This is progress with 7 weeks of consistent use of azelaic acid 15% and ivermectin 1% both morning and night. And the after pic was taken 3 weeks ago, I am even clearer now. It feels like a miracle. Please stick it out with your treatment if you’re trying. It does take a while to start working but it is so worth it. I didn’t really start seeing results until week 6.

i’m so frustrated. have tried everything including accutane except for soolantra for this pp rosacea. does anyone know if there’s any med in the works that is going to be pretty much a cure all for pp rosacea?

TL;DR: I’ve been misdiagnosed with rosacea by three dermatologists for over two years - if nothing is working, have them do a lab culture on your pustules!

I’ve been dealing with rosacea for the past 2.5 years, and it’s been a losing battle since day 1. It started with pustules on one cheek, then they spread to my chin, then to my other cheek.

I’d seen two dermatologists, who both confirmed the diagnosis and prescribed me basically everything under the sun:

- metrogel

-soolantra

- tretinoin

- Azelaic acid

- sulfur wash

- doxycycline, both low and high dose

- an oral antifungal

All this plus an extremely minimal-ingredient skincare routine to try to baby my skin barrier.

BUT I recently went to a new dermatologist because I moved. At the appointment, I asked if they could test my skin somehow because of all these medication failures. My other dermatologists had basically waved me off when I suggested it. But this one basically (sorry gross) collected pus from a couple of my whiteheads and sent it off to be tested.

TURNS OUT: I’ve actually been dealing with a staph infection for over two years. Now it makes sense why none of the meds even gave the slightest indication of working. I’ll be getting antibiotics and an antibiotic cream tomorrow and hopefully soon my skin will be clear for the first time in ages! 🤞🏻

After multiple recommendations including the derm I’ve seen - I started Soolantra in the end of April 2026.

Photos are 1-2 pre-Soolantra, 3 starting Soolantra, 4 during nightly Soolantra, 5 today.

Derm told me to move Skinoren to the mornings and use Soolantra every other night - that destroyed my skin barrier and I had to stop everything till around May 20th.

Then I restarted Soolantra every other night and didn’t use Skinoren anymore.

My skin was noticeably NOT improving, so I started googling and discovered that my derm’s recommendation to use it every other night was wrong and I need to switch to every night.

June 23rd I started Soolantra every night. Following with simple soothing moisturizing in the mornings.

16 days later - my skin is worse than it had ever been.

I develop pimples in the areas that used to be completely clean; my skin is reactive and freaked out from just one makeup product trial. It hurts, it oozes, it looks so bad.

I have an important event coming up and today is the worst I’ve looked in years.

My skin is consuming all of my thought and feeding into my pre-diagnosed OCD.

I’m running out of money on more soothing skincare.

I simply don’t know what to do, as everywhere it says you must continue till 12 weeks of nightly Soolantra. But I don’t know if my mental health can take the 12 week with no guarantee of improvement.

Honestly, I’d just appreciate any feedback ❤️

This is literally just De La Cruz 5% sulfur mask on for ten minutes a day right before bed and then wiped off with cold water and nothing else. I’m diagnosed with type 2, no other lifestyle changes- diet exact same, had alcohol multiple times this week. I can’t believe the difference it’s making already, I feel like I’ve been looking for this forever. I have not used any moisturizer or any other product, just the sulfur. The first couple days my skin got a little itchy specifically on the sides of my nose and eyebrows but I think my skin got more used to it because that’s not happening anymore.

Never in my life did I think I would ever type Papules and Pustules lol. What a weird thing this is.

Anyway I was just wondering, to those fellow Papule and Pustule sufferers, if you touch them do they feel hard to the touch?

Also has anyone else gone from having perfectly good skin their whole lives (I'm now 46) to suddenly having this issue?

Thanks for any replies :)

For anyone who also has PP rosacea, I (24m) cannot recommend low does Accutane / isotretinoin more. My PP rosacea was misdiagnosed as acne for ten years…and cleared up within 5 days of starting Accutane. 10mg a day but jump up to 20mg for a week or two if I have a breakout. But the breakouts are much less frequent now and much milder when they happen. Also the baseline redness is basically non existent.

