1. Avoiding triggers
Avoiding triggers is essential and UV exposure is a common rosacea trigger so sun protection is critical
SPF
Korean sunscreen
Round lab birch juice - I use this one. I would try it first. It uses far less irritating filters than US-based sunscreens and doesn’t leave a white cast or feel too heavy on the skin. Feels like a moisutrizer, unlikely to cause irritation or break you out. Be sure to buy from a website that ships the Korean version and not the USA version that uses older filters.
Beauty of Joseon and Biore Aqua Rich (Japanese) are other good options.
[or]
Mineral sunscreen
Torriden DIVE-IN - some people with rosacea do better with a zinc oxide sunscreen, zinc can reduce inflammation and redness. However, zinc can leave a white cast and is not as cosmetically elegant. I recommend trying a well-formulated foreign ‘chemical’ sunscreen before resorting to mineral. The best suncreen is the one you feel comfortable using every day, and mineral sunscreens can be cosmetically inelegant. Tinted mineral sunscreens are also a good option.
SKINCARE TRIGGERS
Avoid astringents like alcohol or witch-hazel based toners, avoid fragrances both synthetic and natural, avoid prolonged use of topical steroids like hydrocortisone.
PROTECTIVE CLOTHING
HATS 🧢 - protect from the sun, can’t be rubbed off.
Sun umbrella - Sun umbrellas are a highly effective and underrated form of sun protection.
Important note: UV reflects off of surfaces so it is still important to wear SPF to protect from reflected UV even when using a hat or umbrella. However SPF is easy to wipe off and it can be difficult to apply often enough for full protection, this is why redundancy is important—use both protective clothing and SPF.
OTHER TRIGGERS
Environmental triggers: heat (hot weather, sauna, baths), cold/wind, humidity extremes. Avoiding triggers is important for complete symptom relief and may require some lifestyle adjustments. Sauna use is great for many, but not for people with rosacea.
Dietary triggers: alcohol, spicy foods
Emotional triggers: stress, embarassment, anxiety
2. PRIMARY TREATMENT
For the large majority of people you should start with one of the two following medications. These are the most effective and evidence-based. Other treatments can improve rosacea symptoms but should be used to support the primary treatement depending on your rosacea subtype, not as a home remedy alternative.
OPTION 1: IVERMECTIN
Ivermectin both reduces inflammation and kills Demodex mites in the face. Demodex mites exist on nearly all adults, but rosacea sufferers have an inappropriate immune response to these mites which contributes to inflammation, and there is an association between number of mites and rosacea.
Ivermectin 1% once daily has been shown to have both superior efficacy and better tolerability than metronidazole 0.75% twice daily. It has not been directly compared to 1% metronidazole, but efficacy is likely similar with fewer side effects. I am using ivermectin for my rosacea.
Soolantra is the FDA approved 1% ivermectin cream you can get from your dermatologist. If you would prefer to get your treatment online then Honeydew is a telehealth dermatology service that makes treating chronic skin conditions easy and accessible. Soolantra can be expensive it is not covered by insurance.
Alternatively, you can use generic over-the-counter 0.5% ivermectin lice cream. Some drug stores have a generic brand. I use Walgreens brand.
Note: when starting ivermectin you can have an initial breakout as your skin acclimates to the new medication, and possibly from the Demodex mites dying at once, causing an inflammatory response. If an initial breakout occurs it usually lasts 1-2 weeks.
Oral ivermectin is also used for rosacea.
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OPTION 2: METRONIDAZOLE
Metronidazole is the standard of care for rosacea. It is an antibiotic, but it is thought to work for rosacea through anti-inflammatory and antioxidant mechanisms. It has acaracidal action (demodex mite killing), but not as potent as ivermectin. This is prescription medication
Use ivermectin cream once per day. The OTC formula is a little greasy so best to use it at night.