Long-term papulopustular rosacea: I feel like I’ve tried almost everything. What worked for you?
I’ve had rosacea since 2020, around the beginning of the COVID pandemic, mainly affecting my nose.
I have fair/light skin, and my main problem is that my nose is constantly red to some degree, with flares that vary in intensity. The pattern is almost always the same: during the week, 3–4 small papules appear, sometimes a few more. Some remain small, while others gradually become more inflamed, turn into pus-filled pustules, and eventually break open on their own — sometimes even during face washing or when drying my face with a towel. The skin then heals, but the redness of my nose remains.
Then the cycle starts again.
I also frequently experience irritation, redness and flaking in the area directly underneath my nose and on the skin just above my upper lip. This area can become particularly irritated and dry, and I’m not sure whether it’s part of my rosacea, another type of dermatitis, or simply irritation.
Because of my job, I also wear a surgical mask almost every day, often for several hours. I wonder whether the heat, humidity, friction or occlusion from the mask might sometimes aggravate my symptoms. However, I don’t think the mask is the cause, because the same cycle of papules and pustules occurs regardless of whether I’m wearing a mask or not.
I’ve also noticed that spicy foods and drinking too much alcohol can irritate and worsen the redness of my nose, so I generally try to avoid spicy foods and limit alcohol. However, even when I avoid these triggers, the recurring cycle of papules and pustules still happens.
Treatments I’ve already tried:
Over the years, I’ve tried several different treatments:
Oral doxycycline for about one year.
For 3 months during the doxycycline treatment, I also took oral metronidazole at the same time.
Rosiced cream (topical metronidazole) twice a day, morning and evening.
Soolantra (ivermectin 1%) for several months in the past.
Finacea / azelaic acid.
Various soothing and barrier-repair products.
Other topical treatments for rosacea.
There is also something worth mentioning about my previous experience with Soolantra.
When I first started using Soolantra, I may have applied too much product. At that time, my nose became literally covered with pustules and pimples filled with pus. It was a very dramatic flare.
I don’t know whether this was an initial flare caused by ivermectin, irritation from applying too much product, or simply the natural course of my rosacea at that time. Eventually it settled down, but the experience made me quite cautious about Soolantra.
I’ve recently started Soolantra again in the evening, only a few days ago, so I know it’s far too early to judge whether it will work this time. However, this morning, for example, two pustules broke open spontaneously, and now my nose is particularly red and irritated.
My dermatologist basically told me that I’ve already tried most of the available treatments and isn’t sure what else to suggest.
So I’m really interested in hearing from people who have had a similar journey:
Fair skin + persistently red nose + 3–4 or more recurrent papules that periodically turn into pustules + recurrent irritation/flaking around the nose and upper lip, despite doxycycline, metronidazole, ivermectin and azelaic acid.
What eventually worked for you?
Have you had success with:
low-dose isotretinoin?
other antibiotics?
combinations of different treatments?
long-term Soolantra/ivermectin?
IPL / V-Beam / vascular laser?
treatments specifically targeting persistent redness?
treating the irritation/flaking around the nose separately?
changing your skincare routine?
or something completely different?
I’m particularly interested in people who, like me, had already tried several treatments but still couldn’t break the cycle of papules → pustules → breaking open → healing → new papules.
And if you also wear a mask for work on a daily basis, I’d be very interested to hear whether you noticed any connection between mask use and your symptoms — even if, in my case, the flares also occur independently of mask use.
Photo note: The photo I’m attaching was taken recently. I’m slightly tanned because I’ve just returned from a seaside vacation, so my skin is not currently as fair as it normally is.
I’d really appreciate hearing from anyone with a similar experience.
What finally worked for you, how long did you use it, and was the improvement actually long-lasting?