need and your symptoms.

Can I buy rosacea treatment online?

Yes, you can buy rosacea treatment online through safe and regulated online services, like ZAVA.

Ordering these treatments online with ZAVA is quick and easy:

1. Complete a short online questionnaire about your health and symptoms. We will also ask for confidential pictures of the affected area, which will only be seen by the ZAVA doctor in charge of prescribing your treatment.
2. One of our doctors will review your responses and pictures, and prescribe the best rosacea treatment for you if it’s safe and appropriate.
3. If approved, your medication will be delivered to you quickly and discreetly via Royal Mail, or you can choose to collect it from your local Post Office.

Can I get rosacea treatment over the counter?

You may be able to purchase some non-prescription rosacea treatments over the counter. These are usually gentle cleansers, moisturisers, or SPF products that help reduce irritation and minimise flare-ups caused by common triggers.

However, you need a prescription from a healthcare professional for the most effective rosacea treatments, like topical creams and oral medications, as these are not available over the counter.

Can I get rosacea treatment on the NHS?

Yes, you can get rosacea treatment on the NHS after a consultation with your GP. A GP can diagnose rosacea, assess your symptoms, and prescribe suitable medications based on your condition.

They may also refer you to a skin specialist (dermatologist) if your rosacea is severe or unresponsive to other treatments. However, you will need to make an appointment with your GP to find out what is available.

What are the side effects of rosacea treatment?

Like all medications, it’s possible to experience side effects from rosacea treatments. Not everyone will experience side effects, but it’s helpful to know what to expect and how to manage them if they do occur. The type, likelihood and severity of side effects will depend on the type of treatment.

As ZAVA only prescribes topical treatments, and these are the most common type of rosacea treatment, we’ll cover information on topical treatment side effects in this section.

Common side effects of rosacea creams (topical treatments)

These side effects can be common as you adjust to the treatment, and they include:

• skin peeling
• dry or very dry skin
• itchiness
• watering eyes
• a burning or stinging sensation after application
• skin reddening
• increased sensitivity to sunlight
• treated skin lightening in colour

For uncommon and rare side effects, please check the patient information leaflet for your specific medication, which is included in the packaging with your medication.

If you have concerns about any specific side effects, speak to your doctor.

How long do rosacea treatment side effects last?

Most side effects of topical rosacea treatments are mild and temporary. They may only occur as you first start using the medication, and they usually improve within a few days or a couple of weeks as your skin gets used to the treatment.

If your symptoms do not go away or get worse, it's important to speak to your healthcare provider.

What to do if you get side effects from topical rosacea treatment

If you experience side effects while using topical rosacea treatment, such as irritation, dryness or a burning sensation, there are simple steps you can take to manage them, such as:

• reduce how often you use the product to give your skin time to adjust to the treatment
• avoid using harsh cleansers or exfoliants alongside your treatment, swap them for a gentle alternative instead
• remember to wear SPF daily (at least 30) to protect your skin
• speak to a doctor or pharmacist if your symptoms do not improve or if they become too uncomfortable
• stop using the treatment immediately and seek medical help if you experience signs of an allergic reaction (rashes, swelling, or difficulty breathing)

Side effects from topical rosacea treatment are often temporary, but it’s important not to ignore them. Speak to a doctor about your side effects, and they may be able to recommend alternative treatments for you so you can get the best results.

​​Who can take rosacea treatment?

Rosacea treatment may not be appropriate for everyone. Some medications or medical conditions can affect how well treatments work or make them unsafe to use.

A consultation is necessary before you can get prescription rosacea treatment. A ZAVA doctor will review your health information carefully to make sure any treatment prescribed is safe and appropriate for you.

You may not be able to take rosacea treatment if you:

• are under 18 years old
• are pregnant or breastfeeding
• have certain skin conditions (such as eczema or open wounds on the treatment area)
• are taking medications that may interact with rosacea treatments, such as some antibiotics, blood thinners or certain drugs used for depression or Parkinson’s disease (monoamine oxidase or MAO inhibitors)
• are allergic to any of its ingredients

Rosacea treatment FAQs

Do creams work for rosacea?

Yes, topical treatments like ivermectin cream and metronidazole gel can be very effective at reducing inflammation, redness, and rosacea bumps. Many people see noticeable improvement within 4 to 12 weeks. Non-prescription rosacea creams are much less effective.

How long should I use rosacea cream or gel?

Rosacea is a long-term condition, so ongoing treatment is usually needed to prevent flare-ups.

Will long-term rosacea treatment lose its effectiveness?

No, topical rosacea treatment usually controls rosacea on a long-term basis, without loss of effectiveness. Speak to your healthcare provider if you are worried about this.

Can I wear makeup while using topical rosacea treatment?

Yes, you can, but try to opt for sensitive makeup that will not irritate your skin. Always apply your rosacea treatment first, allow it to absorb and only then apply makeup. You can get makeup specially designed for rosacea, such as products with a green or yellow-tinted base, which can help correct redness and even out your skin tone.