Rosacea and antibiotics
Antibiotics are most often prescribed for type 2 rosacea, where there is persistent redness and pustules/bumps. In some cases of rosacea type 1 where there is a lot of flushing happening antibiotics may also be prescribed.
I have type 1 rosacea and I was prescribed metrogel by my doctor when I was first diagnosed. Metrogel is a gel which contains an antibiotic but unfortunately it didn’t give me much relief. That’s not to say that’s the case for everyone - as we know rosacea is a very individual thing and it works well for others. This is really what kick started my journey of researching rosacea and ultimately my passion for good, clean skin care. Antibiotics can work wonders, but I find that I prefer only to turn to them when I really have to and not make them the norm.
How antibiotics for rosacea work
In the last 20 years or so a lot of research and studies have been done on rosacea and a lot has been learned about the condition. We now have a lot more information than the generation before us. One of the most important discoveries has been the understanding of rosacea as a chronic inflammatory disorder. With this coming to light, there has been a shift in the focus of treatment options slightly away from antibiotics as the first port of call and towards more anti-inflammatory options.
“We now know that rosacea is not an infectious disorder but a chronic inflammatory disorder, all of which leads to the concept that antibiotics are not the right way to go about treating it,” says Hilary E. Baldwin, M.D., Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, New York.
Antibiotics now aim to control rosacea by working as an anti-inflammatory rather than what you might think would be an anti-bacterial role. The idea is to reduce the overall inflammation of your skin, the number of pimples and/or the amount of redness around pimples. With antibiotic treatments, symptoms usually improve in a matter of weeks, with greater improvement seen in 2 months. As per the HSE guidelines for antibiotic prescribing, there are multiple options for the pimples and pustules associated with type 2, making it considered the most easily treated subtype.
Topical treatments – creams and gels
For milder forms of rosacea, topical medications are usually tried first.
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.
Brimonidine (Mirvaso) and oxymetazoline (Rhofade)
When it comes to treating subtype 1 rosacea, you’re usually prescribed a topical drug rather than an oral antibiotic. This comes in the form of a cream or gel. Brimonidine (Mirvaso) and oxymetazoline (Rhofade) reduce flushing by constricting blood vessels. These are what I would consider quick fixes - meaning you can see results in as little as 12 hours but the effects are temporary. You need to be applying these medications on a regular basis to maintain the improvements. They are good options for a big event or a night out for example. They’re not a long term solution as in general we don’t want these chemicals on our faces for prolonged periods of time.
Oral antibiotics for rosacea
If your symptoms are more severe, an oral antibiotic medication may be recommended.
A low-dose form of doxycycline (Oracea) – works well to clear up inflamed skin within the first few weeks. It doesn't usually cause any side effects as the dose is low so that it only acts as an anti-inflammatory and not an antibiotic, so this is a good one to start with.
Another oral antibiotic which is also occasionally used to treat severe and resistant rosacea and is often used after other therapies have failed. This medication should only be 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.
Other common antibiotics prescribed for rosacea
Some factors to keep in mind when taking antibiotics
Oral antibiotics destroy some of the normal and necessary bacteria that live in the body. Eating yoghurts that contain active cultures may help prevent some of these side effects as does taking a probiotic.
An antibiotic that works for one person who has rosacea may not work for another. Over time, antibiotics can stop being effective. When this occurs, a different antibiotic may be used. Some antibiotics are not safe for pregnant women. Some antibiotics make your skin more sun sensitive so a high SPF is needed at all times (well, this is actually something we should do regardless!)
Antibiotics both topical and oral, can be really useful when dealing with rosacea, when used at the right time in consultation with a doctor or dermatologist that you trust and understands your individual condition. Aside from antibiotics, concentrating on an anti-inflammatory diet and lifestyle can also make a really big difference in how your skin behaves. More on this here.
Keeping your diet and skincare in order is a good way to try to reduce the constant need for antibiotics, then when they are really necessary taking them. We have developed the Finca Skin Organics range with each subtype in mind to help with the appearance of rosacea.
If you look at our Type 2 Serum we chose the ingredients specifically to help relieve facial redness, swelling, excess oil and bumps. There’s zinc oxide in there to help calm and soothe, licorice root to help reduce the redness, tea tree oil and oregano oil for their antimicrobial properties as well as sulphur to help manage the pimples and pustules. Anti-inflammatory and antimicrobial plant-based ingredients are what I’ve spent decades researching, to bring our clean cosmetic range to the market.
Please remember that our Finca Skin Organics products are not medical treatments but skincare products designed to reduce the appearance of redness, protect, soothe and cleanse without further irritation. Finca Skin Organics is a cosmetic product and is retailed as such. We are not medical professionals but simply fellow rosacea sufferers. We always advise first seeking your doctor’s advice for proper diagnosis and prescribed medication if applicable.
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.
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,
*Clinical evaluation by Harley St. dermatologists on 23 subjects after 8 weeks of use