It’s probably the worst invention for rosacea. I was involved in the Galderma launch 6 years ago & sat on their advisory board. It is not that brimonidine does not work, it is about the dismal hit rate. This means 60-70% of patients think it’s sh*T as it can lead to rebound rosacea, or streaky area. Possibly 1 in 10 find it useful. 

I don’t prescribe it much (hardly at all, unless you have had good responses in the past. Or if you complain about my bill :))

Metronidazole is an antibiotic cream or gel that requires a prescription. Acne like rosacea or papular pustular rosacea responds best to this prescription. You do not need to see me for this prescription, your GP or medical dermatologist can prescribe it.

It does not cure rosacea, but it can help. You can combine this with a short course of anti-inflammatory antibiotics such as doxycycline 50 mg up to twice a day for 4 weeks. Get this from your family physician.

Apart from smelling like rotten eggs, sulphur-based creams can be useful in treating rosacea & acne. They work as an anti-inflammatory agent. In some cases, salicylic acid is added as this is anti-inflammatory & acts as an exfoliant, especially in cases where there is seb derm overlap.

Try this before seeing me, as my work is laser or procedural based. Here is the formula & application instructions. You can either source this online from a pharmacy overseas or get your GP or medical dermatologist to prescribe it for you.

8-10% sodium sulfacetamide + 3-5% sulphur +/- 2% salicylic acid in Cetaphil lotion. Use as face wash, leave on for 15 minutes, wash off thereafter. Increase application time by 15 minutes after one week as tolerated. Some patients can leave this on overnight. About 20-25% of patients find this formulation useful. Good luck.

Yes. It is called steroid induced rosacea or perioral dermatitis (POD). The most common culprit are steroid creams such as Elocon, Advantan, Diprione, Eluphrat, % Betnovate. If you have been using these creams for more than one to two weeks, you may have POD. Ideally you should see a medical dermatologist for this condition. Please book in with my colleagues at Cutis Clinic, as my work is procedural.

Mesobotox or microBotox can work. This is not my first line treatment, far from it. It works by modulation of inflammation as well as modifying smooth muscle in the vessels. Some say it has a role in knocking out the demodex mite population. I use one of two ways to get Botox into the dermis. Firstly, with nano-needles, ie. Aquagold. Secondly via Tixel.

This treatment is considered in patients who fail topicals, orals, lasers & energy devices. It costs between $690 to $990 per treatment, & if it works, it lasts about 3-6 months.

The best solution for natural remedies is not to see a dermatologist. We either prescribe drugs & chemicals or use super powerful lasers. I also use botulinum toxin to mediate vascular responses in resistant rosacea (in theory Botox is natural, as it is derived from clostridium bacteria).

See the section on natural remedies for a guide. See a naturopath for guidance. In summary-

Niacinamide or Vitamin B3: is one of the natural remedies that most dermatologists endorse, including myself. It is anti-inflammatory & can be purchased without a prescription. It also helps with barrier function & photoprotection.  Look for formulations around 5 to 10%.

Hyaluronic acid: is best served under your skin, namely dermal fillers. HAs can also be used on your skin as a humectant, or moisturizer. This naturally occurring substance is rosacea compatible.

Aloe vera: from the plant. Look for a gel formulation, or you can try a live plant. It works well as an anti-inflammatory for sunburn. In the context of rosacea, it can lead to irritant or worse still allergic contact dermatitis. 

Camomile can be used as a drink (tea) or topically as compresses.

Green tea: probably has the most medicinal properties & merit. It is a potent antioxidant with scientific data. Drink it, it’s good for you.

Fever few is another plant. It has antioxidant properties as well as very mild sun protection- in theory.

Not a good idea. It’s like gasoline near a bushfire. Retinol & retinoids topically have a reputation for causing skin irritation in normal people. For rosacea patients things can go pear shaped very quickly. Be guided by your dermatologist, some may start you on short contact therapy or with a retinol derivative like retinyl palmitate. 

