Rosacea treatment
Treatment for rosacea with Mirvaso, Rozex, Soolantra, and Efracea - available to buy online from Dr Fox.
Read medical information and answer medical questions to buy treatment online.
Rosacea medication
PricesAll medicine supplied is UK licensed.
Prices
| Rosacea treatment | Quantity | Cost |
|---|---|---|
| Mirvaso Gel (brimonidine 3mg/1g) | 1 x 30gm tube | £41.00 |
| Mirvaso Gel (brimonidine 3mg/1g) | 2 x 30gm tubes | £80.00 |
| Mirvaso Gel (brimonidine 3mg/1g) | 3 x 30gm tubes | £120.00 |
| Rozex cream/gel (0.75% metronidazole) | 1 x 50gm tube | £19.80 |
| Rozex cream/gel (0.75% metronidazole) | 2 x 50gm tubes | £39.00 |
| Rozex cream/gel (0.75% metronidazole) | 3 x 50gm tubes | £57.00 |
| Soolantra Cream (1% ivermectin, 10mg/gm) | 1 x 45 gram tube | £37.80 |
| Soolantra Cream (1% ivermectin, 10mg/gm) | 2 x 45 gram tube | £72.40 |
| Efracea (40mg doxycycline) | 14 capsules | £18.20 |
| Efracea (40mg doxycycline) | 28 capsules | £34.00 |
| Efracea (40mg doxycycline) | 56 capsules | £55.40 |
| Efracea (40mg doxycycline) | 112 capsules | £104.00 |
Price match guarantee
Prescription issued online - small prescription fee per order.
Prescription fees
Dr Fox supplies medicine on prescription and charges a small prescription fee based on the order value of each prescription.
Prescriptions are issued by our doctors online and sent electronically to our pharmacy.
| Order value | Prescription fee |
|---|---|
| up to £10 | £1.00 |
| up to £20 | £2.00 |
| up to £40 | £3.00 |
| over £40 | £4.00 |
If you have your own private or NHS paper prescription please post to our pharmacy (details).
Dr Fox prices are 25%–50% lower than other UK online clinics.
Delivery charges
UK delivery only: £2.90 per consultation via Royal Mail Tracked 24 Signed For (1-3 working days with tracking).
Parcel forwarding services are not permitted. Use only UK home or work delivery address.
Returns and refunds - unwanted items can be returned within 14 working days for a full refund.
Medical information
Written and reviewed by a team of doctors. Dr Fox is regulated by the CQC & GPhC.
What is rosacea?
Rosacea is a condition causing reddening and sensitivity of skin, with increased flushing and sometimes visible thread-like blood vessels in the areas of the cheeks, forehead, nose, and chin. There can also be red pimples/papules which can become inflamed and pustular in more severe cases. Rosacea often recurs so repeated courses of treatment and varying the treatment used may be necessary.
Rosacea is different from acne, and treatment is different. They can look similar, but in rosacea redness tends to come and go depending on factors like stress and heat, and stimulants such as spicy food and alcohol. In rosacea there are no blackheads, or the infected nodules found in severe acne. Rosacea is sometimes called acne rosacea, but this is a misleading name. Rosacea is not a type of acne.
The exact cause of rosacea is not known.
See a doctor before treatment
People with troublesome facial redness should see a doctor before treatment. Not all facial redness is caused by rosacea - some is due to acne - and there are some other less common and potentially serious conditions, including infection, which need to be considered.
Further information
- NHS - Rosacea
- NHS 111 Wales - Rosacea
- British Association of Dermatologists - Rosacea
- Dermnet NZ - Rosacea
Rosacea treatments
There are several treatments to choose from depending on which features are causing the most problem and how severe the rosacea is.
It is best to use one type of treatment for at least two months before switching to another treatment or adding in a new one.
Dr Fox supplies the following rosacea treatments:
- Mirvaso gel
- Soolantra cream
- Rozex (gel or cream)
- Efracea capsules
These are generally the most effective treatments, but dermatologists may sometimes use other treatments including different antibiotics.
