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Q. Which is the best medicine for rosacea?

Answered by
Dr. Gaurang Gupta
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jun 11, 2016 and last reviewed on: Apr 29, 2020

Hello doctor,

I am 32 year old female. My past medical history includes rosacea (15 years), perioral dermatitis (7 years), melasma and hyperpigmentation in the upper cheeks for three years and ADHD. I am currently under Noritate, occasional Elidel during flare up and Adderall 2.5 mg daily. My hyperpigmentation on my upper cheeks has been progressively getting worse over the last several months. The pigmentation is well demarcated with areas of normal skin. I work indoors and the most sun I get on a daily basis is my short 15 minutes car ride from home to work. I cannot pinpoint the cause of the hyperpigmentation and melasma. I am not on any type of birth control and do not believe the source to be hormonal. I am hesitant to try lightening agents as I have had adverse effects in the past. I am going to trace back the pigmentation for you and maybe you can help me out.Before three years, I applied Noritate and Ziana to my face. My skin in general was fine. I had only one area of pigmentation on my face, right side of face 1 inch x 1 inch. As that was noticeable I asked a dermatologist if there was anything that I could do to lighten it. She gave me Tri-Luma. I decided to put the Tri-Luma on the affected area and also a few freckles on my upper cheeks. The next day I became extremely red and out of fear of triggering my rosacea I dropped Tri-Luma immediately. Then after a month, I stopped taking Ziana, because I moved back to a colder climate and my face was getting too dry.After some eight months, the area of pigmentation (right side of cheek) was started getting darker. So, I decided to give another try for Tri-Luma. I again applied it to the larger area of pigmentation and to the tiny freckles on my upper cheeks. The decision to apply it to the freckles was purely a cosmetic decision. The next day those freckles turned into full blown pigmentation. I immediately stopped the Tri-Luma and the pigmentation in those areas has basically been there up to present day. At that time, a local dermatologist had suggested me to apply some cortisone cream to the areas to lighten them up. The pigmentation subsided very minimally. I did not apply the cortisone cream thereafter. The pigmentation from this point waxed and waned in intensity up until two months back. Then, it has remained prominent.

There were a few times during this two year span where my perioral dermatitis flared up and I was told to restart Ziana, which also made the pigmentation worse. I was unsure whether the Ziana was bringing the pigmentation to the surface or whether it was in fact making it worse. I went to two dermatologists who had differing views of stop Ziana and keep using Ziana. I decided to stop as it appeared to be getting noticeably worse. Again, I do not know if this was a whole process of bringing the pigmentation to the surface or not. Please share your thoughts.

Dr. Gaurang Gupta

Cosmetology Dermatology Hair Transplant Surgeon Venereology


Welcome to

Well, here I discuss everything one by one.

  • You had rosacea and for that you were using Noritate (Metronidazole) and Ziana (combination of Clindamycin phosphate and Tretinoin).
  • Since how long you were using these medicines? For rosacea, new creams have come which are better than these above creams. Tacroz 0.03 % (Tacrolimus) would be the better option than these creams. Apply it on rosacea part every night.
  • You have developed pigmentation which is melasma and for that you got the Tri-Luma (combination of Fluocinolone acetonide, Hydroquinone and Tretinoin) and you applied it.
  • Now, the problem is Tri-Luma contain 0.05% retinoic acid, which highly irritating and almost burn the skin. So, I never ever give such high combination.
  • I am not sure about it, but my 90% patient not able to apply such a high 0.05% retinoic acid or Tretinoin combination cream. So, you are developing redness, buring, irritating sensation and dryness after apply this cream. It is really not a good combination.
  • If you check the Ziana cream it also contain Retinoic acid (Tretinoin), so it also causes dryness. Do not apply it on perioral dermatitis as it will worse the problem. This cream is not hypoallergic, but antiacne.
  • Skin tanning is the side effect of excessive sunlight exposure. I explain treatment and precautions pointwise manner.
  • Avoid direct sunlight exposure as much as you can. Wear sun glasses, caps and cover exposed part of the body all the time.
  • Use sunscreen thrice in a day like 10 o'clock, 12 o'clock and 3 o'clock all over the face. Sunscreen SPF should be around 50. Never stop sunscreen even if melasma go off.
  • Use anti-pigmentation cream over pigmented part like Kojiglo cream (Kojic acid) or Depiwhite cream, but not your combination.
  • The ideal treatment is Glycolic acid peels. Sittings of 6-8 peels must be required.
  • Never stop sunscreen even if melasma go off.
  • For perioral dermatitis, Do not use Ziana cream on it. Apply mild steroid like Flutivate cream. It is a good one. Do not rub any cream just apply in less amount.
  • Now, I want to say that the Tretinoin, which is in both Ziana and Tri-Luma is causing your problem worse. So, do not use it.

For further information consult a dermatologist online -->

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