Best treatment for rosacea

Find the Best Rosacea Treatment for You

While there is no cure for rosacea, early treatment can stop it from worsening and make it less noticeable. Avoiding triggers, like wine and cold weather, and following a gentle skin care regimen will help you manage flushing and other symptoms, like broken blood vessels. Fortunately, dermatologists also have a full arsenal of rosacea treatment options at their disposal and can craft an effective plan of attack against this chronic skin condition.

In fact, your dermatologist can tailor a unique rosacea treatment plan for you, based on the stage and severity of your rosacea. Options range from topical and oral medications to lasers and light therapy. It may take weeks or months of rosacea treatment before there is noticeable improvement, but with consistency and patience, you should see results.

Treatment for Mild Rosacea

Symptoms of the first subtype of rosacea, erythematotelangiectatic rosacea, are flushing, facial redness, and sometimes visible blood vessels. This stage is difficult to treat with medication, so patients are urged to avoid triggers that can irritate the skin.

Molly Wanner, MD, a dermatologist at Massachusetts General Hospital in Boston, says pulsed dye or KTP (potassium titanyl phosphate) lasers and intense pulsed light are the best ways to remove any visible blood vessels. Usually two to four treatments are needed, depending on how widespread the blood vessels are.

Beta blockers like Inderal (propranolol) and Corgard (nadolol) and alpha antagonists like Catapres (clonidine) can help with severe flushing, although their use in treating rosacea has not been specifically approved by the U.S. Food and Drug Administration. Beta blockers are normally prescribed for high blood pressure and heart disease, while alpha antagonists are used to treat high blood pressure and menopausal hot flashes.

Estrogen can be used when hot flashes aggravate rosacea. But hormone therapy carries a risk of breast cancer, heart disease, and stroke, and Dr. Wanner says this is not a strategy that dermatologists regularly employ, because hot flashes and rosacea flushing are two different things.

Treatment for Moderate Rosacea

Pimples and facial redness are the hallmarks of the second rosacea subtype, papulopustular rosacea. Topical treatments and oral medications that reduce inflammation and clear up breakouts are:

  • Finacea and Azelex (azelaic acid) are anti-inflammatory gels that work to control bumps, lesions, and swelling.
  • Metrogel and Noritate (metronidazol) are topical antibiotics that also help control bumps and redness.
  • Other topical medications, like benzoyl peroxide, retinoids, and sodium sulfacetamide and sulfur lotions, are sometimes used.
  • Oral antibiotics like tetracycline and doxycycline are often prescribed to reduce inflammation, but prolonged use can cause antibiotic resistance.
  • A low-dose doxycycline — Oracea — has been developed to specifically treat rosacea. It’s strong enough to fight inflammation, but not strong enough to kill bacteria, so it doesn’t cause antibiotic resistance and can be used long term.

Doctors often use oral and topical medications at the same time to get quicker results, and then switch patients to a single therapy to prevent flare-ups.

Treatment for Severe Rosacea

In phymatous rosacea, the third subtype of rosacea, the major problem is skin thickening and enlargement, especially around the nose. Along with topical and oral medications, lasers are a good treatment for this subtype, Wanner says. Carbon dioxide and erbium:YAG lasers can be used to remove excess skin and improve contours of the nose. Wanner says extra tissue also can be removed surgically. Thickening of the nose should be treated early because advanced stages can cause difficulty breathing or nostril collapse. If emotional problems develop because of damaged self-esteem due to the appearance of the skin, seek professional help.

Treatment for Rosacea Eye Problems

Ocular rosacea may result in bloodshot, watery eyes and other problems. Treatments include artificial tears, oral antibiotics, and daily cleansing of eyelashes with baby shampoo. Wanner says when patients report problems with burning, itching eyes or a history of styes, she refers them to an ophthalmologist.

For all types of rosacea, the length of maintenance treatment varies from person to person. “Some patients experience frequent flares and some flare rarely. Those who flare rarely may find they don’t need maintenance treatments other than gentle skin care and sunscreen,” Wanner says.

Wanner urges people with rosacea to regularly use sunblock with SPF (sun protection factor) 15 or higher because chronic sun exposure can make rosacea worse and trigger flares. Following that advice, avoiding all triggers, and sticking to your treatment plan can help you get the upper hand on rosacea.