How to choose which treatment is best for you
Mostly redness, flushing, and thread veins (erythematotelangiectatic rosacea)
For redness and flushing Mirvaso gel is a good first choice. Mirvaso can also be used with any of the other treatments.
Suggested treatment plan:
- Apply Mirvaso gel once daily in the mornings. This will reduce flushing and redness for up to 12 hours.
- If no improvement in redness and flushing or symptoms are worsening with Mirvaso - stop using Mirvaso and take Efracea capsules once daily for up to 4 months.
- If no improvement after 6 weeks, stop Efracea capsules and consult a GP or dermatologist.
Mild to moderate spots and pimples (papulopustular rosacea)
If the main problem is mild inflammation, soreness and infected spots, choose either Soolantra cream or Rozex gel/cream. If skin is not improving after a couple of months, swap to the other one, or include another additional treatment. They work in slightly different ways, but they should not be used together. Some people find Soolantra cream slightly more effective.
Suggested treatment plan:
- Initially try Soolantra cream once daily.
- If also redness and flushing, add Mirvaso gel once daily in the mornings as necessary.
- If no improvement after 2 months swap, from Soolantra cream to Rozex gel/cream twice daily.
- If still not resolved after using Rozex for 2 months, add Efracea capsules once daily for up to 4 months.
- If no improvement after taking Efracea for 6 weeks, stop Efracea capsules and consult a GP or dermatologist.
Moderate to severe spots and pimples with inflammation and redness
If the inflammation is more severe with more pustules, start Efracea capsules, straight away. Any of the other treatments can be used at the same time.
Suggested treatment plan:
- Start with Efracea capsules once daily for up to 4 months.
- If also redness and flushing, add Mirvaso gel once daily in the mornings as necessary.
- If no improvement after 6 weeks, stop Efracea capsules and consult a GP or dermatologist.
More severe rosacea
Severe rosacea includes thickening and swelling of the nose (rhinophyma), symptoms affecting the eyes (ocular), and associated psychological effects such as severe psychological distress and social phobia. If you have any of these conditions, consult a GP or dermatologist and do not self treat.
General measures for all rosacea
Avoid factors which can cause facial flushing, such as spicy food, sun and sunbed exposure, hot showers, overheated rooms, and in some cases alcohol. Wash your face using emollients - soaps, and facial washes and cleansers, contain detergents which can worsen symptoms. Moisturise regularly and use sunscreen. Don't use oily skin preparations - choose water-based makeup and sunscreens, and particularly do not use topical steroids as they worsen things in the long term. Some people find that they can reduce facial redness for short periods by holding an ice block in their mouth, between the gum and cheek.
If symptoms are not improving or are worsening consult a GP or dermatologist.
Combining rosacea treatments
| Product | Frequency | Use with Mirvaso | Use with Soolantra | Use with Rozex | Use with Efracea |
|---|---|---|---|---|---|
| Mirvaso gel | Once daily | n/a | Yes | Yes | Yes |
| Soolantra cream | Once daily | Yes | n/a | No | Yes |
| Rozex gel/cream | Twice daily | Yes | No | n/a | Yes |
| Efracea capsules | Once daily | Yes | Yes | Yes | n/a |
- Mirvaso can be used together with Soolantra or Rozex. Apply the Mirvaso first and allow it to dry, before applying Soolantra or Rozex.
- Efracea can be taken at the same time as using Rozex or Soolantra, and Mirvaso.
- It may be useful to take a photograph before and after using the treatments to gauge effectiveness.
If there is no improvement with the above treatments, a skin specialist/dermatologist may be consulted. They may recommend different antibiotics, propranolol tablets for flushing, or other more specialist treatments such as oral isotretinoin (Roaccutane), and pulsed light or laser therapy for persistent localised areas of redness (telangiectasia). Surgery may sometimes be advised for rhinophyma - a lumpy misshapen nose which, though rare, can occur in severe cases of rosacea, mainly in men.
