What are the emerging treatments for rosacea?

Question

Hi doctor,

Rosacea has completely taken over my life, starting as occasional flushing and permanent redness across my entire face, with dozens of painful pustules and papules that would not respond to anything. The burning sensation is unbearable; it feels like my face is being held against a hot stove constantly. I tried Metronidazole, Azelaic acid, Ivermectin creams, sulfur washes, and nothing helps for more than a day or two. Doxycycline worked briefly but caused such severe photosensitivity that I developed second-degree sunburn just walking to my car, plus intolerable stomach issues.

The triggers seem endless - any temperature change, wind, spicy food, alcohol, stress, even plain water washing causes intense burning flares.

I developed ocular rosacea now too, with constant eye irritation, styes every few weeks, and blurry vision that is affecting my work as a graphic designer. The broken blood vessels across my cheeks are becoming permanent, creating spiderweb patterns visible even under makeup. Most concerning is the thickening tissue around the nose showing early rhinophyma changes, according to the last dermatologist, but she offered no solutions beyond what I have already tried.

I have become increasingly withdrawn socially and professionally due to my appearance and constant discomfort. Recently, I read about newer treatments like laser therapy, intense pulsed light, or Tranexamic acid, but I am uncertain which might actually help with refractory rosacea. Would laser therapy address both redness and vascular changes? Are there emerging treatments I should know about for severe cases that have not responded to conventional therapy?

Thanks.

Answer 1

Hi,

Welcome to icliniq.com.

I can understand your concern.

Rosacea is a chronic condition and needs a lot of care and preventive measures to avoid flare-ups, such as hot, cold temperatures (hot baths), exercise, sun exposure, cosmetic products, medications (those that cause vasodilation), alcohol, fruits and vegetables, dairy, marinated meat products, tea, coffee, hot spicy food items, and stress.

Avoid all the triggering factors.
Follow a skincare routine like moisturising frequently. Use gentle over-the-counter cleansers. Mild, synthetic detergent-based cleansers rather than traditional soaps due to the risk of irritation.
Use physical sunscreens (zinc oxide or titanium oxide) with SPF (sun protection factor) more than equal to 30.
Provides broad-spectrum UV (ultraviolet) radiation and visible light protection. May be better tolerated than chemical sunscreens.
Avoid exfoliants.
Avoid alcohol-based topical products.
Avoid the use of topical steroids as they may aggravate the condition.

Cosmetics with a green tint are useful to minimise the appearance of redness. Kindly share pictures for a better understanding of the severity of the problem. If topical treatment is not of much help, oral medications will be required, but they need a proper examination before starting the oral medicines.

Also, yes, laser treatment will be helpful for redness and vascular changes. You should definitely consider laser treatment if medications are not much of use in your case.

I hope this information will help you.

Thanks.