The same applies to vitamin C or ascorbic acid. This vitamin has the highest biological activity around pH 3 (2.5 to 3.5). Though your skin is acidic, at pH 5-5.7, most patients will not tolerate ascorbic. If you are into your skin care, consider hyaluronic acid, ceramides, niacinamide & azelaic acid if you have rosacea. 

There are reports that oils can help. As a dermatologist I am always wary of contact dermatitis, either irritant or allergic. Rosacea is an inflammatory skin condition with a compromised skin barrier. Application of oils, plant derivatives & chemicals can potentially irritate skin.

If you really want to have a go, essential oils like lavender, jasmine, rose, tea tree, thyme etc. have anti-inflammatory and healing properties. Be guided by your naturopath as you will only require 2-3 drops of any essential oil. If you react to this, see a medical dermatologist.

Disclaimer: I am a procedural dermatologist, in the context of rosacea my work involves lasers.

This gives you a solid blueprint as to how to manage your rosacea in the shortest possible time & with precision. Keep a diary of your creams & topicals. This will help you & your dermatologist understand what works & what does not. There are many topicals for rosacea. You have to find out what works best for you. The best way is with a logically documented diary. 

This enables your medical dermatologist to be more precise with prescription patterns, rather than ‘having a go at stuff.’ Sure, in the initial phases of rosacea management, it will be a wee bit of trial and error. Rosacea is an adjustment disorder. The more analytical you and your dermatologist are, the faster you can figure things out for your blueprint.

Disclaimer: I am a procedural dermatologist. My role in the management of rosacea is laser. Medical management is complex, please see a medical dermatologist for ongoing care.

If you are really struggling with rosacea, you may get places quicker by seeing a dermatologist. Consider seeing one if-

1. The diagnosis is in doubt. Rosacea can be bloody hard to diagnose. Conditions like perioral dermatitis, acne, keratosis pilaris, physiological flushing & seb dermatitis may resemble rosacea.
2. Creams & over the counter stuff does not work. You may want to see a GP for anti-inflammatories prior to seeing a dermatologist. It’s cheaper.
3. You have broken blood vessels & persistent redness. This is where lasers can help.

Ideally you should see a medical dermatologist, as they can guide you through the complexities of rosacea. They can also organise referrals to ophthalmologists if you have ocular symptoms. As rosacea is chronic, you should develop a professional relationship with a derm of your choice.

With pharmacological agents & lasers. Dermatologists are the last line if you want fluff & fairy dust. They prescribe drugs & use powerful lasers. If you are naturally inclined, or want home remedies, see the section on this website. As guide a dermatologist will-

• Simplify your skin care. Rule out irritants & potential allergens.
• Prescribe sunscreen, discuss flare factors pertaining to you. They may identify flare factors
• Prescribe creams & or a course of anti-inflammatory agents including doxycycline, tetracycline, or erythromycin.
• Prescribe isotretinoin
• Suggest lasers including KTP, pulse dye, or LP Nd Yag, or IPL-BBL

Review this site for useful tips on rosacea. Tips form the 1% rule of management, this means there are numerous lifestyle & skin care modifications that can help, even if it gives a ‘1%’ improvement. Examples include mineral makeup, simple cleansers, sunscreen, avoiding dietary flares, ice post exercise, quick tepid showers, using warm water for face washing, & many more. Go to rosacea.org to understand more on how to look after your skin. A rosacea diary will help you understand more about this chronic condition.

My job focuses on lasers & energy devices, acknowledging that everything listed above & the numerous pages on this site plays an important role in the management of this condition.

My go to device is the pulse dye laser. It does not cure rosacea, but it can reduce redness & inflammation in most patients. Lasers are adjunctive in the management of rosacea. I normally perform 2-4 sessions over 4-6 months. Pain is minimal as the laser has in-built cooling. Downtime, as defined by swelling, may be encountered & last 24 to 72 hours, depending on settings. The higher the setting, the less the number of treatments. Each session cost approximately $450 out of pocket. A more cost-effective solution is to see my clinical team of nurses & therapists, you will save approximately $220 per session.