Prescription Medication and Cosmetic Procedures To Treat Rosacea

Prescription rosacea medication is either topical or oral therapy.  Treatment procedures in my practice are laser/light and electrocautery.

In my previous posts in this rosacea series I explain what rosacea is and describe the symptoms.  I outlined my supportive skin care recommendations and my holistic approach to managing this chronic condition.  In this last and final post of the series I’m going to summarize how I as a dermatologist treat my rosacea patients using prescription medicines and cosmetic treatments. It’s important to note that this information is for educational purposes only.  If you think it may be helpful for you, you need to bring it into your treating dermatologist and discuss it with him/her.

Topical Medicated Prescription Products That I Find Most Effective For Treating Rosacea In My Dermatology Practice

I add the prescription medicated products to my patient’s foundation regimen of skin care which I discussed in part 3 of this series. When compatible products are used they can be layered on the skin to build a complete therapeutic regimen.  The principle steps in any skin care regimen are cleanse, treat, moisturize, sun protect.  Medicated rosacea skin care products typically fall into the cleanse and treat steps.

Medicated Cleansers for Rosacea

The main medicated cleanser I recommend for my rosacea patients is Calming Zinc Soap with 2% pyrithione zinc.  If this is not sufficient I add a prescription sodium sulfacetamide (antibiotic) cleanser if my patient is not sulfa drug allergic.  I have them use this effective but smelly cleanser at night and the Noble Zinc Soap during the day.  One other option is a benzoyl peroxide cleanser; while most rosacea patients can’t tolerate benzoyl peroxide there are rare rosacea patients who actually do best with this medicated ingredient.  It would not be the first cleanser that I try on a patient however.

Topical leave-on prescription medicated skin care products for rosacea

Most of my rosacea patients use either Replenix CF Cream or Green Tea Antioxidant Skin Therapy – Replenix Power of Three Cream  and any prescription leave on product is applied after Replenix.  Options include Metrogel, cream or lotion, Finacea or benzoyl peroixide (again it is a rare rosacea patient who tolerates benzoyl peroxide and does best with this medicine).  I may also use topical lotrimin cream (clotrimazole) or ketoconazole cream if there is a component of facial dandruff, which many rosacea patients also have.  If there are a lot of juicy pimples then I may address demodex mites with elemite (permethrin cream though this is very ‘off label’ and not approved by our FDA since elemite is indicated for the treatment of scabies).

I only use non-halogenated topical cortisone steroid creams as a last resort for short term control of facial inflammation (such as over-the-counter hydrocortisone cream).  It’s important to note that halogenated steroids will aggravate rosacea. Steroid creams can also thin your skin and damage your eyes.  Your dermatologist will know what this means and should be the one to prescribe and supervise any cortisone use on your face.  Lastly, there is that rare rosacea patient who actually does best with benzoyl peroxide creams and lotions even though most rosacea patients can’t tolerate this ingredient on their skin.

Oral prescription medicine to treat for rosacea

Again, I’m biased in that I don’t like to manage a chronic skin condition such as rosacea with lifelong antibiotics.  I use antibiotics to ‘get the attention of a person’s skin’ then stop them once the skin has cleared.  I typically use a full therapeutic dose to ‘get in and get out’ as fast as possible without creating super germs.  My favorite oral antibiotics to treat rosacea are tetracycline and doxycycline.  I don’t use minocycline because of its unique and serious side effects like liver inflammation, autoimmune syndrome/arthritis and gray skin discoloration.  I rarely use erythromycin due to its drug interactions.  In patients with very severe rosacea I’ll also consider a temporary course of Accutane if we’ve tried everything and their rosacea is severe and still making them miserable, though this is a last resort.

Cosmetic procedures to treat rosacea

Intense pulsed light treatments are the biggest advance we’ve had for rosacea treatment in recent years.  In my experience it both improves the cosmetic appearance of the skin’s ‘broken’ capillaries and quiets down a person’s propensity for flare ups of their rosacea.  In my office the treatments are done as an initial series of 5 and then maintenance treatments are necessary every year.  IPL treatments have made a big improvement in my own mild rosacea and I’m a big fan.

Selective ‘broken’ capillaries can be cauterized with electrocautery to improve the cosmetic appearance of the skin.  Lasers such as the V-beam laser can be used to treat more extensive capillaries.

The full 5 Post Rosacea Series:

What is Acne Rosacea?

What Are The Skin Symptoms Of Acne Rosacea?

Rosacea Skin Care Tips From My Dermatology Practice

Acne Rosacea; Dermatologist’s Natural Treatment of Rosacea

Photo: Thanks and gratitude to Mitch

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3 Responses to “Prescription Medication and Cosmetic Procedures To Treat Rosacea”

  1. Matthew J January 13, 2011 at 5:21 am #

    Thank you again for your blog Dr Bailey. I have ordered several of your products and spoken to you via email and will let you know how I get on with the Citrix sunscreen and Replenix CF cream.

    That said, I also have an Rx for Metrogel 1% which I believe is identical to the product usually dispensed in the US by Galderma and was wondering what your opinion on the long-term use of this product is given that it is antibioitc. I know that the long-term use of internal antibiotics can cause resistance but was not sure if and how this applies to topical antibiotics like Metrogel.

    Thanks again for the invaluable information

  2. Cynthia Bailey MD January 13, 2011 at 8:19 am #

    Hello Matthew,
    Even with topical antibiotics I try to stop them when the skin has been clear for many months. In additional to the resistant organism issue, it’s nice to give the skin a chance to ‘forget’ the medicine so that if and when the rosacea flares up again the topical antibiotic product is a surprise to it and stands a better chance of working. This is called a ‘drug holiday’. That said, many rosacea patients need to use Metrogel/lotion/cream long term or else their skin just won’t stay clear. My opinion is that the risks of resistant skin organisms to topical antibiotics is less significant to one’s overall health than it is with oral antibiotics. Great question!

  3. John Tubbs February 7, 2011 at 9:24 am #

    It should be noted that the modern skin care methods and medical procedures allows doctors to perform highly effective treatment easily. Today doctors can easily perform treatments, which were even impossible in the past. But, unfortunately, not all patients are awere of signifficant benefits of innovative medical treatment methods. I would say that efficiency of treatment mainly depends on the following facts: 1) professionalism of a doctor; 2) how quickly you go to the doctor and start working on the problem.