  • Rosacea Basics
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Triamcinolone Cream

WARNINGS

No information provided.

PRECAUTIONS

General

Systemic absorption of topical corticosteroids has produced reversible hypothalamic-pituitary adrenal (HPA) axis suppression, manifestations of Cushing’s syndrome, hyperglycemia, and glucosuria in some patients.

Conditions which augment systemic absorption include the application of the more potent steroids, use over large surface areas, prolonged use, and the addition of occlusive dressings.

Therefore, patients receiving a large dose of a potent topical steroid applied to a large surface area or under an occlusive dressing should be evaluated periodically for evidence of HPA axis suppression by using the urinary free cortisol and ACTH stimulation tests, and for impairment of thermal homeostasis. If HPA axis suppression or elevation of the body temperature occurs, an attempt should be made to withdraw the drug, to reduce the frequency of application, substitute a less potent steroid, or use a sequential approach when utilizing the occlusive technique.

Recovery of HPA axis function and thermal homeostasis are generally prompt and complete upon discontinuation of the drug. Infrequently, signs and symptoms of steroid withdrawal may occur, requiring supplemental systemic corticosteroids. Occasionally, a patient may develop a sensitivity reaction to a particular occlusive dressing material or adhesive and a substitute material may be necessary.

Children may absorb proportionally larger amounts of topical corticosteroids and thus be more susceptible to systemic toxicity (see PRECAUTIONS – Pediatric Use section).

If irritation develops, topical corticosteroids should be discontinued and appropriate therapy instituted.

In the presence of dermatological infections, the use of an appropriate antifungal or antibacterial agent should be instituted. If a favorable response does not occur promptly, the corticosteroid should be discontinued until the infection has been adequately controlled.

These preparations are not for ophthalmic use.

Laboratory Tests

A urinary free cortisol test and ACTH stimulation test may be helpful in evaluating HPA axis suppression.

Carcinogenesis, Mutagenesis, and Impairment of Fertility

Long-term animal studies have not been performed to evaluate the carcinogenic potential or the effect on fertility of topical corticosteroids.

Studies to determine mutagenicity with prednisolone and hydrocortisone have revealed negative results.

Pregnancy.

Teratogenic Effects, Pregnancy Category C

Corticosteroids are generally teratogenic in laboratory animals when administered systemical-ly at relatively low dosage levels. The more potent corticosteroids have been shown to be ter-atogenic after dermal application in laboratory animals. There are no adequate and well-controlled studies in pregnant women on teratogenic effects from topically applied corticosteroids. Therefore, topical corticosteroids should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Drugs of this class should not be used extensively on pregnant patients, in large amounts, or for prolonged periods of time.

Nursing Mothers

It is not known whether topical administration of corticosteroids could result in sufficient systemic absorption to produce detectable quantities in breast milk. Systemically administered corticosteroids are secreted into breast milk in quantities not likely to have a deleterious effect on the infant. Nevertheless, caution should be exercised when topical corticosteroids are administered to a nursing woman.

Pediatric Use

Pediatric patients may demonstrate greater susceptibility to topical corticosteroid-induced HPA axis suppression and Cushing’s syndrome than mature patients because of a larger skin surface area to body weight ratio.

Hypothalamic-pituitary-adrenal (HPA) axis suppression, Cushing’s syndrome, and intracranial hypertension have been reported in pediatric patients receiving topical corticosteroids. Manifestations of adrenal suppression in pediatric patients include linear growth retardation, delayed weight gain, low plasma cortisol levels, and absence of response to ACTH stimulation. Manifestations of intracranial hypertension include bulging fontanelles, headaches, and bilateral papilledema.

Administration of topical corticosteroids to pediatric patients should be limited to the least amount compatible with an effective therapeutic regimen. Chronic corticosteroid therapy may interfere with the growth and development of pediatric patients.

Triamcinolone Topical

Triamcinolone comes in ointment, cream, lotion, and aerosol (spray) in various strengths for use on the skin and as a paste for use in the mouth. It usually is applied two to four times a day. For mouth sores, it is applied at bedtime and, if necessary, two or three times daily, preferably after meals. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use triamcinolone exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor. Do not apply it to other areas of your body or use it to treat other skin conditions unless directed to do so by your doctor.