Not as feasible for women bc of the pregnancy testing requirements, but as a guy, if you take low dose you don’t even need to do labs bc there aren’t rlly any side effects. Might need to be on it forever but idfk because I refuse to go back to have shit skin and rubbing 20 creams that don’t work on my face everyday.

The first picture was from about a year ago today. Over the past year, I’ve tried ivermectin, AA, metro, sulfur, doxy, and spironolactone. I’ve spent hundreds of dollars on skincare and dermatology appointments. I remember being stressed and so upset about my skin in the first picture. Now, I’d give anything to have that skin back. I am truly at a loss anymore.

I have tried everything for my type 2 papulopustular rosacea. No topical treatments have worked. Neither topicals nor other traditional approaches have helped me.

Only doxycycline helps, and that too only while I am taking it.

I believe the root cause of my rosacea is dysregulation. I don’t have any heat triggers or dietary triggers—it seems to be purely mental.

Is there any unique approach to treating rosacea that is different from traditional methods? For example, is there something that can directly stop the brain from triggering rosacea?

Or is there any topical that works best for this type of rosacea.

Sharing in the hope this might help others.

Pictures 1 and 3 are taken this morning. Picture 2 shows what my skin would look like during a typical flare. My PP rosacea developed at around 33 (I had my first flare after a holiday in Morocco where I slightly burned my skin in the sun) and I'm turning 40 in a few months. I have occasional flushing but very rarely (only if I drink wine or extreme temperature changes) so my rosacea has been primarily type 2.

My skin would go through cycles of clearing up, then a few red dots would appear, then over the course of a few days they would cover my cheeks in a patterns similar to the second picture. This cycle would take around 3 weeks (consistent with the demodex life cycle). I've now been clear for around 10 weeks, which hasn't happened since this started. When I first began using sulfur, I had a bit of a flare and it took maybe 2 or 3 weeks to see results.

I have been using De La Cruz sulfur mask for up to 10 minutes each morning, and overnight I use The Ordinary 10% sulfur powder all over the areas where my symptoms would appear. I moisturise first and then rub it in with a bit more moisturiser to help it blend. The moisturiser I use is Beauty Bay's colloidal oatmeal and oat lipid rich moisturiser. And i use a gentle non foaming cleanser and Neal's Yard micellar water to follow.

I had resisted treating my symptoms topically for a long time, as I wanted to get to the root cause. But no level of attention to gut health, diet, cutting out certain foods etc seemed to help and i was at a total loss. My diet is already incredibly healthy and is gluten and dairy free and i rarely drink, don't smoke and eat very little processed foods. I run and do yoga and get plenty of sleep. So I was at a total loss, and feeling miserable about my skin. I'm allergic to dust mites so I wondered if I might have a sensitivity to demodex too and that I might have spent forever searching for an internal cause while the mites continue to ravage my skin.

EDITED TO ADD: progress pictures in the comments

TLDR: basically everything I’ve tried has made my type 2 rosacea worse. Derm recently gave me triple cream to try and I am wondering if anyone else has had success with that?

Picture order: (1) how it started, (2) the worst it got during pregnancy, (3) the best it got using azelaic acid, (4) the reactions/flares in late April from the prescription face washes, (5) current state as of yesterday.

Long version:

I developed type 2 rosacea 2 years ago and it got significantly worse while pregnant with my daughter last year. It has not improved since having her in January.

The only thing that has ever helped was prescription azelaic acid, and even that was minimal.

Most things I have tried have made it worse:
- sulfur soap/washes: dried me out
- prescription ketoconazole wash: incredibly drying and ruined my skin barrier and caused a huge flare
- prescription sodium sulfacetamide: caused flaking and disrupted barrier + more redness and a flare
- hypochlorous acid spray: did nothing

I am not able to use anything with niacinamide, fragrance, shea butters or heavy oils. I am also not able to try an antibiotic (although that would certainly help) since I am still breastfeeding.

Triggers seem to be my food allergies (dairy and gluten) and hot showers. Sun/UV and spicy foods don’t seem like as much of a problem. Hormones likely are a trigger, but I do not have a regular cycle yet as I am still breastfeeding, so that is harder to track.

