and Pus-filled Lesions
This rosacea subtype tends to respond
well to treatment, and there are many treatment options. To see
clearing of the bumps, pus-filled lesions, and persistent redness,
treatment often begins with combination therapy (the use of two or
more treatments). Combination therapy tends to produce faster, more
effective results. To maintain results, a patient may be switched to
a single therapy.
The treatments prescribed for the
bumps, pus-filled lesions, and redness include:
The following topical
(applied to the skin) medications are often prescribed to treat this
subtype of rosacea:
Effectiveness: Several studies
have shown that topical (applied to the skin) medications can be
just as effective as oral (taken by mouth) medications for treating
the bumps, pus-filled lesions, and redness of rosacea. The topical
medications, however, tend to take longer to produce results. Many
patients notice slight improvements within the first month; however,
it usually takes about two months to notice more dramatic results.
Side effects: These tend to be
mild. Side effects include burning, stinging, itching, or skin
irritation when applying a topical medication. Some patients may
experience dry skin. Others can see scaly skin or a rash.
After applying a topical retinoid, the
skin may feel warm or sting. Sometimes redness increases
temporarily. Peeling of the skin also can occur. When using a
topical retinoid, it is important to apply sunscreen before going
outdoors as topical retinoids tend to increase sensitivity to the
sun. Some patients also experience increased sensitivity to wind and
Often used in combination with oral antibiotics,
glycolic acid is a topical that can help a patient gain faster control
over rosacea. The following may be prescribed:
Glycolic acid peels -
Given every 2 to 4 weeks, these peels are applied to
the face for up to 5 minutes. Following treatment,
the skin is red for a few hours, and patients should
avoid sun exposure until their skin returns to its
Glycolic acid washes
and creams - Dermatologists may use these in low
concentrations to further enhance the effectiveness
of a peel.
The following oral
(taken by mouth) medications may be prescribed to treat papulopustular rosacea:
Non-antibiotic Dosage Doxycycline
Weighing in at only 40 milligrams of doxycycline per capsule,
this dosage of doxycycline is not potent enough to kill bacteria.
Since it cannot kill bacteria, it does not act as an antibiotic.
Effectiveness: Research shows
that 40 milligrams can effectively stop inflammation. When
inflammation decreases, patients tend to see fewer bumps and
In clinical trials, this medication has proven safe and effective
for treating the bumps, pus-filled lesions, and redness of rosacea.
This led the U.S. Food and Drug Administration (FDA) to approve
non-antibiotic dosage doxycycline for the treatment of the bumps and
pus-filled lesions of rosacea in adults. The medication is meant for
once daily use and can be taken long term.
Side Effects: While the
antibiotic dosage of doxycycline can cause side effects, these side
effects were not observed in the clinical trials for non-antibiotic
dosage. Patients did not say they had an upset stomach or sun
sensitivity. None of the women treated with the non-antibiotic
dosage, also called the anti-inflammatory dosage, experienced a
yeast infection. Since the anti-inflammatory dosage cannot kill
bacteria, a patient would not be expected to develop antibiotic
resistance. When a patient develops antibiotic resistance, the
antibiotic becomes ineffective in killing or weakening the targeted
bacteria. Antibiotic resistance is a global health concern.
If a patient cannot tolerate the above
antibiotics, one of the following oral antibiotics may be
prescribed. These have been shown to work faster and cause less
gastrointestinal problems, but they are much more expensive:
Effectiveness: The antibiotics
listed above are highly effective in reducing the bumps and
pus-filled lesions of rosacea. Most patients see results after 3 to
4 weeks of treatment. Once the rosacea is under control, many
patients are switched to a topical therapy to keep the rosacea under
control. Some patients require long-term use of an antibiotic or
non-antibiotic dosage doxycycline to maintain control.
Side Effects: Antibiotic
resistance is the primary concern when an antibiotic is prescribed.
Antibiotic resistance develops when a person takes an antibiotic too
frequently or for too long, which can cause the medication to no
longer effectively kill or weaken the bacteria. This means that
previously treatable diseases could become untreatable worldwide.
Tuberculosis, gonorrhea, and malaria have become much more difficult
to treat because the microorganisms that cause these diseases have
mutated. This means that treatment that was previously effective no
Other side effects include yeast
infections in women, upset stomach, light sensitivity, vertigo, and
Other Treatment Options
In some cases, rosacea does not respond to the therapies
described above. If you have been following the prescribed treatment
plan and treatment fails, be sure to discuss this with your
dermatologist. Less commonly used treatment may be an option.
Baldwin HE. “Systemic Therapy for Rosacea.” Skin Therapy
Letter.com March 2007; 12. Available at
www.skintherapyletter.com/2007/12.2./1.html. Last accessed May
Crawford GH, Pelle MT, James WD.
“Rosacea: I. Etiology, pathogenesis, and subtype classification.”
J Am Acad Dermatol 2004; 51: 327-41; quiz 42-4.
Del Rosso JQ. “Recently Approved Systemic Therapies for Acne
Vulgaris and Rosacea.” Cutis 2007; 80: 113-20.
Pelle MT, Crawford GH, James WD. “Rosacea: II. Therapy.” J Am
Acad Dermatol 2004; 51: 499-512; quiz 3-4.
Webster GF. “Rosacea and Related Disorders.” In: Bolognia JL,
Jorizzo JL, Rapini RP et al, editors. Dermatology,
Spain, Mosby Elsevier; 2008. p. 509-11.
content solely developed by the American Academy of Dermatology
Facial redness that
spares the skin around the eyes and mouth
Small bumps (papules)
(pustules) may develop on top of papules
Visible blood vessels
may not be apparent due to intense redness
Thickening skin can
occur in men and is rare in women
This patient has classic signs of
papulopustular rosacea — redness, bumps, and pus-filled lesions.