What Are the Best Treatment Options for Acne Rosacea?

There is no cure for rosacea, but it can be treated and managed with medications, self-care practices, and avoiding triggers.

Rosacea often starts with a tendency to blush or flush red easily. It is a common and chronic skin condition that affects 14 million Americans. Over time people who have rosacea may have permanent redness.  

Rosacea is an inflammatory skin condition that sometimes looks like acne. It produces redness, inflammation, and bumps usually on the cheeks and nose. 

There are different forms of rosacea that range from visible blood vessels and redness to rosacea acne and thickening skin. 

The symptoms of rosacea may vary based on the type, but some common symptoms include: 

• Tendency to blush
• Redness, especially across the nose and cheeks
• Visible blood vessels 
• Swelling
• Stinging or burning skin 
• Sensitive skin
• Acne-like bumps and breakouts, but without whiteheads or blackheads
• Raised patches called plaques
• Thickened skin
• Large pores
• Oily skin
• Red and irritated eyes
• Swollen eyelids

Researchers don’t yet know the exact cause of rosacea or rosacea acne. There may be some factors that contribute to rosacea.

Rosacea runs in families. If someone in your family has rosacea, you may be more likely to develop it. 

Demodex mites may play a role in rosacea and rosacea acne. Everyone has mites on their skin, but people with rosacea may have more than people without rosacea. 

People with rosacea may also often have a bacteria infection called H. pylori. However, research doesn’t show that this bacteria causes rosacea and many people without rosacea have this infection as well. Some people with rosacea may also have a problem with their immune system where it overreacts to a bacteria called Bacillus oleronius. 

Certain things may also trigger rosacea flare ups. These may include:

• Alcohol
• Caffeine
• Hot drinks
• Spicy foods
• Cheese
• Exercise 
• Sunlight
• Sunscreen
• Emotional stress
• Cosmetics
• Cold or hot weather
• Hot baths

Anyone can develop rosacea. However, most people who get rosacea and rosacea acne:

• Are fair-skinned 
• Have blonde hair and blue eyes
• Are from Celtic or Scandinavian ancestry
• Are between age 30 to 50
• Have had lots of acne or acne cysts
• Have family members who have rosacea

Women are more likely to get rosacea than men. Children and people of all races can also develop rosacea.

Some rosacea may look like acne, but your doctor will be able to spot the differences right away. There aren’t any specific tests for rosacea or acne rosacea, so your doctor will rely on a physical examination. They may ask questions about when your symptoms first appeared and your family history. 

The lack of blackheads and whiteheads will help your dermatologist determine rosacea acne from other acne.

There is no cure for rosacea, but it can be treated and managed with medications, self-care practices, and avoiding triggers. 

Medications

Rosacea acne treatment may involve medications like:

• Antibiotic cream
• Antibiotic tablets
• Metronidazole gel
• Tretinoin
• Immune system medications
• Anti-parasitic medication
• Silymarin with methylsulfonylmethane 

Home care

Good self-care practices are an important part of managing your rosacea. You can:

• Wear sunscreen to protect your skin.
• Avoid sunlight, heat, and humidity. 
• Avoid foods and drinks that trigger your rosacea.
• Avoid too much or intense exercise.
• Regularly wash eyelids with a gentle cleanser.
• Apply a warm washcloth to your eyelids.
• Manage stress.

Skincare is an important part of managing your rosacea. Some products can ease your symptoms and relieve your symptoms, including: 

• Oil-free, soap-free, and fragrance-free cleanser
• Sulfur cream
• Azelaic acid
• Benzoyl peroxide
• Oil-free, gentle moisturizer
• Broad-spectrum sunscreen with zinc oxide or titanium dioxide

Your skin may be sensitive with rosacea and rosacea acne. You may want to avoid irritating products like astringents with alcohol, sodium lauryl sulfate, and soap-based cleansers.

Alternative therapies

Alternative therapies may be recommended for rosacea, including:

• Intense pulsed light treatment
• Laser therapy

Surgery

Some dermatologists may recommend procedures for cosmetic improvement of rosacea or rosacea acne. These may include:

• Carbon-dioxide laser peel
• Cold steel excision
• Dermabrasion
• Surgical shave

These procedures may be used to improve thickening skin, a bulbous nose, large pores, or skin texture. However, researchers are still studying how effective these treatments are. 

Some treatments may have side effects. Products like benzoyl peroxide or azelaic acid may be useful for rosacea, but they may also cause burning and itching. These may not be suitable for your skin. 

Long term use of antibiotics may lead to antibiotic resistance and changes to the good bacteria in your intestines called your microbiome. Some antibiotics may also cause sensitivity to the sun and increase the risk for sunburn and irritation. 

Tretinoin cream may also be helpful but may cause side effects like skin redness, dryness, or irritation.