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Rosacea treatment for acne-like breakouts

Before and after treatment for acne-like breakouts of rosacea: After 3 laser treatments (right), this woman has less redness and fewer acne-like breakouts.

If your rosacea causes breakouts that look like acne, you have some effective treatment options. Here’s what your rosacea treatment plan from a dermatologist may include:

Medications you apply to your skin

Azelaic acid: Most patients apply this medicine twice a day — in the morning and again in the evening.

Findings from 6 research studies show that between 70% and 80% of patients have had noticeably less rosacea with azelaic acid. Some patients saw complete clearing.

When you apply this medicine, you may feel some tingling or burning at first. This feeling tends to go away as you continue to use the medication. If it doesn’t, be sure to tell your dermatologist.

Another possible side effect of this medication is skin lightening. If your rosacea caused patches of darker skin on your face, you may not mind this side effect. Should you notice skin lightening, be sure to tell your dermatologist immediately.

Metronidazole: Available as a gel or cream, this treatment has been used for more than 60 years to treat the acne-like breakouts of rosacea. Research studies show that it can effectively reduce both the redness and the acne-like breakouts.

Some patients are able to stop applying this medication and keep the results they gained by using metronidazole. In one study, only 23% of patients had a rosacea flare-up 6 months after stopping metronidazole.

If you need stronger medication to control your rosacea, your dermatologist may prescribe metronidazole along with other treatments. Using everything in your treatment plan can improve results.

Possible side effects of using metronidazole gel or cream include itching, stinging, irritated skin, or dryness where you apply the medication.

Sodium sulfacetamide and sulfur: You’ll find these ingredients in treatment that you can buy without a prescription, such as a cleanser, and prescription medication that you apply to your skin.

These ingredients have been used to safely treat the acne-like breakouts of rosacea for more than 60 years. It’s considered safe, but be sure to tell your dermatologist if you have kidney disease or are sensitive to sulfur. You’ll also want to mention if are pregnant or planning to become pregnant.

In research studies, scientists have found that these ingredients can effectively treat the acne-like breakouts and surrounding redness. According to research findings, patients typically see a 65% to 78% decrease in acne-like breakouts in about 6 to 8 weeks. Redness can decrease by 66% to 83%.

You can improve these results by following your rosacea treatment plan and avoiding what triggers your rosacea.

Possible common side effects from sodium sulfacetamide and sulfur include itching, dryness, temporary redness, or irritated skin. These tend to decrease as you use the medication.

Retinoid: This is a form of vitamin A that can irritate skin with rosacea. Once you get the rosacea under control, however, applying a retinoid can help you prevent flare-ups. It can also reduce signs of aging on your skin.

This option isn’t right for everyone. Your dermatologist can tell you if a retinoid is right for you.

Medicine you take

Antibiotics: For more than 50 years, dermatologists have prescribed tetracycline, an antibiotic, to their patients with rosacea. It can quickly reduce the acne-like breakouts and redness. In research studies, most patients have noticeably fewer acne-like breakouts within one month.

Other antibiotics, such as minocycline, doxycycline, or erythromycin, can also effectively treat rosacea.

If you need an antibiotic, it will generally be prescribed to get the rosacea under control. Once under control, most patients use another treatment to maintain results.

Taking antibiotics too frequently or for too long can cause a serious health problem called antibiotic resistance. This is a growing health problem around the world. Antibiotic resistance occurs when deadly bacteria become harder to treat because the antibiotics used to treat them become less effective.

To prevent antibiotic resistance, you may receive another treatment option called low-dose doxycycline.

Low-dose doxycycline: Doxycycline is an antibiotic. When you take this low dose, however, it doesn’t act like an antibiotic because it doesn’t have the power to kill bacteria.

Studies show that low-dose doxycycline can reduce the acne-like breakouts of rosacea. Based on these studies, the U.S. Food and Drug Administration (FDA) approved low-dose doxycycline to treat rosacea.

Information from studies show that taking the low dose is safe. It also causes fewer side effects than an antibiotic.

You should not take this medication if you are pregnant or nursing.

Isotretinoin: Approved only to treat severe acne, this medication may be an option. It has been shown to reduce the redness and acne-like breakouts. Because isotretinoin can cause serious birth defects, it’s not an option for every patient.


Laser or light therapy: These can effectively treat the redness and acne-like breakouts. However, it’s important to know a few things about this treatment option.

Insurance will not cover the cost. Each treatment generally costs hundreds of dollars, and most patients need 1 to 5 treatments to achieve the best results.

To maintain results, most patients also need follow-up laser or light treatments.

It’s also important to know that your results depend largely on the person performing the procedure. Side effects, such as scarring, are much higher when the person who treats you knows little about the skin. To get the best results, look for a board-certified doctor who has experience treating rosacea with lasers and lights.

When you see FAAD after a dermatologist’s name, you know the doctor is a board-certified dermatologist.

Getting the best results from treatment

Keeping follow-up appointments with your dermatologist is essential to get the best results from treatment.

During your follow-up appointments, your dermatologist will examine your skin. If you’re getting good results, you may need to continue the treatment for a few more weeks. If not, your dermatologist can change your treatment.

Your dermatologist will also want to change your treatment as needed to reduce the possibility of long-term side effects.

To get the best results from treatment, it helps to make some lifestyle changes. To find out what dermatologists recommend, go to:

Images used with permission of the Journal of the American Academy of Dermatology. (J Am Acad Dermatol 2015;73:333-6.)

Di Nardo A, Holmes AD, et al. “Improved clinical outcome and biomarkers in adults with papulopustular rosacea treated with doxycycline modified-release capsules in a randomized trial.” J Am Acad Dermatol. 2016;74:1086-92.

Pelle MT. “Rosacea.” In: Wolff K, Goldsmith LA, et alFitzpatrick’s Dermatology in General Medicine (seventh edition). McGraw Hill Medical, New York, 2008:703-9.

Tan SR and Tope WD. “Pulsed dye laser treatment of rosacea improves erythema, symptomatology, and quality of life.” J Am Acad Dermatol. 2004;51:592-9.

Two AM, Wu W, et al. “Rosacea Part II. Topical and systemic therapies in the treatment of rosacea.” J Am Acad Dermatol. 2015;72:761-70.

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