How to treat rosacea - subtype 2
If you’ve found your way here, the chances are you are looking for some answers or advice on rosacea. Rosacea by nature is a complicated condition with not one, but four different subtypes. Then within each subtype you have different levels of severity.
Something I always say is that it’s a really personal thing with no one size fits all answer. That can be overwhelming in the beginning when you just want a quick fix. I’ve been there and can tell you it’s a very personal journey. This is why I started this blog though. Hopefully using the experience myself and others have built up over the years can give you a head start, so you’re not as in the dark as I was in the early days!
In this past decade or so rosacea research and resources have come on leaps and bounds. The internet can be a massive help when you feel alone or flustered. Taking the time to read into your diagnosis and the different options available can really help you.
A quick recap - what is rosacea?
Rosacea is a common condition that affects the skin by causing redness, visible blood vessels, and/or small acne-like bumps. It mainly affects the face, particularly the cheeks and nose and can come and go in terms of severity. It affects around 415 million people worldwide or one in ten people in the US and is also known as the curse of the celts.
Rosacea is a long-term condition that can affect anyone. It’s more prevalent in women but tends to be more severe in men. Fair-skinned people are more susceptible to rosacea and it’s more common in those over 30. Genetics can have a part to play in whether or not you will develop rosacea at some point and it mostly affects people of northern or eastern European descent. There’s currently no known cure, but there are many effective ways to manage the symptoms.
Rosacea is the overall condition but under this umbrella there are four different subtypes. Most of the time, rosacea can be categorised into one of the subtypes. But sometimes, people can have overlapping symptoms from more than one subtype. (I have mainly subtype 1 - dry dehydrated sensitive face generally but with subtype 2 around my nose and chin)
The subtypes are:
- Subtype one - Erythematotelangiectatic Rosacea (ETR Rosacea)
- Subtype two - Papulopustular Rosacea (PPR or “Acne” Rosacea)
- Subtype three - Phymatous Rosacea (Rhinophyma)
- Subtype four - Ocular Rosacea
Papulopustular Rosacea - Subtype two
In this blog we’re going to focus specifically on the second subtype. Papulopustular rosacea is sometimes known as acne rosacea, PPR rosacea, or inflammatory rosacea. This is the subtype that’s often mistaken for acne. The reason for this is that it causes acne-like breakouts; think red spots and pimples which come and go. People with this subtype often also experience burning and stinging. The key difference to acne is that there aren’t usually blackheads or whiteheads when rosacea is the culprit.
Subtype 2 rosacea can happen alongside the symptoms of redness and flushing that are associated with subtype 1 ETR. Subtype 2 affects mostly middle-aged people and tends to affect women more than men. This is a generalisation and not always the case of course!
A lot of people call subtype 2 “acne rosacea”. This isn’t a great nickname as it can lead people to believe that the two are in some way related. There is actually no known connection between acne and rosacea. This has led to a lot of confusion and wrong self-diagnosis which is harmful. If either condition is mistaken for the other and incorrectly treated, symptoms can worsen.
Symptoms of subtype two:
- Papules and pustules (spots and pimples)
- Redness on the central areas of the face
- Burning/stinging sensation on the skin
- Visible broken blood vessels
- Raised, scaly red patches on the skin
- Oily skin
- Sensitive skin
How to manage subtype 2. What are the options?
Treating PPR rosacea has its very own set of medications, skin care and ingredients that can be considered. The difference to type one is mainly that type 2 is more commonly an oily condition whereas type one is usually more related to dry skin. There are several things you can take to help combat PPR rosacea and this should always be determined in consultation with your doctor or dermatologist.
Azeliac acid comes most often in the form of a cream or gel which is applied directly to the skin twice daily (morning and evening). Studies have shown that azeliac acid helps 70-80% of patients with the reduction of their type 2 rosacea.
During application you might notice a stingy or burning sensation which should lessen as your skin becomes used to it. If this sensation doesn’t go away, or you notice your skin lightening be sure to tell your dermatologist.
Another topical option which comes in a gel or cream. This has been used for many years in the treatment of the pimples and pustules associated with rosacea. Metronidazole can be an effective treatment that you only need to be using from time to time (for some). According to one study, only 23% of the group had a flare up within 6 months of using this medication.
Possible side effects of this can include itching, stinging, irritation or dryness.