To use triamcinolone topical, apply the ointment, cream, or lotion sparingly in a thin film and rub it in gently.

To use the lotion or aerosol (spray) on your scalp, part your hair, apply a small amount of the medicine on the affected area, and rub it in gently. Protect the area from washing and rubbing until the lotion or spray dries. You may wash your hair as usual but not right after applying the medicine.

To apply an aerosol, shake well and spray on the affected area holding the container about 3 to 6 inches away. Spray for about 2 seconds to cover an area the size of your hand. Take care not to inhale the vapors. If you are spraying near your face, cover your eyes.

To apply the paste, press a small amount on the mouth sore without rubbing until a thin film develops. You may need to use more paste if the mouth sore is large. If the mouth sore does not begin to heal within 7 days, call your doctor.

Triamcinolone aerosol (spray) may catch fire. Stay away from open fire, flames, and do not smoke while you are applying triamcinolone aerosol, and for a short time afterward.

If you are using triamcinolone topical on your face, keep it out of your eyes.

Do not apply other skin preparations or products on the treated area without talking with your doctor.

If you are using triamcinolone on a child’s diaper area, do not use tight-fitting diapers or plastic pants. Such use may increase side effects.

Triamcinolone topical

Generic Name: triamcinolone topical (TRYE am SIN oh lone)
Brand Name: DermasilkRx SDS Pak, Dermasorb TA, DermaWerx SDS Pak, Kenalog, Oralone, Trianex, Triderm, …show all 21 brand namesAristocort A, Triacet, Aricin, Aristocort R, Delta-Tritex, Flutex, Rx Triamcinolone, Aristocort Topical, Cinalog, Cinolar, Kenalog in Orabase, Triamcinolone Acetonide in Absorbase, Pediaderm TA, DermacinRx SilaPak

Medically reviewed by Drugs.com on Aug 1, 2019 – Written by Cerner Multum

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What is triamcinolone topical?

Triamcinolone is a steroid that helps reduce inflammation in the body.

Triamcinolone topical (for the skin) is used to treat the inflammation and itching caused by skin conditions that respond to steroid medication.

The dental paste form of triamcinolone topical is used to treat mouth ulcers.

Triamcinolone topical may also be used for purposes not listed in this medication guide.

Important Information

Follow all directions on your medicine label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.

Before taking this medicine

You should not use triamcinolone if you are allergic to it.

Tell your doctor if you have ever had:

  • any type of skin infection;

  • a skin reaction to any steroid medicine;

  • liver disease; or

  • an adrenal gland disorder.

Steroid medicines can increase the glucose (sugar) levels in your blood or urine. Tell your doctor if you have diabetes.

Tell your doctor if you are pregnant or breastfeeding. If you apply triamcinolone to your chest, avoid areas that may come into contact with the nursing baby’s mouth.

How should I use triamcinolone topical?

Follow all directions on your prescription label and read all medication guides or instruction sheets. Use the medicine exactly as directed.

Triamcinolone topical cream, lotion, ointment, or spray is for use only on the skin. Triamcinolone dental paste is applied directly onto an ulcer inside the mouth and left in place.

Do not swallow triamcinolone topical.

Wash your hands before and after using triamcinolone topical, unless you are using this medicine to treat the skin on your hands.

Apply a thin layer of medicine to the affected skin. Do not apply this medicine over a large area of skin unless your doctor has told you to.

Do not cover the treated skin area with a bandage or other covering unless your doctor tells you to. Covering treated areas can increase the amount of medicine absorbed through your skin and may cause harmful effects.

If you are treating the diaper area, do not use plastic pants or tight-fitting diapers.

To use the dental paste, press a small dab onto the mouth ulcer but do not rub in the medicine. The dab will form a thin film that should be left in place for several hours. Triamcinolone dental paste is usually applied at bedtime and/or after meals. Follow your doctor’s instructions.

Call your doctor if your symptoms do not improve, or if they get worse. A mouth ulcer should improve within 1 week of using triamcinolone dental paste.