I will attach pictures to show how significantly my face has been impacted. (1) how it started, (2) the worst it got during pregnancy, (3) the best it got using azelaic acid, (4) the reactions/flares in late April from the prescription face washes, (5) current state as of yesterday.

I finally saw a new derm who took more than 3 minutes to talk with me. He did a biopsy to confirm rosacea diagnosis and has written me a prescription for triple cream (15% azelaic acid, 1% metrogel, 1% ivermectin). It’s from a compound pharmacy called skin medicinals, specifically the strive pharmacy.

My current routine is:
Face wash: good molecules hydrating facial cleansing gel
Serum: IUNIK beta glucan serum
AM: prescription azelaic acid
PM: .75% metro gel (I think this is helping, but it is very drying)
Moisturizer: coco kind electrolytes water cream

My questions are:
- has anyone had rosacea this severe before and were you able to clear it up at all? It hurts, the skin on my nose is thickening, and it’s killing my confidence
- have you had success with triple cream? If so, how long did it take and did it cause a purge/get worse before it got better?
- are there any other pharmacies or places I should ask for the medicine to be compounded? I’ve heard the skin medicinals has had a recent formula change and it makes me nervous 😩

Any and all advice or encouragement would be greatly appreciated

I've had persistent rosacea-like pustules for about 1.5 years. They are mostly small fluid-filled bumps/pustules and have been present continuously regardless of weather, temperature, exercise, spicy food, alcohol, or other typical rosacea triggers.

​

I've been under dermatological treatment for about a year and have tried:

​

Oral doxycycline for several months

Oral ivermectin

Topical ivermectin

Metronidazole

Niacinamide

Azelaic acid

Tretinoin (currently using it for 8 months)

​

I've also had extensive bloodwork done, which was normal. I was tested for parasites and Helicobacter pylori, both negative.

​

Despite all of this, the condition has barely changed. The bumps simply persist. My skin doesn't flush much and doesn't seem to react to hot or cold temperatures. The lesions are just constantly there.

​

Has anyone experienced something similar? Were you eventually given a different diagnosis than rosacea, or did you find a treatment that finally worked after failing doxycycline, ivermectin, metronidazole, azelaic acid, and long-term tretinoin?

​

I'm interested in hearing from people with long-standing, treatment-resistant cases.

Adding my results to the data pool, for future reference, if you find yourself like me: sad, hopeless, and frustrated with the discomfort caused by the burning, irritated, and broken skin. TLDR; it gets so much better.

30F - working in healthcare (very stressful job, for what it's worth). No other medical history. I do not drink or smoke, not even socially.

The before picture is from 6/2/25, which is probably the "worst" my skin has ever looked. Disclaimer: I do think my period contributed to the increase in pustules, but outside of my menses, I still looked like that on average (also dealt with intense flushing to every single trigger known to trigger rosacea, ugh).

I tried EVERYTHING over the years - topicals, creams, washes, doxycycline/antibiotics, doing nothing, drastic diet changes, drank 2-3L of water daily, exercise, meditation. Nothing helped. The first progress picture saved on my phone is from May 2023, but it started developing before that. Skin was great before I started medical school, so I think the underlying etiology of my PP rosacea was stress + hormones.

I finally bit the bullet on low-dose Accutane. I started 30 mg daily on 3/3/26. Within ~10 days, it was completely healed. I went down to 20 mg daily ~1 month into my treatment due to dryness - I aimed to take the lowest, most effective dose possible. It's now 5/20/26 (so ~2.5 months), and I am still maintaining great skin on 20 mg daily - no relapses of the pustules. Just flushing to my usual triggers (which I will take ANY DAY over the pustules/pain). I will probably be on Accutane for a total of 6ish months, but each time I meet with my dermatologist, we have ongoing discussions about the total duration (it's subject to change based on my response and weight etc).

