- Rosacea is a chronic, inflammatory skin condition that causes facial redness, flushing, inflammation, burning and stinging.
- Rosacea creams are a critical component in the management of rosacea.
- Prescription rosacea creams are often combined with oral antibiotics or other treatment modalities.
- Over-the-counter and rosacea-friendly products include creams, cleansers, moisturizers, sunscreen and makeup.
Rosacea is an inflammatory, chronic skin condition that causes redness and irritation on the face. Other common symptoms include facial flushing, inflammation, stinging, burning, pimples, papules and visible blood vessels beneath the skin’s surface.
One form of rosacea treatment is rosacea cream. Creams for rosacea are used to address facial redness, inflammation and Demodex mites. There are two major rosacea types that can benefit from rosacea cream: erythematotelangiectatic rosacea (ETR) and acne rosacea.
What Causes Rosacea?
The exact causes of rosacea are not clear, but evidence points to a number of contributing factors.
Blood vessel abnormalities are one possibility; dilated vessels near the surface of the skin cause rosacea’s signature redness in some individuals. When blood vessels widen, increased blood flow under the skin is more noticeable.
Demodex dust mites are said to be another contributing factor, as they can cause chronic inflammation. People with rosacea have much higher numbers of Demodex on their skin and in their eyelashes.
For many people, rosacea is an inherited disorder. A recent study shows that rosacea is caused by specific skin pigmentation and immunoinflammatory genes. If genetics are at play in rosacea’s presentation, it could be passed from one generation to the next.
Some people with rosacea also show a high number of cathelicidins, protein-like structures that are presumed to be associated with immune system abnormalities.
Topical Treatments for Rosacea
There are a number of topical treatments for rosacea, including prescription and over-the-counter (OTC) rosacea creams. Because rosacea has multiple potential causes and tends to be a complicated disorder to treat, topical treatments are just one approach to managing rosacea. A multipronged approach seems most effective for rosacea, the exact cause of which is still unclear.
Rosacea creams are medicated, topical treatments that reduce redness, swelling and the appearance of dilated blood vessels below the skin’s surface.
Generally, topicals are combined with other treatments; however, a topical rosacea cream is one of the most important components of rosacea care. Medicated, topical creams for rosacea address specific rosacea-related symptoms. Some creams address Demodex mites; others address skin redness and inflammation.
Over-the-Counter Rosacea Creams
While there are some OTC products said to decrease the redness and discomfort associated with rosacea, many of those products are simply moisturizers, serums or cleansers. Some brands labeled as homeopathic or natural products contain ingredients such as sulfur to dry up blemishes associated with rosacea, but there is no scientific evidence that these products are effective.
It may be helpful to bolster your doctor’s recommended skin care regimen by applying soothing, anti-inflammatory OTC products alongside your prescriptions. Avoid corticosteroid creams, though, as steroids can induce rosacea.
Prescription Rosacea Creams
Creams for rosacea are often prescribed by a dermatologist in conjunction with a short course of low-dose, oral antibiotics to control the symptoms of rosacea. Rosacea prescriptions are available in cream, gel and lotion forms.
Your doctor may prescribe one of a number of prescription rosacea cream options. They might also recommend a combination of a topical treatment with a low-dose antibiotic regimen to address your rosacea symptoms, based on how severe your condition is.
While all prescription rosacea creams address redness, some are indicated for papules and pustules, while others are intended to address dilated blood vessels or Demodex mites. Your doctor will determine the best prescription rosacea cream for you based on the type and severity of your symptoms.
Pustules and papules
For acne rosacea that involves pustules and papules, your doctor may prescribe azelaic acid, clindamycin, dapsone, metronidazole or sulfacetamide.
- Azelaic acid gel 15% has been scientifically proven to be effective at killing bacteria on the skin’s surface and reducing swelling and redness; possible side effects include burning, itching, tingling, a warm sensation, stinging, irritation, dryness, peeling, or changes in skin color.
- Clindamycin is a topical antibiotic that has been proven more effective than oral tetracycline. Potential side effects include burning, stinging, redness, dryness, oily or peeling skin, abdominal pain and stomach upset.
- Dapsone is a sulfone antibacterial that is used for up to 12 weeks. Side effects include redness, dryness, oily or peeling skin.
- Metronidazole is a gel topical that has been shown to reduce the average number of papules and pustules by 48–65% in acne rosacea patients. Potential side effects include redness, irritation, burning, stinging, itching, scaling, dryness, nausea, tingling or numbness in feet or hands, or a metallic taste.