Mirvaso gel information
Mirvaso gel, containing the active ingredient brimonidine, reduces the redness and facial flushing of rosacea by shrinking the blood vessels in the skin. It is applied thinly to the face once daily, preferably in the morning, and lessens the redness of rosacea quickly, usually within 30 minutes. It works for up to 12 hours. It should not be used more than once in a 24 hour period.
In studies 7 out of 10 people with rosacea had reduced redness 3 hours after applying Mirvaso. However, Mirvaso can actually make symptoms worse in 1 in 6 people so care must be taken when starting treatment.
Side effects of Mirvaso gel (brimonidine)
Up to 16% of users experience the most common side effects: flushing, reddening of the skin, a burning sensation and skin irritation. Only a small amount of the active ingredient, brimonidine, is absorbed through the skin, so there are not usually any general side effects. However, Mirvaso should not be applied to broken skin, particularly following laser therapy, as this is more likely to lead to side effects, which can be severe.
See manufacturer's Mirvaso patient information leaflet for full details.
How to start and use Mirvaso gel
Start treatment with a very small amount of gel (less than the maximum dose) for at least 1 week and increase the dose gradually to the full dose.
Apply thinly and evenly once daily only over the affected areas of the face, avoiding the lips and eyes. The full dose is a pea-sized amount of gel for each of the reddened areas of the cheeks, forehead, nose, and chin. Gel should not be applied to open sores. Wash hands thoroughly after use.
It is important not to exceed the maximum daily dose (1gm of gel in total weight, approximately 5 pea-sized amounts). One tube should last a month.
Makeup can be applied once the gel has dried.
Who should NOT use Mirvaso gel
Checks are carried out during the Dr Fox online questionnaire to ensure Mirvaso gel is suitable.
Mirvaso gel is only for use by adults over 18, including over 65s, and NOT children.
Not suitable for people prone to low blood pressure or people with serious heart conditions. Some prescribed medicines can interact with Mirvaso gel, most notably medicines which lower blood pressure, and some types of antidepressants.
Although there is no evidence of harm, Mirvaso gel should be avoided in pregnant and breastfeeding women.
Soolantra cream information
Soolantra cream (ivermectin) is used for mild/moderate inflammatory papules and pustules of rosacea. Use once daily, initially for 3-4 months. If there is no improvement after 2-3 months, stop using Soolantra. The course can be repeated if symptoms recur on stopping. A break of 1 month is recommended after using for 12 months and to assess if further treatment is needed. It is only to be used by adults and only on the face.
How to apply Soolantra cream
Use a pea-sized amount of the cream once daily on each part of the face: forehead, chin, nose, and both cheeks. Spread thinly over the whole face, making sure to avoid eyes, lips, and mouth.
Wash hands after applying. Once dried, makeup can be applied.
If using with Mirvaso gel: apply the Mirvaso gel first and allow that to dry, before applying Soolantra cream. Alternatively, use Mirvaso gel in the morning and Soolantra cream in the evening.
Side effects of Soolantra cream
Rarely there is a slight worsening of rosacea on starting treatment but this usually settles within a week. If it continues, stop using Soolantra cream.
Up to 1 in 10 people feel some initial burning on application. This usually settles as your skin gets used to the treatment.
For a full list of less common side effects see manufacturer's Soolantra patient information leaflet.
Can anyone use Soolantra cream?
Do not use if you:
- Are pregnant or breastfeeding.
- Have severe liver problems.
Do not use Soolantra cream if also taking these medications:
- Warfarin or other coumarin type blood thinning tablets (anticoagulants where you need regular blood tests).
- Levamisole (rarely used to treat roundworm infection).
Rozex gel and cream information
Rozex (metronidazole) is used for mild to moderate inflammatory pimples, papules, redness, and pustules (spots) of rosacea. Use twice daily, morning and evening. An average course of treatment is 3-4 months. If there is no improvement after 2-3 months, stop and try a different treatment. Always use the least amount and for the shortest time required. Courses can be repeated or continued.
How to apply Rozex
- Wash the face with a mild cleanser before applying the Rozex gel or cream.
- Smooth a thin layer onto the affected skin only.
