How do I treat facial redness and pimples?
The following prescription topical (creams, gels) and oral (pills) treatments may be prescribed alone, in combination, or with Flushing and Facial redness treatments.
Topical treatments
Oral treatments
Azelaic acid is a natural substance derived from wheat, rye and barley. Available in Canada since 2010, it is prescribed as a gel to treat mild to moderate rosacea with red bumps, pimples and some facial redness. Many studies have shown it is effective in reducing these symptoms.
How it works
Azelaic acid has anti-inflammatory effects and is also anti-bacterial.
Side effects
Some people experience mild, temporary burning, stinging and irritation. See package insert for full information.
Dos and Don’ts
If you feel stinging, take a break from this treatment and restart once the skin has settled down with moisturizing. Avoid triggers and maintain good skincare.
Expect result
Results can be seen from 4 weeks onwards.
Ivermectin, an anti-parasitic and anti-inflammatory drug, was approved by Health Canada in 2015 as a topical treatment for the pimples and bumps of rosacea. Studies show this cream effectively reduces these pimples and bumps.
How it works
In recent years, research suggests microscopic Demodex mites, always present in human skin, may play a role in aggravating rosacea in some people. People with rosacea have a higher prevalence of these mites than normal and their skin may be more immunologically reactive to the mite. Ivermectin cream has an anti-parasitic action that lowers the number of mites and inflammatory properties that reduce redness and swelling of the skin.
Side effects
A small number of people (less than 1%) reported a skin burning sensation or skin irritation.
Do’s and Don’ts
Not for use during pregnancy or if nursing. Concealer and cosmetics can be applied after the cream has dried. Avoid rosacea triggers, particularly getting too much sun, and maintain good skin care.
Expect results
Results start to show from 4 weeks onwards.
Metronidazole is an antibiotic used in a topical form (applied to the skin) to treat rosacea for more than 20 years. Studies show it significantly reduces the red bumps, pimples and some redness. It is also used as a maintenance therapy to keep rosacea under control.
How it works
Although it is an antibiotic, metronidazole’s anti-inflammatory and anti-oxidant effects are at work in improving rosacea.
Side effects
Some people have mild skin irritation. See package insert for full information.
Dos and Don’ts
Let your doctor know if you are pregnant or plan to be. Avoid rosacea triggers and maintain good skincare.
Expect results
It takes around 4 – 6 weeks to start seeing results.
Doxycycline, an antibiotic at full doses, has been formulated into a low dose (40 mg) oral treatment that works as an anti-inflammatory but does not lead to antibiotic resistant bacteria. This treatment significantly reduces the red bumps and pimples seen in moderate to severe rosacea, and reduces some redness.
The low dose also means patients do not have as many of the side effects associated with full dose antibiotics.
How it works
Treats inflammation. Also helps ocular rosacea.
Side Effects
A small number of people get stomach upset, heartburn, diarrhea, headaches or yeast infections. See package insert for full information.
Dos and Don’ts
Let your doctor know if you are pregnant or plan to be or if you are nursing; do not take if pregnant. Avoid rosacea triggers and maintain good skincare.
Expect results
Improvement can be seen from 3 weeks onwards with full results at 12 – 16 weeks.
Oral antibiotics such as full dose tetracycline or doxycycline may be prescribed to treat moderate to severe rosacea with red bumps and pimples, and some redness. These treatments may offer more rapid improvement than topicals alone.
Once rosacea is brought under control, patients may be changed to topical (on the skin) treatments.
How it works
Reduces inflammation. May also help ocular rosacea.
Side effects
Risk of yeast infection, upset stomach, vertigo, light sensitivity, and antibiotic resistance. See package insert for full information.
Dos and Don’ts
Not for those who are pregnant or plan to be or if nursing. Avoid rosacea triggers and maintain good skincare.
Expect results
Results can be seen in 4 – 6 weeks, but full results may take 2 – 4 months.
Isotretinoin, a vitamin A derivative, is used in a low, oral dose to help some patients with more stubborn red bumps and pimples of rosacea. Often, other treatments have already been tried with limited success. Studies show this low dose treatment is effective.
How it works:
Low dose isotretinoin is thought to work as an anti-inflammatory.
Side effects:
This medication can cause dryness of the skin and lips. Mood change, irritability and depression may occur rarely. This medication can cause severe birth defects. Women of childbearing age must go on the Pregnancy Prevention Program which includes 2 forms of birth control to avoid pregnancy during therapy and for one month after the drug has been stopped. Patients also have to be monitored for possible cholesterol or liver problems. See package insert for full information.
Dos and Don’ts
Not for those who are pregnant or plan to be or if nursing. For those at risk of pregnancy, highly effective methods of contraception must be used. Avoid rosacea triggers and maintain good skincare.
Expect results
Improvement can be seen after several weeks but it takes 3 – 4 months to see the full results.