You should stop using this medicine once your symptoms are controlled.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Apply the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not apply two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222 if anyone has accidentally swallowed the medication.

High doses or long-term use of steroid medicine can lead to thinning skin, easy bruising, changes in body fat (especially in your face, neck, back, and waist), increased acne or facial hair, menstrual problems, impotence, or loss of interest in sex.

What should I avoid while using triamcinolone topical?

Avoid getting triamcinolone topical in your eyes.

Avoid using other topical steroid medications on the areas you treat with triamcinolone unless your doctor tells you to.

Do not use triamcinolone topical to treat any condition that has not been checked by your doctor.

Do not share this medicine with another person, even if they have the same symptoms you have.

Triamcinolone topical side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • worsening of your skin condition;

  • redness, warmth, swelling, oozing, or severe irritation of any treated skin;

  • blurred vision, tunnel vision, eye pain, or seeing halos around lights;

  • high blood sugar–increased thirst, increased urination, dry mouth, fruity breath odor; or

  • possible signs of absorbing this medicine through your skin or gums–weight gain (especially in your face or your upper back and torso), slow wound healing, thinning or discolored skin, increased body hair, muscle weakness, nausea, diarrhea, tiredness, mood changes, menstrual changes, sexual changes.

Children can absorb larger amounts of this medicine through the skin and may be more likely to have side effects such as growth delay, headaches, or pain behind the eyes. A baby using this medicine may have a bulging soft spot (the top of the head where the skull hasn’t yet grown together).

Common side effects may include:

  • burning, itching, dryness, or other irritation of treated skin;

  • redness or crusting around your hair follicles;

  • redness or itching around your mouth;

  • allergic skin reaction;

  • stretch marks;

  • acne, increased body hair growth;

  • thinning skin or discoloration; or

  • white or “pruned” appearance of the skin (caused by covering treated skin with a tight bandage or other covering).

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect triamcinolone topical?

Medicine used on the skin is not likely to be affected by other drugs you use. But many drugs can interact with each other. Tell each of your healthcare providers about all medicines you use, including prescription and over-the-counter medicines, vitamins, and herbal products.

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Copyright 1996-2018 Cerner Multum, Inc. Version: 8.01.

Medical Disclaimer

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Consumer resources

  • Triamcinolone Cream and Ointment
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Other brands: Kenalog, Trianex, Triderm, Aristocort A, … +6 more

Professional resources

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Rosacea Treatment Options

Creams and Gels

Your doctor might start treatment with a prescription cream or gel you use on your face once or twice a day. These include:

Azelaic acid (Azelex and Finacea)
Brimonidine(Mirvaso)

Clindamycin (Cleocin and ClindaMax)

Erythromycin (Erygel)
Ivermectin (Soolantra)

Metronidazole (MetroCream or MetroGel)
Sodium sulfacetamide and sulfur (Clenia and Plexion)
Tretinoin(Avita, Retin-A), a retinoid, is used in some hard-to-treat cases.

These treatments have side effects, like skin irritation. A few are not safe for women who are pregnant or planning to become pregnant. Talk to your doctor about any risks.

Antibiotic Pills

If your rosacea is more serious or doesn’t respond to ointments, your doctor might suggest antibiotic pills, though you might keep using skin creams, too. Antibiotic pills may also be used if you have ocular rosacea.

Your doctor might try doxycycline(Vibramycin), erythromycin (ERYC), metronidazole (Flagyl), or minocycline(Dynacin).

Like any medicine, antibiotics can cause side effects. Treatment is typically long-term, often lasting at least 6 months.

Other Drugs

If these rosacea treatments don’t work, your doctor may try other medicines, such as isotretinoin(Absorbica, Amnesteem, Claravis, Myorisan and Zenatane). But because of serious side effects, it’s not used often.

6 Rosacea Treatments That Can Help With Redness and Bumps

Rosacea may begin with a mild blush or flush. But over time, depending on the type of rosacea you have, this skin condition can worsen and become far more bothersome.

Besides redness, rosacea can cause swelling, acne-like breakouts, bumps with pus (pustules) or without (papules), thickened skin, eye irritation, and even a change in the shape and size of your nose.