- Keep Rozex out of eyes (rinse well with large amounts of water if it gets in the eyes).
- Wash hands after use.
If using with Mirvaso gel: apply the Mirvaso gel first and once dried apply Rozex.
Side effects of Rozex
As very small amounts of Rozex are actually absorbed into the body, most side effects are skin related.
Up to 1 in 10 people may develop dry skin, redness, itching, burning or stinging feelings, or worsening of rosacea. If the skin is irritated, it should settle by using Rozex less frequently (such as once a day or on alternate days), or stopping it for a while.
More information on side effects can be found in the manufacturer's Rozex patient information leaflet.
Avoid sun and sunbeds
Strong sunlight and ultraviolet light (sun & sunbeds) can make Rozex less effective.
Rozex gel and alcohol
The active ingredient in Rozex is metronidazole, which when taken by mouth can react with alcohol, causing an unpleasant Antabuse type reaction (nausea, vomiting, flushing, dizziness, throbbing headache, chest and abdominal discomfort). This is unlikely with Rozex because it is only applied to the skin. However, it is still advised not to drink alcohol whilst using Rozex.
When not to use Rozex
Do not use Rozex if:
- Pregnant or breastfeeding.
- Under 18.
- Any type of blood disorder.
- Taking warfarin or other coumarin type blood thinning tablets (anticoagulants where you need regular blood tests).
Efracea capsules information
Efracea capsules are an effective treatment for moderate to severe papules and pustules (spots) of rosacea, improving appearances in over 8 out of 10 patients.
Efracea capsules should only be used after first trying a topical treatment (skin application) such as Soolantra cream or Rozex gel/cream for at least 3 months.
Efracea capsules contain a low dose (40mg) of doxycycline, and work through the anti-inflammatory (not antibiotic) effects of doxycycline.
The course is 8-16 weeks but if there is no improvement by 6 weeks stop taking the capsules.
After finishing the course, some symptoms may gradually recur. Wait at least 1 month, before repeating the course.
How to take Efracea capsules
Take one capsule each morning, on an empty stomach with a full glass of water, either one hour before or two hours after food.
Can anyone take Efracea capsules?
Do not take Efracea if you are/have:
- Pregnant, breastfeeding, or under 12 years old.
- Taking certain other medications - checks made in the online consultation.
- Exposed to strong sunlight/sunbeds.
- Reduced stomach acidity, or pre-existing gullet irritation/ulceration.
- Liver disease.
- Colitis.
- Myasthenia gravis.
- Ocular rosacea.
Side effects of Efracea
As Efracea contains a low dose of doxycycline, side effects are generally not common. The manufacturer's Efracea patient information leaflet lists those found at any dose of doxycycline which include stomach problems such as heartburn, nausea, vomiting & diarrhoea, and light sensitive skin reactions and rashes.
Dr Fox supplies rosacea medication on prescription - you are required to answer a short medical questionnaire before your order can be completed.
Product leaflet
Further information
- NHS - Rosacea
- NHS 111 Wales - Rosacea
- British Association of Dermatologists: Rosacea and Rhinophyma
- Rosacea FAQs
Authored 27 September 2014 by Dr Tony Steele
MB ChB Sheffield University 1983. Former hospital doctor and GP. GMC no. 2825328
Reviewed by Dr A. Wood, Dr C. Pugh, Dr B. Babor
Last reviewed 31 January 2024
Last updated 15 October 2024
Editorial policy
References
- NICE, 2023, Rosacea - acne, accessed 31 January 2024
- Galderma, 2023, Mirvaso 3mg/g Gel: Summary of Product Characteristics, accessed 31 January 2024
- Galderma, 2022, Rozex Gel: Summary of Product Characteristics, accessed 31 January 2024
- Galderma, 2022, Soolantra 10mg/g Cream: Summary of Product Characteristics, accessed 31 January 2024
- Galderma, 2022, Efracea 40mg Modified Release Hard Capsules: Summary of Product Characteristics, accessed 31 January 2024
- British Association of Dermatologists, 2021, Guidelines for the management of people with rosacea, accessed 31 January 2024
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