Rosacea Acne Treatment Options?

I'm a 44-year-old Indian female, and have redness on central portion of my face, particularly the cheeks and nose. There is also a lot of burning sensation in my neck and face. There is skin peeling and acne flares up after redness. I  have a dry skin. My doctor diagnosed it as acne rosacea and I have been taking treatment for it since 6 months but there's no improvement. What other acne rosacea treatments would you suggest? Please help.

Doctor Answers 3

Here are some of the primary acne rosacea treatments you can try.

Thanks for your question.

For acne rosacea (stage 2 rosacea), here are some of the treatments we like to use:

1. Doxycycline once or twice daily - this should be essential for your case

2. Metrogel - in my opinion, only mildly effective in selected patients

3. Finacea - good choice for twice daily use in your case

4. Sodium sulfacetamide / sulfur cream or wash - may be helpful in your case

5. Elidel - no proven effect in rosacea, but I have seen it help in stage 1 rosacea in those patients that also had dryness or seborrheic dermatitis

6. Accutane - low dose accutane daily or 3 times weekly may be very effective

7. Sunscreen - an essential component of your treatment if you spend time outdoors

8. Trigger avoidance - avoid hot or spicy foods / liquids, coffee, alcohol, stress, sunlight

9. IPL / Vbeam laser - sometimes the only way to remove facial vessels and telangiectasias from rosacea

You will an individualized treatment plan based on your rosacea and previous treatments.

Hope this helps!

Beverly Hills Dermatologist
5.0 out of 5 stars 1 review

Many Treatments For Rosacea

Unfortunately, you did not specify which treatments have been tried so this might be repetitive.

Rosacea is likely caused by an excess of a protein called stratum corneum tryptic enzyme ( SCTE). This enzyme cleaves Procathelicidins to produce the activated Cathelicidins. These are products of inflammation which protect our skin from all the nasty bacteria we are exposed to everyday. Our skin is challenged daily by bacteria so why do we rarely get infections? If you are interested you should reference the article Antimicrobial Peptides and the skin Immune Defense System in the Journal of Allergy and Clnical Immunology April 24, 2008.

Once Cathelicidins are activated inappropriately, they cause the symptoms of Rosacea, ie. the reddness, swelling, dilated blood vessels. You might check out another great article which appeared in Nature Medicine online August 2007 which brilliantly studied this problem or Dr. Gallo's article in the Journal of Investigative Dermatology from 2004 that first brought up this theory.


As you know various trigger factors worsen rosacea. It has not been proven scientifcally by any means but I suspect these so-called trigger factors are changes which induce SCTE. These would include elevated temperatures, alcohol, stress, heavy lifting or certain foods.

The point is antibiotics usually help by probably working as antiinflammtory agents. Hence, many of us dermatologists are prescribing Oracea. It is safe and does not kill bacteria and lead to resistance. Metrogel and Finacea have both been shown to be effective topically. Curiously, Niacin flares Rosacea but Niacinamide, its precursor does not and in fact helps Rosacea. Sunscreens are important and I like Aveeno Ultra Calming Cream with Feverfew for this. Incidentally, the Aveeno product does not contain oxybenzone which has recently been implicated by the Environmental Working Group as causing all sorts of vile problems. Some preliminary research has shown that Afrin, made into a cream, and applied topically helps with the reddness of Rosacea.

Sulfa-sulphur topical combinations help in cases; although a recent paper showed them inferior to Finacea and Metrogel.

Obviously avoiding the trigger factors helps significantly. Please do not let a Medi-Spa or some such convince you to have a peel. Peels aggrevate Rosacea. You may end up back in your dermatologists office pleading for relief.

You also did not describe what type of rosacea you have. If it is the pustular type with Rhinophyma, Accutane actually can workswell since this type is associated with large sebaceous glands.

Finally, light devices such as IPL in the green spectrum help with the vascular component of Rosacea.

So there are many things to try. Maybe they have already been tried and if so you can fall back on the ingenuity of your dermatologist.

Arnold R. Oppenheim, MD
Virginia Beach Dermatologist
4.7 out of 5 stars 14 reviews

You didn't mention the types of treatments you've used but generally none of the topical

rosacea medicines work well for the manifestations you seem to have...the best single treatment is intermittent low dose hydrocortisone cream that you can get without a prescription at the drugstore...alternatively a low potency prescription like desonide might also work well...can't be used on a long term basis but short term, you'll be surprised by the results and the speed of improvement...then you must avoid any harsh topicals, washing habits (no scrubbing) and lay off the cosmetics temporarily...

Ken Landow, MD
Las Vegas Dermatologist
4.6 out of 5 stars 9 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.