Yes. Antibiotic resistance can be encountered with long term use. This is more important if one is treating acne, less important if it is used as an anti-inflammatory. This is why I prefer to limit the use of doxycycline-minocycline to 4–12-week cycles. 

You can take probiotics to help any gut related issues.

Antibiotics can cause gastrointestinal side effects, thrush, heartburn. Doxycycline can cause photosensitivity, reflux & headaches.

Isotretinoin causes dryness, redness, sun sensitivity & another 125 side effects. If you experience side effects & can not troubleshoot, stop your medications.

Disclaimer: I do not ordinarily practice prescription based medical dermatology (hence why I am procedural). The fact remains that the majority of rosacea patients who consult me have failed conventional therapy, hence move on to laser treatments. Other patients who see me would like to avoid prescription medications (fair choice). My job is to offer you prescriptions if they apply to your condition, as in some cases they are synergistic to lasers.

This tablet is frequently used by dermatologists to treat cystic acne. In rosacea it works primarily as an anti-inflammatory. This drug can also reduce sebum or oil production. This tablet is reserved for recalcitrant cases of rosacea, not responsive to topicals, tablets & lasers.

Lots. Read the product information for an overview. In the context of rosacea, the dosing is much less compared to acne treatments. This tablet is teratogenic, meaning foetal malformation occurs if you fall pregnant on this medication. The washout period is one month. Ocular changes are important to note, especially if you suffer from dry eyes.

Your dermatologist will guide you through their preferred regime. For my patients, it goes something like this-

Take as directed. I have written the instructions on your prescription. This is the maximum dose by default. If you have good control, you can decrease frequency to find the minimum dose that gives you the best results. This will vary for everyone. If you have any side effects that you can not fix, stop the medication.

*DIsclaimer: I would rather not prescribe you any tablets, that is why I am a procedural dermatologist. However the majority of rosacea patients I see are referred to me by other dermatologists because normal treatments do not work.

It ranges from 6 weeks to 2 years. The dose varies from 10 mg isotretinoin per day, to 5 mg per week & everything in between. I do not like prescribing tablets, that is why my job involves lasers. The flipside is that the patients I typically treat fail to respond to skin care, fluffy natural remedies & the usual prescription medications.

This form of rosacea is challenging to treat. It can occur in isolation, or frequently be seen with other causes of flushing. In younger patients it occurs with emotive- physiological flushing. In middle aged females with menopausal flushing. Tablets are used to stabilise blood vessels. They include beta-blockers such as propranolol as well as alpha agonists such as clonidine.

Disclaimer: For flushing & blushing, please see a medical dermatologist. Laser is not the first line treatment. Lasers are useful in cases of static redness, ruddy skin or broken capillaries.

If you are naturally inclined to avoid prescription medications, a dermatologist is the last specialist you see. My colleagues prescribe drugs as listed above. Hence you should try all the lifestyle changes, natural skin care, topicals, supplements & dietary restrictions before seeking advice.

I personally do not like to prescribe, hence why I am a procedural dermatologist. If I do prescribe, it is because I act in your best interest, as lasers are synergistic with certain anti-inflammatories & oral retinoids.

Prescription creams are used early in management of rosacea. You can obtain these from your family general practitioner. Creams are best used for mild papular-pustular rosacea. They do not treat broken capillaries, & are of limited value for background redness. Topicals include-

Rozex or metronidazole. This works as an anti-inflammatory medication. Apply nightly, you can increase to twice a day.

Finacea or Azelaic acid. This formulation can also be purchased over the counter- Azclear or Paula’s Choice. Use nightly, option for twice daily application.

Soolantra or ivermectin. This targets demodex mites found in higher numbers in rosacea patients.

Mirvaso or brimonidine. This can target redness & flushing. Rebound is frequent. It is difficult to apply correctly.

Sulphur based topicals include sodium sulfacetamide +/-salicylic acid. Used as a wash or leave on. Usually compounded OTC formulations in the US.

Retinoids can be useful. Very tricky to apply as they can easily flare up rosacea. Short contact application of retinol, tretinoin, & others advisable.

Disclaimer: I do not prescribe topicals as a stand alone treatment as my work is procedural. These formulations can be prescribed by your GP or a medical dermatologist.

If you are not yet ready to take the step with medical management, a DIY skincare routine may help. A simple, yet cost effective rosacea regime is:

AM: Wash with La Roche Posay Rosaliac – tepid water. Apply Anthelios sunscreen

PM: Wash as above. Apply azelaic acid Monday to Friday nights, and niacinamide on weekends. You can supplement this regime with remedies below, additionally modifying lifestyle factors can be useful- see the section on rosacea tips.

You may want to try these out before seeking heavy duty prescription medications from a dermatologist. The majority of the listed ingredients can be sourced topically, some are in tablet form. Your local naturopath can guide you.

Niacinamide – nicotinamide or vitamin B3 is probably the best vitamin for rosacea patients. Best applied topically, can be taken as a tablet.

Aloe vera is the go-to plant for skin inflammation. It is tasty in a drink.

Camomile can be used as a drink (tea) or topically as compresses. Low chance of allergic contact dermatitis. Relaxing at best.

Green tea is a potent antioxidant with scientific data. Drink it, it’s good for you.

Other botanical extracts include raw honey, ginger, rosemary & thyme. Chuck them in your food, they do no harm.

Disclaimer:I am all for natural remedies. If they work, it is one less person I need to prescribe medication for. In most cases, natural remedies work best with mainstream medicine.

Frequently known as perioral dermatitis, steroids can cause & flare up rosacea. The antibiotics of choice include doxycycline, tetracycline, and azithromycin for erythromycin. Oral medications work much better than topicals. You need to be on it for 4-8 weeks.

Disclaimer: I do not treat perioral dermatitis. Please ask for a referral to my colleagues. My work is procedural.

Be guided by your ophthalmologist. Eye disease is seen in one quarter of rosacea patients. Simple baths, topicals & lubrication can help. Doxycycline can work as an anti-inflammatory, oral isotretinoin can go either way with rosacea. IPL or vascular lasers can help alleviate signs & symptoms of ocular rosacea.

Tying it all together, an average script looks something like this:

Wash AM: La Roche Posay Rosaliac wash, Invisible Zinc SPF

Tablets: Doxycycline 50 mg twice a day for 10 days, dropping down to once a day for 6- 10 weeks.

Wash PM: La Roche Posay Tolerane wash, niacinamide (or azelaic acid) cream.

The above is as simple as it gets. You can obtain prescriptions from your family physician. Note: I manage complex cases of rosacea, namely with laser therapy. For topicals & oral medication, please see a medical dermatologist.