Ivermectin (aka Soolantra)
Topical ivermectin is an anti-inflammatory and antiparasitic medication for the treatment of inflammatory papules and pustules (bumps and pimples). It’s available by prescription and is applied once a day. The role ivermectin plays in treating rosacea is as an anti-inflammatory and anti-parasitic agent targeting Demodex mites. The Demodex unfortunately tends to live in greater numbers in those with rosacea. There can be 10x the number of Demodex mites on subtype 2 rosacea skin, as there is on regular skin.
Read our full blog on the link between Demodex and rosacea here. You may experience skin burning sensation and skin irritation while using Soolantra Cream.
Sulfacetamide Sodium / Sulfur
These are ingredients you can find without a prescription in cleansers for example. You can also get a topical gel or cream that does require a prescription for the treatment of rosacea, acne and seborrheic dermatitis. These ingredients have been used in the treatment of the mentioned conditions for years and can help with reducing bumps, pimples and redness over the course of 6-8 weeks.
This treatment should only be taken in consultation with your doctor or dermatologist and you should mention if you have kidney disease or a sulfur sensitivity. You should also make sure to mention if you are pregnant or trying to become pregnant. Potential side effects include itching, dryness, redness and irritation which tends to decrease with use.
Skincare options (Non medical cosmetics)
There are certain ingredients you can use yourself that are known to be beneficial if you suffer from type 2 rosacea. These are not intended to replace treatments, but can be good to add to your skincare routine! Plant ingredients such as tea tree oil, licorice root oil and oregano oil for example have been widely recognised to help with certain symptoms associated with PPR rosacea. Tea tree oil and oregano oil have antimicrobial benefits, and tea tree is also a potent killer of demodex mites. Licorice root on the other hand helps to tone down the appearance of redness and has anti-inflammatory effects.
We have designed our Calming Serum 2 product which is formulated for sensitive skin and helps treat subtype 2 rosacea.
If you’re interested in plant ingredients known to help rosacea, have a look through our website or have a quick Google. There’s lots of helpful info out there!
If your rosacea isn’t responding to topical medications, you might be prescribed an antibiotic. This is generally given just to get the rosacea under control, then other treatments are used to maintain the results. Generally, you don’t want to stay on antibiotics for too long or you could build up a resistance which is then a serious problem. Sometimes if a long-term antibiotic is deemed necessary, you could be put on a low dose of doxycycline. A low dose of doxycycline isn’t technically considered an antibiotic as it doesn’t have enough power to kill bacteria.
Some of the most common antibiotics given are:
Isotretinoin ( also known as Roaccutane )
This medication is usually only prescribed in severe cases. It is effective in reducing redness and bad breakouts associated with type 2. This medication isn’t for everyone and shouldn’t be taken lightly due to the serious potential side effects including severe birth defects. More information about the side effects here.
Lazer or light therapy
Lazer or light therapies can be an effective measure in the reduction of redness, pimples and spider veins. It’s worth keeping in consideration though that these procedures can be expensive and generally aren't covered by your insurance. It’s also not a “one and done” thing and most people usually need follow up treatments to maintain results. Laser therapy also affects the sensitivity of your skin to UV. Wearing a high spf is therefore very important. Some specialists will not use laser during the height of Summer for this very reason - that it increases sun sensitivity of the skin.
Rosacea is a very individual journey, so it might take a few attempts before you find the right option for you. Always refer to your doctor or dermatologist before trying a new route and it’s always safest to talk to a professional and work out your treatment plan together. Remember that there are lots of others in a similar situation and you’re by no means alone! There are also a lot of online communities you can join to meet others with rosacea. We all have our off days but try not to get too discouraged and you will eventually get it under control!
All Finca Skin Organics products are made using a minimal, plant-based ingredients list and formulated by me, a rosacea sufferer.
The Finca Skin Organics range has undergone a Harley Street clinical study. After using our products, 87% felt the appearance of their skin significantly improved.
View the entire range of Finca products here or find out what subtype your skin is.
When in doubt, always refer to your doctor or dermatologist as the condition differs for everyone. It’s always best to talk to your dermatologist first and work out your treatment plan together.
If you have any queries regarding your rosacea or how to use our products get in contact with us, we'd love to hear from you.
With love from Ireland,
Finola*Clinical evaluation by Harley St. dermatologists on 23 subjects after 8 weeks of use.