“Given the many different ways that rosacea can affect the skin, I would encourage patients with rosacea to discuss their care with a dermatologist to develop a personalized treatment plan,” says John Barbieri, MD, a research fellow in dermatology at the University of Pennsylvania’s Perelman School of Medicine.

While there’s no cure for rosacea, prompt attention and therapy can prevent some of its long-term complications. Here, some options to consider when searching for the best rosacea treatment for you.

RELATED: 7 Home Remedies for Rosacea You Should Try

Topical treatments

When he’s helping patients select a rosacea treatment, Richard Torbeck, MD, a dermatologist and Mohs surgeon in New York, first gauges which aspects of the condition are the most distressing.

If redness ranks high, he targets that, often beginning with a non-invasive treatment. One option is metronidazole; while it’s technically an antibiotic, doctors believe that for rosacea, it works to decrease inflammation and irritation.

For more intense cases of redness, a cream or gel called oxymetazoline may constrict blood vessels and decrease blood flow, says Robyn Gmyrek, MD, a board-certified dermatologist at Union Square Laser Dermatology in New York City. A similar product is brimonidine gel. Both reduce redness for about 12 hours.

For rosacea cases that involve papules or pustules, your doctor may recommend twice-daily applications of a gel, foam, or cream containing azelaic acid. These products also fight bacteria. Plus, they decrease levels of a compound called keratin—a fibrous protein that provides structure to hair, skin, and nails but can block pores if you produce too much of it.

Finally, a cream called ivermectin is sometimes prescribed. This drug is effective in killing off microscopic skin mites called Demodex folliculorum, which are thought to contribute to some cases of rosacea, Dr. Gmyrek says.

RELATED: The Best Moisturizers for Rosacea, According to Dermatologists

Oral medications

Because rosacea can be caused or aggravated by bacteria—some of which may live within the mites, Dr. Gmyrek says—oral antibiotics are sometimes used to address flare-ups. Your doctor may prescribe a course of drugs such as tetracycline, minocycline, doxycycline, or erythromycin to bring your rosacea symptoms under control.

However, taking antibiotics at high doses for long periods of time can contribute to what’s called antibiotic resistance, when illnesses become impervious to these germ-killers. You might soon switch to a lower dose of doxycycline, which acts more as an anti-inflammatory than an antibiotic, Dr. Torbeck says.

With less-intense formulations, “you’re not building resistance or getting the complications you get with long-term antibiotic use,” including the unintentional disruption of beneficial bacteria, he says. But what you do receive is relief from the eye problems related to rosacea as well as prevention of new papules and pustules.

RELATED: The Best Anti-Aging Products for People With Rosacea (That Won’t Irritate Skin)

Laser and light therapies

Other treatments for rosacea can be administered in a dermatologist’s office. One popular treatment for rosacea is the pulsed dye laser. Heat and energy from the laser’s beam target a compound called hemoglobin in your blood vessels; small vessels then collapse, decreasing the appearance of redness, Dr. Torbeck says.

Treatments using other forms of focused light—including intense pulsed light, which works by similar mechanisms—can also reduce redness. Though both are effective for many people with rosacea, they’re not permanent, he notes. Repeated treatments are necessary to address new blood vessels as they form.

Besides banishing redness, laser or light therapy can also temporarily reduce thickening of the skin, including the type that frequently distorts the shape of the nose, Dr. Gmyrek says.

RELATED: The 4 Types of Rosacea—and How to Treat Them

Eye care

When patients have rosacea symptoms in their eyes, Dr. Torbeck recommends they see an ophthalmologist at least once per year. Treatment can include prescription eye drops and oral antibiotics in these cases too. Laser treatments may also open glands in the eyes that become blocked in rosacea.

In the meantime, there are steps you can take to ease discomfort and irritation, such as washing your eyelids with diluted baby shampoo and placing warm compresses over them.

RELATED: 6 Rosacea Triggers Anyone With Sensitive Skin Should Know About

Lifestyle modifications

If you’re looking at options for natural rosacea treatment, know that there are many powerful steps you can take that don’t involve drugs at all. Making notes about your triggers—which often include spicy foods, exercise, stress, and hot liquids—can help you learn what worsens your rosacea, Dr. Gmyrek says.