- Sulfacetamide is an emollient foam sulfur cleanser proven to have a low instance of side effects and a good safety profile. Side effects include redness, itching, swelling, dryness or discoloration.
Dilated blood vessels
Some prescription rosacea creams are vasoconstrictors, which help narrow dilated blood vessels in the face.
- Brimonidine tartrate gel works in minutes and has a good safety profile for up to 12 months of use. Only a small percentage of users involved in one study (4–15%) experienced the possible side effect of worsened redness within the first week of use. Other potential side effects include headache, nausea and discomfort or stinging in the eyes.
- Oxymetazoline hydrochloride is also a vasoconstrictor, but as an added bonus, works to resolve acne rosacea pustules. While this treatment has been shown to be effective in clinical trials, more long-term research is needed.
As Demodex mites are linked to cases of rosacea, some rosacea products target these mites.
- Benzyl benzoate has been proven to be an effective treatment. It may cause the skin to itch or burn; rare but more severe side effects including scaling, oozing, crusting, blister formation, redness, jerking movements, difficulty urinating, and sudden loss of consciousness.
- Ivermectin is another treatment proven to reduce the density of mites present on the skin. Side effects are rare but may include stinging, burning, redness, itching, dandruff, dryness, watery eyes, blepharitis and eye pain.
Ask your doctor about possible side effects before you begin using any topical medication.
It could take weeks to see changes in your skin. Be consistent with your treatment and follow up with your doctor to assess your progress. If you don’t begin to see improvement, your doctor may opt for another prescription rosacea cream.
Other Rosacea Treatments
Rosacea patients may undergo a combination of rosacea treatments in addition to topical rosacea creams and oral antibiotics such as tetracycline and doxycycline. These include:
- Laser skin resurfacing, a minimally-invasive cosmetic procedure that encourages growth of new, healthy skin cells
- Intense pulsed light (IPL) treatments, a type of phototherapy that uses light in specific wavelengths to treat visible veins and capillaries beneath the skin
- Electrosurgery, which uses a small electrical current to shrink visible blood vessels
- Dermabrasion, a procedure that involves exfoliating the top layer of skin with a special device, to reveal a new, fresh layer of skin
Rosacea-Friendly Skin Care Products
Together with topical and prescription rosacea treatments, adding rosacea-friendly skin care products to your routine offers a multipronged defense against this condition.
Choose a gentle, hypoallergenic, fragrance-free cleanser with neutral pH to help minimize the symptoms of rosacea. Clearing your skin of makeup, bacteria and debris is a soothing, essential part of any skin care routine.
For dry and combination skin, choose from a range of nonsoap cream, milk or noncomedogenic oil cleansers. If your skin is dry, an oil or moisturizing cleanser would be ideal; if oily, a mild soap or gel based cleanser might be a better choice.
Mild exfoliants such as gluconolactone (PHA) are suitable for people with acne rosacea, dry or oily skin. Bentonite clay is also a mild, pore-clearing exfoliant that can work well for some people with rosacea. Be sure to avoid cleansers with sulfates, though, as they can be irritating to the skin.
Moisturizing is another important skin care step in any skin care routine. However for those with rosacea, to address the increased sensitivity and irritation, it is important to choose a moisturizer that will create a protective, nourishing barrier between the skin and environmental triggers.
Moisturizers also reduce and can even prevent some of rosacea’s most uncomfortable symptoms, such as stinging, burning and itching, by soothing and moisturizing the skin. Choose a fragrance-free, noncomedogenic hydrate with soothing ingredients such as chamomile, calendula, niacinamide and green tea.
Avoid potentially irritating ingredients such as synthetic fragrances, dyes, retinol, witch hazel, alcohol, citrus extracts, peppermint, menthol and lanolin.
Consider using a moisturizer that contains sunscreen, which provides two important benefits: soothing hydration for your skin, plus protection from overexposure to the sun’s UV rays, which can trigger a rosacea flare.
To even your skin tone, consider using a green-tinted primer, followed by an oil-free foundation and concealer. Mineral makeup in either liquid or powder form could be a smart choice for rosacea-prone skin, as it tends to have fewer synthetic ingredients. As with sunscreen, avoid fragrances and other possible skin irritants.
UV rays are particularly damaging to people with rosacea. Not only can they destroy collagen and elastin in the skin, they can also damage the delicate blood vessels that are already affected by the condition. Whether sunscreen is a component in your moisturizer or you’re using it as a standalone step in your skin care regimen, protecting your rosacea-prone skin is essential.
