Rosacea is a skin condition that mainly affects the face. Rosacea can affect people of all ages, but is most common in middle-aged adults. It is a common condition and accounts for 1–3% of all dermatology consultations. Many of those seeking advice may not give the name ‘rosacea’ to their condition, but will simply be aware of their facial symptoms (redness and flushing). Women are affected more than men, especially between the ages of 30 and 50 years1.

Given that rosacea changes a person’s facial appearance it can impact negatively on self-confidence and mental wellbeing, making it difficult for the affected individuals to live a fulfilling social and work life. As with other skin conditions, there are steps that can be taken to regain control and to minimise and reduce the impact of changes in appearance.

Rosacea has a number of different subtypes. The most common (subtype 1) is characterised by flushing, burning and stinging, and a background redness that does not disappear. This redness is the most common but hardest symptom to manage. Other subtypes of rosacea include the development of spots and visible small blood vessels, enlargement of the nose and irritation of the eyes.

It is not really clear what causes rosacea2. Many people who get rosacea have a family member also affected, so there is some suggestion that there is a gene contributing to the condition that can be inherited3. Research includes the role of the lymph system in the face (that drains away toxins and inflammatory mediators), the role of the immune system (that fights off infection) and the connection to specific bacteria and skin mites. Rosacea is NOT contagious and regular contact carries no risk. Many people also wrongly assume that excessive alcohol causes the symptoms of rosacea; this is simply not true.

There is no cure for rosacea but avoiding personal triggers for symptoms can reduce them. These triggers can include certain soaps, make-up remover wipes, changes in temperature, cold winds, sun, spicy foods and alcohol.


Pharmaceutical (i.e. non-surgical) rosacea treatments that may be recommended by a pharmacist or prescribed by a GP in the UK are described in the table below.

Rosacea treatment options 
Treatment   Pros   Cons  
Topical metronidazole
Metronidazole gel or cream that is applied directly to the skin
  • Can be effective for mild to moderate spots
  • Less irritation to the skin than azelaic acid  
  • Required for several weeks or more
  • You need to avoid strong sunlight and UV light
  • May be less effective than azelaic acid  
Topical azelaic acid      
Azelaic acid gel that is applied directly to the skin  
  • Can be effective for mild to moderate spots
  • Doesn't make skin sensitive to sunlight
  • May be more effective than metronidazole
  • Required for several weeks or more
  • More likely to cause side effects than metronidazole
  • Can cause mild burning, stinging, dryness and itchiness
Ivermectin cream      
A new medicine for rosacea papules and pustules that's applied directly to the skin once a day  
  • Can be effective for mild to moderate spots
  • Doesn't make skin sensitive to sunlight
  • May be more effective than metronidazole
  • Side effects are uncommon
  • May take a few weeks to have an effect
  • Not available on the NHS everywhere
  • May only be recommended if other topical treatments don't work
  • Can cause mild burning, stinging, dryness and itchiness
Oral antibiotics      
Antibiotics, such as tetracycline or erythromycin, taken as tablets or capsules  
  • Can be effective for moderate to severe spots
  • Useful if affected area is widespread and creams are difficult to use
  • Can be effective for inflammation of the eyelids (blepharitis)
  • Can be taken at a low dose, which acts as an anti-inflammatory
  • Required for several weeks or more
  • Can make the contraceptive pill less effective, so alternative contraception should be used
  • Can cause sickness, diarrhoea and mild stomach pains
A very powerful medication often used to treat severe acne  
  • Can be effective in treating severe spots caused by rosacea
  • May help improve facial redness and flushing
  • Can only be prescribed by a dermatologist
  • High risk of causing serious birth defects, so women must use reliable contraception
  • Can cause inflammation and dryness of lips, nosebleeds, headaches, inflammation of the eyelids and eyes, skin rashes, muscle, joint and bone pain, and blood in urine
  • Has to be used with caution because of potential mood changes
Brimonidine tartrate      
A gel that stops the blood vessels in the face widening (dilating)  
  • Can be effective in reducing facial redness
  • Usually starts to work after about 30 minutes and the effect can last around 12 hours
  • Common side effects include itchiness and a burning sensation where the gel is applied
  • Less common side effects can include a dry mouth, headaches, pins and needles, and dry skin
  • A rebound effect, where redness gets worse, has been reported

By improving the removal of toxins via the lymph (the vessels in the skin that carry away toxins and unwanted chemicals), SEQuaderma Redness Prone Skin has been shown to reduce background redness and flushing after just 2 weeks of treatment. These reductions are either maintained or further improved after 4 weeks of treatment. This is the first drug-free over the counter (OTC) medication that has clinically proven efficacy for the symptoms of facial redness. Please check our life changing stories.