Rosacea comes in four flavours:

1. Erythematotelangiectatic (redness/flushing, visible blood vessels),
2. Papulopustular (red bumps, sometimes mistaken for acne),
3. Phymatous (thickened skin, often the nose: “rhinophyma”),
4. Ocular (irritation, red or gritty eyes).

The cause? It’s a team effort—genetics, immune overactivity, neurovascular sensitivity, sun damage, Demodex mites, and sometimes the microbiome. No single villain, but lots of collaborators.

Major offenders include heat, UV light, wind, spicy foods, alcohol (especially red wine), hot drinks, stress, certain skincare products, and even dairy in some people. Each face is unique—tracking flares in a diary is a smart move.

Topical Treatments

Metronidazole

• Standard first-line therapy. Gel or cream (0.75–1%) used once or twice daily.
  
• Efficacy: RCTs show up to 74% decrease in inflammatory lesions after 8–12 weeks.
  
• Side effects: Mild irritation (3–7%) or dryness.
  

Azelaic Acid

• 15–20% gel or foam, used twice daily.
• Efficacy: Studies show 70% have reduced papules/pustules and significant decrease in redness after 12 weeks.
• Additional benefit: Brightening effect and good for post-inflammatory pigmentation.

Brimonidine

• 0.33% gel, applied once daily for redness.
• Action: Vasoconstrictor that reduces visible facial erythema within 30 minutes, effects last up to 12 hours.
• Data: 80% report improvement in redness on standardized scales.
• Side effects: Temporary worsening of redness in some (5–10%).

Sulfur-based creams

• Efficacy similar to metronidazole or azelaic acid in mild-moderate cases.
• Data: Trials show reduction in pustules and papules with regular use.
• Benefit: Also has mild anti-demodex activity (for mite-associated rosacea).

Oral Treatments

Doxycycline

• 40–100 mg daily (sub-antimicrobial dose preferred for anti-inflammatory action).
• Efficacy: Reduces inflammatory lesions by 61% in moderate-severe rosacea within 8 weeks.
• Side effects: GI upset, sun sensitivity, yeast infections.

Minocycline & Azithromycin

• Used off-label for antibiotic-resistant cases or when doxycycline is not tolerated.
• Efficacy: Small studies show moderate reduction in lesion counts (about 50%).

Other Options

Isotretinoin (oral)

• Considered for severe, phymatous (skin thickening) or resistant cases, only under dermatologist supervision.
• Efficacy: High-dose courses can reduce phymatous changes and clear resistant lesions, but relapses occur if discontinued too soon.
• Risks: Teratogenicity, lab monitoring required.

Key Data

• Topical treatments are first-line for mild to moderate rosacea (success rates 60–75%).
• Oral therapies are for moderate-severe or persistent cases (inflammatory lesion reduction 50–60%).

Other interventions include pulsed dye laser or IPL for redness, and lifestyle modification (sun avoidance, trigger management). 

Absolutely. For persistent redness or visible vessels, pulsed-dye laser (PDL) and intense pulsed light (IPL) are effective and well-tolerated, with evidence for meaningful reduction in flushing and telangiectasia. These are especially helpful when topical or oral options haven’t done the trick.

Laser and light-based therapies are powerful allies in the fight against persistent rosacea—especially when redness, visible vessels, or flushing won’t budge with creams and pills alone. Pulsed dye lasers (PDL, e.g. VBeam®) and Intense Pulsed Light (IPL) both work by targeting and collapsing overactive blood vessels underneath your skin. This means less redness, fewer broken capillaries, and real relief from the “perma-flush” that’s so typical of rosacea.

What does the evidence say?

• Multiple RCTs and large clinical reviews confirm that PDL and IPL can reduce redness and visible vessels by up to 50–70% after a few sessions. Symptom improvements last for months, especially when combined with skincare and trigger avoidance.
• Laser Genesis (Nd:YAG), Excel V+, and other vascular lasers also provide sustained improvement for challenging cases with minimal downtime.

Where can you get PDL or IPL for rosacea in Vancouver?

• Arbutus Laser Centre: Pioneers in laser medicine with both PDL (VBeam) and a range of vascular lasers.
• Pacific Derm: Dermatology clinic with advanced IPL and laser therapies, plus in-house dermatologists.
• Vancouver Laser & Skin Care Centre: Offers Picoway®, Clearlift™, and BBL (broadband light, a newer form of IPL) with highly experienced staff.
• Celebrity Laser & Skin Care (North Vancouver): Non-invasive Laser Genesis, Limelight IPL, and capillary treatments for redness and documented rosacea.
• Skin Technique & DermLab: Excel V+ vascular laser and custom programs for rosacea, redness, and visible blood vessels.
• Rejuv Clinic & SparrowMD: VBeam & IPL with a focus on vascular and rosacea-specific protocols.
• Lougheed Laser Clinic (Burnaby): VBeam PDL treatments with extensive experience.