From there, you can alter your habits to avoid these triggers when possible. When it’s not feasible or recommended—for instance, in the case of an otherwise health-promoting trigger such as exercise—you can time your other treatments to reduce a trigger’s impact. For instance, wash your face and apply one of your prescription creams soon after you stop sweating, Dr. Torbeck says.

Finally, using gentle, non-irritating skin products can ease your symptoms. Steer clear of strong fragrances, scrubs, toners, and astringents. Instead, look for mild cleaners and moisturizers specifically formulated for sensitive or rosacea-prone skin.

RELATED: 5 Things That Might Cause Rosacea, According to Dermatologists

Over-the-counter treatments

While many therapies require a prescription, you can buy some types of rosacea treatment over the counter. This includes one of the most critical tools for keeping your skin healthy: sun protection.

“A mineral sunscreen is the first and last line of defense and prevention,” says Carolyn Jacob, MD, medical director of Chicago Cosmetic Surgery and Dermatology.

In addition, creams and washes containing sulfa—and even some with azelaic acid—are also available at the drugstore, Dr. Gmyrek says. Topical antioxidants may also prevent cell damage and ease redness, Dr. Jacob says.

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Rosacea, a chronic inflammatory condition usually involving the face and the eyes, affects 16 million Americans of all genders, ages, races, and ethnicities.1 Symptoms generally appear when patients are in their thirties or forties, and wax and wane throughout life.2
Rosacea can occur in anyone, but its clinical presentation varies substantially. Certain symptoms are common (Table 13), but symptoms can occur along a spectrum and often together.4
Rosacea’s pathophysiology is still largely unknown. Researchers have determined that blood vessel dilation, infiltration of T-helper cells, macrophages, and mast cells are frequent histologic findings. In addition, keratinocyte Toll-like receptors are cited as having a likely role in the pathogenic process of unwarranted activation of the immune system.4
Treatment
Pharmacologic treatment of rosacea is neither curative nor the sole option, and nonpharmacologic interventions are critical to successful treatment. Patients also must avoid triggers (eg, sunlight, hot food, exercise, alcohol, ultraviolet light exposure, hot showers).5 The associated drug therapies are topical or systemic. Each category includes FDA-approved and unapproved options, and some homeopathic possibilities. In addition, whereas light or laser therapies are often used to treat redness and skin thickening, patients’ insurance often does not cover this costly option. Because no therapy is considered curative, patients often have to try many medications and combinations of them to find what works best.4
Topical Treatments
The FDA approved brimonidine tartrate gel (Mirvaso), an alpha-2 agonist, in 2013. It is the only product approved for persistent facial flushing.2,4,6 This gel reverses vasodilation, reducing redness.4 Patients should apply a pea-size amount to the face once daily. The adverse effects (AEs) are mostly mild and often cutaneous, occurring at treatment initiation. Several reports of rebound erythema have been reported, however. This medication can be used in combination with other therapies, including those used to treat papules.6
Some rosacea sufferers use oxymetazoline to treat redness and flushing of the face. It has alpha-1 and alpha-2 effects and causes vasoconstriction. A facial formulation is currently in clinical development; however, doctors may recommend patients purchase the 0.05% nasal solution and apply it topically.4
Metronidazole, a cornerstone of papulopustular rosacea (PPR) treatment, comes in 0.75% and 1% formulations in different vehicles and is applied once or twice daily. Its exact mechanism of action is unknown, but it seems to have antimicrobial, antioxidant, and anti-inflammatory properties.7,8
Azelaic acid (Finacea) is another FDA-approved agent that is safe and effective for PPR.4,6 It is available as a 15% gel and is applied twice daily. It decreases enzyme activity and immune system activation,2 and it has anti-inflammatory, antimicrobial, and antioxidant benefits.2,6
Combination sulfacetamide 10%/sulfur 5% is available in many formulations, although these preparations are rarely used. These products can cause irritation and allergic reaction, and are malodorous.4 Their efficacy is questionable, based on a small number of clinical trials and mixed findings.2,4
The FDA recently approved once-daily ivermectin 1% cream (Soolantra) to treat PPR. Phase 3 trials proved it to be safe and effective at 12 weeks. It is thought to reduce papules by killing Demodex mites, which live in the sebaceous glands.9-11 The AEs include burning, itching, and dryness at the application site.2 Despite only a few clinical trials, numerous other topicals are also effective and used off-label (Table 24,12,13).
Systemic Treatments
Doxycycline 40 mg (Oracea) works through numerous mechanisms to treat PPR.4 This once-daily sub-antimicrobial dose decreases antibiotic selection.2,4,6 Studies have shown it to be effective as monotherapy and when used in combination with topicals such as metronidazole and azelaic acid.4
Isotretinoin is a last-line option for patients with refractory rosacea. Generally thought to treat PPR, it also benefits erythematotelangiectatic rosacea. Isotretinoin is a retinoid derivative that reduces the size of sebaceous glands and sebum production. Prescribed at various doses, isotretinoin has been shown to be more effective than doxycycline. However, isotretinoin creates greater risk of AEs such as fragile, sensitive skin.14,15
Zinc sulfate appears to be beneficial in small clinical trials. Zinc supplementation is relatively benign, with no AEs reported in clinical trials. Further research is warranted.4,16,17
Lasers and Light Therapy
Light therapy can be used to treat multiple subtypes and presentations of rosacea. Pulsed dye laser uses light wavelengths specific for the absorption of oxyhemoglobin, which targets superficial vasculature and decreases erythema.4
Another option, intense pulsed light (IPL) is more flexible and offers many benefits (eg, less discomfort, higher efficacy). In addition, IPL systems can target deeper blood vessels.4 With numerous types of lasers available, physicians must work closely to customize the best regimen for each patient.4
End Note
Few patients with rosacea find adequate relief from lifestyle modifications or monotherapy alone. Most patients need a topical medication and, sometimes, oral tetracycline. For most patients, the treatment process requires many frustrating trials to find what works.4 The Figure4 describes typical approaches to each type of rosacea.

