Rosacea treatment

Medical information

Written and reviewed by a team of doctors. Dr Fox is regulated by the CQC, GPhC, & MHRA.

Mirvaso gel

Mirvaso gel applied to the face once daily reduces the redness of rosacea quickly and works for up to 12 hours. Mirvaso gel contains the active ingredient brimonidine. Relief of redness usually starts within the first 30 minutes.

In studies 7 out of 10 people with rosacea had reduced redness 3 hours after applying Mirvaso. The improvement with Mirvaso lasts up to 12 hours (see detailed study data).

Mirvaso worsens symptoms in 16% of people and care must be taken when starting treatment - see details below. Worsening of redness can occur soon after Mirvaso is applied or later when the effects are wearing off (after 8 to 12 hrs). Most people recovered on stopping treatment.

What is rosacea?

Rosacea is a reddening and sensitivity of skin, with increased flushing and sometimes visible blood vessels in the areas of the cheeks, forehead, nose and chin. Inflamed pustules develop in severe cases. Rosacea is more common in fair-skinned people.

Rosacea is different from acne, and treatment is different. They may 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 black heads and white heads, 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. Various genetic and environmental causes may play a part. Disturbances of blood flow to the skin and chronic inflammation may be factors. Exposure to ultraviolet radiation sometimes plays a part.

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 less common and potentially serious conditions which need to be considered. Your doctor may want to carry out tests or refer to a skin specialist before treatment.

Further information from NHS - Rosacea.

Side effects of Mirvaso gel (brimonidine)

The most common side effects, occurring in up to 16%, are flushing, reddening of the skin, a burning sensation and skin irritation. Other possible side effects include worsening of rosacea, nasal congestion and irritation, puffiness of the eyelids, dry mouth, and headache. Mirvaso should not be applied to broken skin, particularly after laser therapy, as this could cause low blood pressure and dizziness.

See manufacturer's patient information leaflet for full details.

How to start and use Mirvaso

Start treatment with a small amount of gel (less than the maximum dose) for at least 1 week and increase the dose gradually, based on tolerability and response to treatment.

Apply thinly and evenly over the affected areas of the face, avoiding the lips and eyes. A pea sized amount of gel should be used for each of the reddened areas of the cheeks, forehead, nose and chin. Gel should not be applied to open sores.

It is important not to exceed the maximum daily dose (which is 1gm of gel in total weight, approximately 5 pea-sized amounts).

• Wash hands thoroughly after use
• Keep out of the reach of children
• Apply once daily

It may be useful to take a photograph before and after applying Mirvaso to gauge effectiveness. Makeup can be applied once the gel has dried.

Consult a doctor face-to-face if symptoms are getting worse.

Who should NOT use Mirvaso gel

Checks are carried out during the Dr Fox online consultation to ensure Mirvaso is suitable.

Mirvaso is for use by adults over 18, including over 65s, and NOT children.

Most people can use Mirvaso without significant side effects. Only a small amount of the active ingredient, brimonidine, is absorbed through the skin. Not suitable for people prone to low blood pressure or people with serious heart conditions. Some prescribed medicines can interact with Mirvaso, most notably medicines which lower blood pressure, and some types of antidepressants.

Although there is no evidence of harm, Mirvaso is best avoided in pregnant and breastfeeding women.

Other treatments for rosacea

Mirvaso can be used with other treatments and with other medicines for rosacea. A GP or skin specialist will be able to advise.

Avoid factors which can cause flushing, such as spicy food, sun exposure, hot showers, and in some cases alcohol. Don't use oily skin preparations and particularly not topical steroids.

Prescribed medicines for rosacea include long-term antibiotics, particularly tetracyclines and metronidazole, anti-inflammatory creams and lotions containing Azelaic acid and long-term low dose isotretinoin tablets. Other medicines such as clonidine may reduce facial flushing and oral anti-inflammatory tablets are sometimes recommended. Laser treatment can be used for persistent localised areas of redness (telangiectasia) and even surgery is sometimes used for the lumpy misshapen appearance of the nose (rhinophyma) which occasionally occurs in severe cases of rosacea.

Dr Fox supplies Mirvaso on prescription – you are required to answer a short medical questionnaire before your order can be completed.

Authored 27 September 2014 by Dr Tony Steele
Last updated 17 January 2020

Reviewed by Dr B. Babor, Dr Tony Steele
Last reviewed 04 January 2017

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