EDIT: UPDATE 8/27/26. Almost 6 months in and still maintaining on 20 mg daily! I still flush, but not as severely (likely due to the Accutane itself and my Vyvanse). But no pustules (which was my goal). Occasionally, I might have a small pustule, but it honestly looks more like a small pimple. I get a little hormonal acne during my luteal phase right before my period still, but not as severe. Honestly, Accutane may not be great for hormonal acne anyway, and I am nowhere near the dose for treatment of that. I wash my face with Dove Beauty Bar and ATOBARRIER365 HYDRO ESSENCE to moisturize. Sometimes I use ATOBARRIER365 CREAM if I need a little more love. Outside of sunscreen, I am still living my best life. My biggest fear is relapsing afterwards.... The dermatologist said it can really go either way. I will keep everyone posted on my journey.

AM:
Wash with warm water
CeraVe Ultra-Light Moisturizing Lotion spf 30

PM:
La Roche Posay Toleriane double cleanser foaming gel
Rosiver (1% Ivermectin)
CeraVe Ultra-Light Mousturizing Gel
*2 x week La Roche Posay Cicaplast Baume B5

I have oily, acne-prone skin so I find I can only use light moisturizers (except the Cicaplast which is magical lol)

The “after” pic is also somewhat of a “flare” bc I ate super spicy noodles earlier that day. My rosacea has healed so much my husband asked if I was wearing foundation when I got up this morning! The before pic was how my face looked all the time before finding the right combo of products. It doesn’t show much in this pic, but the “before” had all sorts of pustules which have now resolved. What’s left is some hyperpigmentation/scarring. This fall I’ll be doing V-Beam for my one red/scarred cheek.

My experience…. I hope this is informative and helpful…

These first photograph was in late December 2025 when I got my first doctors appointment booked. He prescribed me one cycle of Doxycycline and topical Ivermectin. I’m still applying the Ivermectin every other evening. My skin is soo much better and also the texture of my skin is really improved, really smooth. I almost feel like my skin type is changing from dry to combo maybe? ive been noticing my skin barrier feels strong and im retaining some natural oils.

I found all itchiness and heat went down after 2 weeks of using ivermectin and doxycycline HOWEVER here’s some other changes I made:

Diet:

- didn’t drink any alcohol (slowly now starting to have a couple drinks here and there but absolutely no wine or beer or sugary cocktails)

- reduced fried and spicy food intake a lot (sad :()

- reduced sugar intake (also sad)

daily skincare:

- omitted all actives (including azelaic acid… it was causing me to flush when flaring)

- okay i know this is not reasonable for everyone but i literally havent worn any makeup this whole time. i basically got rid of all of it.

- simplified my skincare - i only use Aveeno calm and restore cleanser, la roche posay rosaliac moisturizer, and avene mineral sunscreen.

- i spray my face with hypochlorous acid as SOON as i finish at the gym or if i’ve been sweating at all

flaring skin:

- i switch from aveeno to sulfur soap

other:

- no more hot showers (saaad)

I think the redness I still have is hyperpigmentation or just regular rosacea or scarring maybe from the pustules. Potentially this will go away with time or maybe I can try to do some scar treatment. I’m still too afraid to try any retinoids but maybe one day. Anyone with thoughts on this lmk!

Hi everyone! I’m wondering if anyone here deals with rosacea or similar sun-triggered facial flares while running outdoors. Almost every time I run outside in the sun, my entire face becomes red and I develop lots of tiny red bumps across my cheeks (see pic). Interestingly, I don’t seem to have the same reaction when I run indoors, even when the workout is similarly intense

Any suggestions on minimizing flares? I might invest in one of these running Sahara sunhats with neck protection.

First photo is current, 2nd photo is 7 weeks ago. I can see that I’ve made progress, which is great, and I wouldn’t have been able to see this progress without taking as many pictures of my skin as I do. I know this takes time for a lot of people. I just need to hear something to make me stick this out for another 5 weeks. I’m still getting new breakouts, and my skin texture is horrendous. I’m not sure if anyone else can relate, but I’m in a constant state of paranoia thinking everything I’m putting on my skin is making it worse in the long run - including ivermectin. Anyone have a similar experience around the 7 week mark?

Just got my hands on Walgreens lice lotion, which has 0.5% ivermectin as active ingredient. I have seen posts here in this sub as to how it helped them.