Ms. Wick is a visiting professor at the University of Connecticut School of Pharmacy.
References

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Triamcinolone Acetonide – Overview

Triamcinolone acetonide ointment, marketed under brand names such as Kenalog, is a topical cream used to treat medical conditions such as allergies, psoriasis and eczema. Push Health connects people who need a triamcinolone acetonide cream prescription with licensed medical providers who can prescribe triamcinolone ointment if it is indicated to do so.

What Is Triamcinolone Acetonide Cream Used For?

Triamcinolone, like desoximetasone, is a type of medication known as a synthetic corticosteroid medication. Triamcinolone creams are absorbed by the skin and exert anti-inflammatory and anti-itching effects. Triamcinolone works by activating specific glucocorticoid receptors which ultimately reduce the synthesis of prostaglandins and leukotrienes – chemicals that increase the inflammatory response. Triamcinolone also inhibits the production of cytokines. Because of these effects, triamcinolone ointment is frequently prescribed for treating conditions like psoriasis. In function, triamcinolone acts similarly to other steroid medications such as the Medrol Dosepak (methylprednisolone) and prednisone.

Triamcinolone Cream – Dosage and Cost

Triamcinolone ointment is available as triamcinolone 0.025% cream, triamcinolone 0.1% cream and triamcinolone 0.5% cream. The absorption of triamcinolone varies from person to person. Triamcinolone cream can be absorbed through healthy skin although the absorption pharmacokinetics can be influenced by the integrity of the epidermis and the use of occlusive dressings. Triamcinolone is considered an affordable medication. Triamcinolone 0.1% cream costs under $4 for a 15 gram tube. The cost of a triamcinolone ointment prescription may be covered by some insurance plans. Triamcinolone coupons may also be available online at times to help reduce any out-of-pockets costs associated with a prescription. Triamcinolone cream should be stored at room temperature and should not be frozen.

Can I Buy Triamcinolone Acetonide Online?

Triamcinolone acetonide is a prescription medication that is not available over-the-counter (OTC). Legally, in the US, one cannot simply buy triamcinolone online. The first step to getting a triamcinolone prescription is consulting with a medical provider. People who need a triamcinolone cream prescription, however, can use Push Health to connect with a licensed medical provider who can prescribe triamcinolone ointment if it is appropriate to do so.