Choose a sunscreen of SPF 30 or above. Physical, or mineral sunscreen is a gentler choice for rosacea than chemical sunscreen because chemical ingredients can aggravate symptoms. Active ingredients in mineral sunscreens include zinc oxide and titanium oxide.
If you use a physical sunscreen, avoid potentially irritating ingredients such as fragrances, alcohols, padimate O and para-aminobenzoic acid (PABA).
Rosacea creams treat symptoms of rosacea such as pimples, pustules, redness, inflammation and dilated blood vessels. They also address demodex mites, considered to be one of the causes of rosacea symptoms.
For acne rosacea, common creams include azelaic acid, clindamycin, dapsone, metronidazole and sulfacetamide. For ETR, common creams include brimonidine, oxymetazoline hydrochloride, benzyl benzoate and ivermectin.
Most people under a doctor’s care for rosacea have a combination of treatments in their skin care plan, including not only topical creams but also oral antibiotics and skin rejuvenation procedures such as IPL and laser skin resurfacing.
Talk to your doctor about the treatment regimen that is best for your skin. If one treatment isn’t effective, it’s common to switch approaches until you identify the best combination for your skin.
- Aponte JL, Chiano MN, Yerges-Armstrong LM, Hinds DA, Tian C, Gupta A, Guo C, Fraser DA, Freudenberg JM, Rajpal DK, Ehm MG, Waterworth DM. Assessment of rosacea symptom severity by genome-wide association study and expression analysis highlights immuno-inflammatory and skin pigmentation genes, Human Molecular Genetics, Volume 27, Issue 15, 01 August 2018, Pages 2762–2772, https://doi.org/10.1093/hmg/ddy184
- Bhat, Y. J., Manzoor, S., & Qayoom, S. (2011). Steroid-induced rosacea: a clinical study of 200 patients. Indian journal of dermatology, 56(1), 30–32. doi:10.4103/0019-5154.77547
- Jackson, J. M., Knuckles, M., Minni, J. P., Johnson, S. M., & Belasco, K. T. (2015). The role of brimonidine tartrate gel in the treatment of rosacea. Clinical, cosmetic and investigational dermatology, 8, 529–538. doi:10.2147/CCID.S58920
- Patel NU, Shukla S, Zaki J, Feldman SR. Oxymetazoline hydrochloride cream for facial erythema associated with rosacea. Expert Rev Clin Pharmacol. 2017 Oct;10(10):1049-1054. doi:10.1080/17512433.2017.1370370
- Trumbore MW, Goldstein JA, Gurge RM. Treatment of papulopustular rosacea with sodium sulfacetamide 10%/sulfur 5% emollient foam. J Drugs Dermatol. 2009 Mar;8(3):299-304. https://www.ncbi.nlm.nih.gov/pubmed/19271381
- Wilkin JK, DeWitt S. Treatment of rosacea: topical clindamycin versus oral tetracycline. Int J Dermatol. 1993 Jan;32(1):65-7. https://www.ncbi.nlm.nih.gov/pubmed/8425809
- Forton FMN1, De Maertelaer V2.Treatment of rosacea and demodicosis with benzyl benzoate: effects of different doses on Demodex density and clinical symptoms. J Eur Acad Dermatol Venereol. 2019 Sep 7. doi:10.1111/jdv.15938
- Gollnick H, Layton A. Azelaic acid 15% gel in the treatment of rosacea. Expert Opin Pharmacother. 2008 Oct;9(15):2699-706. doi:10.1517/14656518.104.22.16899
- Rivero, A. L., & Whitfeld, M. (2018). An update on the treatment of rosacea. Australian prescriber, 41(1), 20–24. doi:10.18773/austprescr.2018.004
- McClellan KJ, Noble S. Topical metronidazole. A review of its use in rosacea. Am J Clin Dermatol. 2000 May-Jun;1(3):191-9. https://www.ncbi.nlm.nih.gov/pubmed/11702300
- Sarac G, Cankaya C, Ozcan KN, Cenk H, Kapicioglu YK. Increased frequency of Demodex blepharitis in rosacea and facial demodicosis patients.J Cosmet Dermatol. 2019 Sep 25. doi:10.1111/jocd.13150
- Schaller M, Gonser L, Belge K, et al. Dual anti-inflammatory and anti-parasitic action of topical ivermectin 1% in papulopustular rosacea. J Eur Acad Dermatol Venereol. 2017;31(11):1907–1911. doi:10.1111/jdv.14437