How soon will I see results?

Expect improvement after 1–3 sessions, with effects building over time. Most clinics will space treatments 4–6 weeks apart for best results. Downtime is minor (some redness/swelling for a day or two).

Summary:

 PDL and IPL are safe, effective, and available at multiple Vancouver clinics with experienced operators. 

Demodex mites are part of normal skin, but in higher amounts may worsen rosacea. You don’t usually need special mite tests; if standard treatments fail, we may try anti-Demodex options (e.g., topical ivermectin, tea tree oil derivatives), which are supported by some studies.

• Avoid personal food/environment triggers. Keep a diary to find your personal triggers!
• Gentle, non-soap cleansers and fragrance-free moisturizers.
• Daily use of a physical (mineral) sunscreen SPF 30+ (zinc or titanium dioxide bases).
• Hats, shade, and avoiding mid-day sun.
• Manage stress (deep breathing, relaxation).
• Avoid alcohol-based gels and strong exfoliants.

Topical creams rarely cause side effects with long-term use. Long-term oral antibiotics can lead to gut upset and resistance; we recommend using them for the shortest possible duration (usually 3 months or less), then switching to topical maintenance. Laser/light or non-drug options are suitable for those wanting to minimize medication.

Absolutely—naturopathic treatments for rosacea have evolved, with increasing support from clinical research. Here’s a breakdown of the evidence for leading strategies:

• Anti-inflammatory diets: A large, prospective study found that high adherence to a Mediterranean-like, anti-inflammatory diet was linked to a reduced risk of incident rosacea. Such diets help modulate the gut microbiome and lower systemic inflammation—a key player in rosacea flare-ups.
• Barrier-repair creams/moisturizers: Rosacea patients often have a compromised skin barrier, increasing irritation and sensitivity. Clinical studies demonstrate that barrier-supportive moisturizers improve hydration, reduce transepidermal water loss, and decrease redness and dryness—not only comforting the skin but also supporting outcomes when combined with medical treatments.
• Topical niacinamide: Moisturizers with 2–5% niacinamide have been shown in RCTs to reduce redness, flakiness, and bumps after just four weeks by strengthening the epidermal barrier and lowering skin inflammation. Most patients with sensitive or rosacea-prone skin tolerate niacinamide well.
• Azelaic acid: Azelaic acid is naturally derived and backed by robust meta-analyses: 58% reduction in inflammatory lesions after 12 weeks, superior to vehicle, and comparable to standard pharmaceuticals.
• Licorice/root extract (Glycyrrhiza glabra): Licorice's active components, such as licochalcone A, demonstrate significant anti-inflammatory and antioxidant effect in both lab and early clinical studies. Topical preparations may reduce redness and improve skin texture, with efficacy comparable to metronidazole and azelaic acid in some trials.
• Green tea polyphenols (EGCG): Animal and small human trials show that EGCG from green tea reduces inflammation and supports autophagy in skin cells, possibly reducing rosacea-like features. A blend of green tea polyphenols, resveratrol, and caffeine improved facial redness in a small study with no adverse effects.
• Oral and topical zinc: RCTs show oral zinc sulfate and topical zinc may reduce severity scores significantly, likely via anti-inflammatory effects.
• Turmeric and polyherbal blends: One RCT showed a 40% decrease in redness compared to baseline for a turmeric-based polyherbal supplement, though turmeric alone was less effective.
• Gut health optimization: The “gut-skin axis” is increasingly recognized, with altered GI microbiota observed in rosacea and Mediterranean diet studies showing benefit through both anti-inflammatory and microbiome-balancing effects.

Key data points:

• Azelaic acid 15% gel: 58% (vs 40%) reduction in lesion count over 12 weeks.
• Niacinamide 2% moisturizer: improvement in redness, flakiness, and bumps after 4 weeks in several studies.
• Topical zinc: significant improvement in severity scores (RCT, p < 0.00003).
• Green tea blend: continuous use led to reduction in redness over 6 weeks.

Caveat: These naturopathic strategies are best considered add-ons to standard care for moderate/severe rosacea—think of them as supporting actors alongside prescription topicals/orals and, when needed, laser therapy. 

Summary: A comprehensive rosacea regimen incorporates barrier-repair skincare, anti-inflammatory nutrition, select botanical topicals, stress reduction, and gut support—layered over a foundation of evidence-based medical treatment.