Triamcinolone Acetonide – Side Effects

Triamcinolone, like other medications, can cause side effects. Triamcinolone side effects include burning, itching, irritation, dermatitis and skin atrophy. Triamcinolone is a steroid medication and should be used cautiously as it can cause HPA axis suppression and hyperglycemia. Triamcinolone acetonide and alcohol should not be used together. Questions about side effects related to triamcinolone use should be directed to one’s medical provider and pharmacist. Triamcinolone should not be used by people who have a known hypersensitivity to triamcinolone or other steroid medications.

More Triamcinolone Information

  • Medline

Last updated December 12, 2019. Given the evolving nature of medicine and science, this information might not be accurate and should not be construed as medical advice or diagnosis / treatment recommendations. Please consult a licensed medical provider if you have additional questions.

It’s bad enough having acne as a teenager, but with acne rosacea, redness and pimples may visit you even after the age of 30. Also, rosacea can look a lot like common adult acne, so you have to be careful—they require a completely different set of treatments. Here are the latest recommendations for treating rosacea.

What does rosacea look like?

There are 4 types of rosacea, but to keep it simple, if you have flushing, broken capillaries, and acne on your face, think rosacea. Rosacea likes to involve the center of your face, and persistent redness is characteristic. Folks with rosacea tend to have sensitive skin and difficulty tolerating many cosmetics, skin care products, and topical medications. Rough, dry, or scaly skin on the face is also common.

Rosacea is more frequently seen in women and people with fair skin. Also, people with a “peaches and cream” complexion at a young age often have rosacea as adults.

What causes rosacea?

The truth is, we don’t know what causes rosacea. Some of the leading ideas include:

  • Abnormal immune function
  • Inflammation reactions to microorganisms on the skin
  • Skin damage from ultraviolet (UV) light
  • Dysfunctional blood vessels, especially small ones like capillaries

You are BORN with rosacea and sun exposure BRINGS it out. If you have rosacea, the most important thing to remember is to protect yourself from the sun, which will make it worse.

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How do I treat rosacea?

Many options for treatment exist, but they vary depending on what type of rosacea you have.

Laser and intense pulsed-light therapy reduce the redness you get in rosacea from flushing and broken capillaries. They’re worth pursuing, although they can be expensive.

Topical prescription medications can help reduce redness and flushing or treat pimples associated with rosacea, depending on the medication you choose.

To reduce redness and flushing, we have Mirvaso and Rhofade:

  • Mirvaso. Of all the medications for reducing persistent redness in rosacea, Mirvaso is supported by the strongest research evidence. Mirvaso works well for redness and flushing, but can be expensive. You may need to ask your doctor to help you submit a coverage appeal to your insurer in order to get it covered.
  • Rhofade. In 2017, the FDA approved Rhofade as a medical treatment for facial redness related to rosacea. Rhofade lessens redness and doesn’t have many side effects, but like Mirvaso, it can also be quite expensive and is rarely covered by insurance plans.

To treat papules and pustules (i.e., pimples), we have Metrogel, Azelex, Finacea, and Soolantra:

  • Metrogel. A 45 g tube of generic Metrogel (metronidazole) costs less than other topical treatments for pimples associated with rosacea, so it’s often prescribed first for rosacea therapy. While Metrogel works for rosacea’s pimply bumps, it doesn’t work well for redness and flushing. Metrogel as a cream, gel, or lotion all work the same, so it doesn’t matter which one you pick. One downside is rosacea may reappear when you stop using it.
  • Azelex and Finacea. Azelex and Finacea may work slightly better than Metrogel for rosacea-related pimples, but they can be expensive and are often not covered by insurance.
  • Soolantra. Soolantra may also be slightly better for pimples than Metrogel, but again, it’s expensive and rarely covered by insurance.

As we’ve discussed, medications for rosacea can be expensive. Fortunately, there are ways to save. If you have insurance, check there first. Find more information here on how to get your medication covered if it isn’t already. And for more tips on how to save on expensive drugs, visit goodrx.com.

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Dr O.

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