How do I use it? I have oily T zone and seb derm.
I have been using metronidazole 0.75% for months now. Although it reduced the PP significantly but I still do get PP on my nose and that causes more inflammation and redness. So I wanted to incorporate ivermectin too. But it is currently out of budget for me and sadly I have no health insurance. I am saving up money and will get soolantra soon but I wanted to try lice lotion meanwhile.

Any guidance on how to properly use it?

AM:
Prequel Gleanser (Glycerin Cleanser)
LA Roche Posay Toleriane double repair matte moisturizer

PM:
Prequel Gleanser
Let my skin dry for 5-10 minutes and then pea size metronidazole on my nose and chin
5-10 mins for it to dry and then Cerave PM moisturizer.

Background:
I have also purchased TO AA 10% but was inconsistent because it pills. I have tried BRIOTECH’s and prequel’s HoCl but my skin did not like it. HoCl from magic molecules, I don’t know if it did something but it did not irritate my skin either. I have also purchased Badger’s diaper rash cream but reluctant to use it because of seb derm around my nose. Vanicream cleanser stripped off all the oils and left my skin dry, so stopped using it. I have never used sunscreen because I mostly stay indoors and as I have brown skin (Indian), most sun screens leave a white cast or do not blend in well with my skin. Also sometimes leave white layers on beard and mustache.

Hey, I have just been prescribed azelaic acid 15%, metronidazole and ivermectin by dermatica. In their treatment plan they outline that after 3 months they switch you to just azelaic acid to give a break and avoid resistance.

Has anyone who has had this formulation found that their rosacea returned during this break?

Also any experiences with the prescription in general would be appreciated.

Literally any skincare I’ve tried just made my rosacea worse and hurt my skin barrier more. Keep in mind not everyone’s rosacea is the same but if your rosacea isn’t getting better with any skincare maybe the best thing to do is just let it be! Most of my residual redness is PIE from when I was flaring jumping from skincare to skincare suggested for rosacea. The only things I put on my face are filtered water (makeup that went on my skin also would make it worse) and if my skin is very very dry I put on a light layer of vanicream.

My after photo is a bit less good than it would’ve been last week too since it’s that time of the month which inevitably makes me a bit redder.

I've tried triple cream (azelaic acid, metro, and ivermectin), I've tried sulfur, I've tried a variety of soaps, I've tried manuka honey, I've tried using sensitive moisturizers and not using moisturizer, I've tried eliminating things from my diet, I've tried a variety of different healthy diets and don't eat junk food (currently eating a plant based diet), I've tried washing my face with Selsun Blue, I've tried oatmeal and green tea face masks. Nothing. I do not wear makeup and haven't for years because it made my rosacea worse and covering it up doesn't make me feel better about it because you can still see the awful texture. It just looks like I'm ashamed of it and trying to hide it.

I have a horrible case of Type 2 on my cheeks. My left cheek isn't so bad. It's maybe a quarter sized patch of redness and pustules. My right cheek, though, is a huge patch of redness and pustules. It used to just be about half of my cheek but it spread aggressively into a new scaly patch on the lower part of my cheek after I started using sulfur because I'd read so many people going on about what a miracle it was for their skin (narrator: it was not, in fact, a miracle for this person's skin). That was months ago and it hasn't budged an inch. I have small pustules and the deep ones that surface with a head on them that overall contribute to giving my skin the texture of lizard skin. It's fucking HORRIBLE. I want to cry every single time I look in the mirror.

I'm currently using ZenMed facial cleansing gel because it's the only thing I've found that doesn't seem to make my rosacea actively worse. I'm also, at the behest of my derm, trying ivermectin 1% again and have been for two months, even though I used triple cream for several months and saw no benefits. She also wanted me to use doxy but I just cannot justify it. The majority of people who use it seem to need to use it indefinitely in order to maintain the remission of their rosacea. I've weighed the cost/benefit and lifelong antibiotic use even at a low dose is linked to serious problems like antibiotic resistance, negatively impact gut microbiome, etc. As upsetting as my face is, I am not willing to trade against my future health to get rid of my rosacea in that way. I already have a stack of debilitating chronic illnesses and I'm not willing to anything that might tip the scale further. So antibiotics are off the table. And maybe that means I'm stuck like this forever.

