Written by Dr. James Macdonald MD, HBSc
March 3, 2024 - My goal here is to help you understand your treatment options, how well they work, what they cost and what to look out for.
References are available at the bottom of this article and will be updated as new studies are published.
It is important to remember that rosacea is a progressive disease and your first step is to eliminate environmental and lifestyle factors that trigger your symptoms.
A well documented survey conducted by the National Rosacea Society showed that the identification of triggers and appropriate skin care resulted in a significant improvement in 90% of people.
To put this in perspective the most successful prescription medications(summarized below), cost upwards of $500 / month and have only been documented to help improve symptoms in 26% of users.
Leading Rosacea specialist, Dermatologist Dr. Jason Rivers, spent 30 years in clinical practice before devoting 8 years to the development a routine of skincare products for his most deserving patients, those with sensitive, rosacea-prone skin. His approach was to:
- Eliminate all known irritants, fragrance, colorants and unnecessary harmful chemicals like parabens, and formaldehyde-releasing agents
- Ensure all products exist at a pH of 5.5 – preventing further damage to an already compromised skin barrier
- Create moisturizing complexes at every stage of the routine, to activate skin barrier repair, reduce moisture loss, enhance proper moisture movement in the skin and finally allow the skin to restart stimulating the production of its natural moisturizers.
- Validate new active ingredients to target the root cause of rosacea symptoms. Riversol products contain a proprietary combination of ingredients with anti-inflammatory, antioxidant, and natural anti-biotic properties. Riversol was the first company to stabilize Beta-thuljaplicin into a skincare formula that met all the other requirements needed for rosacea-prone skin.
- Let everyone try the product for free, for enough time to make sure it works for you. A 15-day free sample of Dr. Rivers’ skincare line for rosacea is available here.
Included with your sample is a free guide and printable trigger mapping journal to help you identify and eliminate your triggers.
Current prescription treatments on the market are broken down in to two categories based on the individual symptoms:
Treatments for redness and visible blood vessels:
Topical Vasoconstrictors
Trade Names: Brimonidine (Mirvaso), Oxymetazoline (Rhofade)
How they work:
Temporarily reduces facial redness by constricting blood vessels.
Effectiveness:
Reduces facial redness in 26 out of 100 subjects.
Potential Downsides:
Overuse can worsen flushing, skin irritation, and allergic reactions.
Cost: Mirvaso: $618/30g, Rhofade: $661/30g
Surgical Laser Therapy
Trade Names: Intense Pulsed Light (IPL) therapy
How it works:
Destroys superficial red blood vessels through targeting application of heat.
Effectiveness:
Considered the primary treatment for visible blood vessels and thickened skin. (rhinophyma)
Potential Downsides:
Temporary pain, redness, blisters, scabs, swelling. Small scars may remain. Cost and accessibility of properly trained physicians.
Cost: $400 to $1200 per session
Beta-Blockers
Trade Names: Off-label prescription
How it works:
Reduces blood flow to the face.
Effectiveness:
Promising results but not commonly used due to side-effects.
Potential Downsides:
Not approved for rosacea in many places, not suitable for asthma patients, side effects like tiredness and dizziness.
Cost: $14 / 50 tablets @ 10 mg
For Red and Yellow Spots - (Papules and Pustules):
Azelaic Acid (Topical)
Trade Names: Skinoren, Finacea
Benefits:
Reduces inflammation
Effectiveness:
Relieves symptoms in 18 out of 100 users.
Potential Downsides:
Can cause burning, itching, dry skin, rash, may worsen symptoms
Cost: $369 / 50g
Antibiotics (Topical)
Trade Names: MetroCream, MetroGel, MetroLotion, Noritate, Rosadan
How it works:
Topical Antibiotic activity, reduces inflammation.
Effectiveness:
Comparable to azelaic acid, with some contradictory results.
Potential Downsides:
Skin irritation, contact dermatitis, allergic reactions, increased sun sensitivity.
Cost: $405 / 60g (generic: $145 / 55g)
Antibiotics (Oral)
Trade Names: Oracea
How it works:
Topical Antibiotic activity, reduces inflammation.
Effectiveness:
Systemic Antibiotic activity, reduces inflammation.
Potential Downsides:
Skin irritation, contact dermatitis, allergic reactions, increased sun sensitivity.
Cost: $972 / 30 capsules (generic: $645 / 30 capsules)
Note: Cost's listed are in USD and can vary based on insurance coverage and pharmacy location. Always consult with a healthcare provider for personalized advice and to understand the potential risks and benefits of each treatment option.
Ready to treat your Rosacea? Start with a 15 day sample kit from Riversol, and help fight the effects with Dermatologist developed skincare. Get yours here.
References:
- Logger JG, Olydam JI, Driessen RJ. Use of beta-blockers for rosacea-associated facial erythema and flushing: a systematic review and update on proposed mode of action. J Am Acad Dermatol 2020; 29 [Epub ahead of print]. [PubMed: 32360760]
- Reinholz M, Tietze JK, Kilian K, Schaller M, Schöfer H, Lehmann P et al. Rosacea - S1 guideline. J Dtsch Dermatol Ges 2013; 11(8): 768-780. [PubMed: 23647643]
- Van Zuuren EJ. Rosacea. N Engl J Med 2017; 377(18): 1754-1764. [PubMed: 29091565]
- Van Zuuren EJ, Fedorowicz Z, Tan J, van der Linden MM, Arents BW, Carter B et al. Interventions for rosacea based on the phenotype approach: an updated systematic review including GRADE assessments. Br J Dermatol 2019; 181(1): 65-79. [PMC free article: PMC6850438] [PubMed: 30585305]
- Drug Prices sourced March 3, 2024 from Drugs.com. *Costs are variable and depend on where you live and your personal drug plan
- org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. What are the treatment options for rosacea? [Updated 2020 Sep 10].Available from: https://www.ncbi.nlm.nih.gov/books/NBK279475/
- Laughlin SA, Dudley DK: Laser therapy in the management of rosacea. Journal of Cutaneous Medicine and Surgery. 1998;2(suppl 4):S4/24-S4/29.