Q. I have redness in skin especially on nose with pimples and large pores. Is this rosacea?

Answered by
Dr. Deepti Shukla
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Jul 26, 2020

Hello doctor,

I am just concerned about the redness on my skin, specially my nose area, and it has large visible pores and does not go away. Since I have some background about health and medicine I suspected I have rosacea but I am not a physician. Can you help me with medical advice and treatment? That would be a great help since this skin condition affects my confidence and mental state being.

About my skin condition back then, I thought it just some breakouts, so I ignore it and just focused on my skincare to fight off the acne or pimple and the pimple always appearing to my face and nose is pustules and it tends to get redder when I am stress like in school or when I have anxiety attacks. But as years passed, I am bothered because even though it does not have pimple, my skin, especially in the nose area is red but it is not painful and there is visible large pores. But sometimes during my menstrual period pimple will appear in my nose but pimple will go but my nose will remain red.



Welcome to

From your history and photo (attachment removed to protect patient identity), it looks like rosacea only. But still, I want to ask a few questions to confirm the diagnosis. Do you get burning sensation over the nose lesions on sun exposure or drinking hot fluid or tea, stress? Stop Clindamycin. I will prescribe you one gel to apply, but I need to start oral medicine also. Kindly get back to me.

Treatment plan:

1% Metronidazole gel apply at night daily for 15 days.

Thank you doctor,

No, I do not feel any burning sensation on my nose when exposed to sun or drinking coffee and tea but I notice it will get redder and the pimple will pop up if I am stress and when having period and those pimples make my nose feel at pain and looks inflamed. Metronidazole gel is not available in our country as I work and knowledge in pharmacy and I think Azelaic acid is not also available. What is a better option or alternative? And can I know what type of rosacea I am experiencing base on my research there are 4 types but I do not know what type of rosacea I have?



Welcome back to

You have erythematotelangiectatic type of rosacea, in which mainly redness occurs on the nose. And yes, rosacea have a tendency to flare before period know an premenstrual flare.

As you mentioned, Metronidazole is not available, the best alternative is 1 % Ivermectin cream apply once daily at night for two weeks. For redness, you can apply Brimonidine gel once daily for two weeks. First, we should try to control it with topical creams only if you do not respond to these, I will advise you a short course of Doxycycline antibiotics.

Always apply sunscreen. Sun protection is a must. Do not apply any harsh products on the skin.

Thank you doctor,

Unfortunately, all the topical medicines you prescribe are not available in our country and already phase-out. Only medicines available for topical are Isotretinoin, Benzoyl peroxide and I do not know if it will work with my skin condition. But on the other side, I also consulted a dermatologist based here in my country and she prescribed me immediately with an oral antibiotic Doxycycline for three weeks. Should I take it or there are any alternative topical medicines?



Welcome back to

Yes, please take Doxycycline, it will definitely help and also yes, Benzoyl peroxide 2.5 % cream you can use for rosacea. Obviously Metronidazole and Ivermectin works better but Benzoyl peroxide can also work. Apply Benzoyl peroxide 2.5 gel in a very small quantity at night, and if you feel burning then stop. And always apply sunscreen, sun protection is a must.

Follow up in 15 days.

--file attached--

# Hello,
Really happy to hear that.

I went through your photo, there is lot of improvement.
Now we need more improvement and maintenance treatment.

Azaelic acid cream - apply two times daily for 3 weeks

Tacrolimus 0.1% cream daily at night in very very small quantity for 2 weeks.

T zinc acetate one table daily after dinner for 2 weeks.

If you get brimonidine cream that is best but if you don't get it then apply Tacrolimus 0.1 cream as suggested above.


As i am living in rural area as of the moment due to lockdown tacrolimus cream is hard to find. Are there any alternative for this? or should I continue my maintenance without it? Thank you
# Hi,
Tacrolimus cream and brimonidine work wonder for redness, but as you are not getting both these cream then apply azelaic acid cream and sunprotection is must. Sunscreen is must.
Also take zinc tablets and start any antioxidant tablets available

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