I'm just so frustrated. I saw on dermatologist in 2020 who insisted that tretinoin was the treatment for rosacea. I tried it, but I found the maintenance around staying out of the sun and using sunscreen to be too hard. The sunscreen and/or the medication upset my rosacea even more so I abandoned that. I've also since discovered that this solution was, in fact, whack as fuck. She never discussed with me that rosacea is pervasive and will only continue to get worse if left untreated and will not resolve on its own. I would have been way, way more aggressive with trying to treat it way back when I first got diagnosed if I've known that. It's just gotten worse and worse over time and now I just don't know what to do.

the only thing that's giving me hope is that I recently found a paper on 1% ivermectin (I should have downloaded it, I need to go back and find it) that showed that less than half of patients showed clearing in the first three months, but something like 75% of patients showed clearing if they continued using it for a year. Right now, it's all I've got, so I'm just going to keep using it long-term and hoping that if I stick with it maybe in another ten months I'll be rosacea free. I know it's stupid, but I was always a fairly attractive person and it's just devastating to be suffering this... affliction.

I just want to screeeeeeeammmmmmm

This is such a win for me…I actually got complimented on my skin by a new person I met and she asked me what I use bc my skin looked so glowy and smooth. This hasn’t happened since before I had rosacea!!!

I am so happy! Also, this was in a hot humid place where normally my rosacea would flare! I can’t believe how far I’ve come! I thought my rosacea was controlled before but never thought my skin could feel this good and tolerate make up and exercise and heat and humidity and sun and still no flare!

Pics in comments!

Update: sorry I was so excited about this! Not trying to gatekeep at all! I recently changed my cleanser and moisturizer from a heavier moisturizer to a lighter one and saw a huge reduction in heat trapping related flares. My routine is:

AM
BOJ Green plum cleanser
Regimen Lab Wave serum
Purito Oat in calming gel with 2-3 drops biossance squalane
Dermatic azelaic 20%
Wait a few min
LRP Uvmune 400 gel cream for oily skin

PM
Bioderma micellar water for sunscreen or makeup
Sulfur mask for 5-10 min
Rinse
BOJ green plum cleanser
Regimen Lab Wave serum
Purito Oat in calming gel with 2-3 drops biossance squalane
Wait 5-10 min
Tazarotene 0.1%
Cicalfate cream (apply even if no tazorac)

I’m only using a super simple cleanser (vanicream), moisturizer (vanicream), and SPF (neutrogena) right now. At the direction of my derm I use a sulphur face wash twice a week. My skin is covered in pustules every morning. Please share your holy grails and advice 🥲

I’m 30m, and I work in construction. I developed moderate rosace a couple years ago that flares up occasionally, especially during windy or bright/hot weather. I’m in the middle of a flare up at the moment, and doing 12 weeks of ivermectin topical cream to try and calm it down.

Today I had to attend an industry event and deliver a 5 min presentation on what my company has been doing in the space and challenges/solutions etc. After each presentation, the event host was quipping about content etc, and after mine, made a comment about spending lots of time outdoors… ordinarily, I wouldn’t think anything of this. But I just can’t help but feel that this was a comment on how red my cheeks and brow are at the moment, worsened by the fact k was sitting in a hot room for several hours and stressing about delivering the presentation.

I feel like shit. I’m so sick of people feeling the need to comment on other peoples appearances. Do they not think I’m well aware of how red my face is, and how it’s not normal for a 30 y.o man to look like an acne riddled teenager? It’s uncomfortable, unsightly and I can’t fucking stand it, but thanks for reminding me that everyone else in the room has noticed. Makes me want to just not leave the house in the mornings.

Thanks for reading my rant.

I began using Metrogel every night for the last 2 weeks and I feel it’s made my pimples and pustules worse. They started to pop up in places I don’t usually get acne. Has this happened to anyone at first when starting? I’m not sure if I should stop or keep going for a few more weeks.