Rosacea affects 1 in 10 adults and gets progressively worse without treatment. Here is what the evidence says about managing it effectively.
Rosacea is a chronic inflammatory skin condition that affects around 10% of adults in the UK, most commonly between the ages of 30 and 60. It is characterised by episodes of flushing, persistent facial redness, visible blood vessels, and in some forms, acne-like papules and pustules. It is frequently misdiagnosed — particularly papulopustular rosacea, which is often confused with acne vulgaris — and commonly undertreated.
Without treatment, rosacea typically worsens over time. The good news is that with the right prescription treatments and trigger management, most people can achieve excellent control. At Lambert Medical Practice in Surbiton, Dr Nancy Abdelrahman provides comprehensive private rosacea assessments and treatment.
Rosacea is not a single condition — it has four recognised subtypes, and many people have features of more than one:
| Subtype | Key features |
|---|---|
| Erythematotelangiectatic (ETR) | Flushing, persistent central facial redness, visible superficial blood vessels (telangiectasia) |
| Papulopustular | Inflammatory papules and pustules on a background of redness; often confused with acne vulgaris |
| Phymatous | Skin thickening and irregular surface texture, most commonly affecting the nose (rhinophyma) |
| Ocular | Eye irritation, dryness, lid inflammation (blepharitis), styes, watery eyes |
Accurate subtype identification is important because it determines which treatments are most appropriate. Papulopustular rosacea requires anti-inflammatory treatment; erythematotelangiectatic rosacea requires vasoconstrictors and trigger management; phymatous changes may require laser treatment or surgery.
Rosacea flares are triggered by factors that cause vasodilation or neurogenic inflammation in susceptible skin. The most common triggers are:
Keeping a trigger diary and working systematically to reduce exposure is an essential part of management alongside any prescription treatment.
Topical ivermectin 1% cream is currently considered the most effective topical treatment for papulopustular rosacea. It works by reducing Demodex mite density (a key contributor to papulopustular rosacea) and directly reducing inflammation. Clinical trials show superiority over topical metronidazole. Applied once daily, improvement is typically visible at 4 weeks and optimal at 12–16 weeks. It is prescription-only.
Topical metronidazole 0.75% gel or cream has been used for rosacea for decades and has a good evidence base for reducing papules, pustules, and redness. It is applied once or twice daily. It works as an anti-inflammatory and antimicrobial agent.
Azelaic acid 15% gel (Finacea) reduces redness, papules, and pustules. It also has mild depigmenting properties, which can help with post-inflammatory erythema. It is well tolerated and has a good safety profile.
These topical alpha-agonists cause vasoconstriction and reduce facial redness and flushing. Effects are rapid (onset within 30 minutes) but temporary — they treat the appearance of redness rather than the underlying inflammation. Useful for specific occasions. Rebound redness can occur.
Oral doxycycline 40mg modified-release (Efracea) is used at a sub-antimicrobial dose that is below the threshold for antibiotic activity — meaning it works through its anti-inflammatory properties rather than as an antibiotic. It is effective for moderate-to-severe papulopustular rosacea. NICE recommends limiting duration to minimise antibiotic resistance risk.
Rosacea-prone skin is sensitive and reactive. Many people inadvertently make it worse with their skincare routine. Key principles:
Dr Nancy Abdelrahman · Lambert Medical · Same-week appointments available · No referral needed