Rosacea treatment: How to reduce redness from brimonidine gel

A wide-brimmed hat and sunscreen may help reduce redness. You also want to seek shade and stay out of the midday sun.

Is the medicine you’re using to treat the redness of rosacea actually increasing the redness? Before giving up on brimonidine (bri-moe-nə-dean) gel, consider this. The redness may be caused by something you’re doing — or not doing.

That’s what dermatologist discovered while trying to figure out why some patients have increased redness after using this gel. To reduce the risk of increased redness and improve results, dermatologists recommend the following when this gel is prescribed:

  1. Protect your skin from sunlight. This gel cannot stop triggers that cause redness, so sun protection is essential.

    To prevent sunlight from causing a flare-up, you want to:
  • Apply sunscreen every day. Use one that offers broad-spectrum protection and an SPF of 30 or higher. If sunscreen irritates your rosacea, try using one that contains only zinc oxide, titanium dioxide, or both.
  • Wear a wide-brimmed hat when outdoors during the day.
  • Seek shade.
  • Avoid the midday sun.

  1. Know what triggers your rosacea. Even when treating with this gel, your triggers can cause your rosacea to flare. To stop the redness, it’s important to know your triggers and avoid them.

    Triggers differ from person to person. If you’re not sure what triggers your rosacea, be sure to read:

    Triggers could be causing your rosacea flare-ups
    How to prevent rosacea flare-ups

  2. Make sure your dermatologist knows what medical conditions you have and what medicines you take. It’s important to mention everything. Even conditions like low blood pressure, heart disease, depression, or allergies, which may seem unrelated to rosacea should be mentioned.

  3. Follow a rosacea friendly skin care plan. This means using a mild cleanser to wash your face and applying the cleanser gently with your fingertips. You also want to stop using toners, astringents, exfoliants, washcloths, and other abrasive products on your face. Anything abrasive can cause redness.

    You can learn more about skin care by watching Rosacea: Skin care dos and don’ts.

  4. Apply rosacea friendly moisturizer every day. This helps protect your skin.

  5. Avoid starting a retinoid for 4 weeks after you start brimonidine. Starting both within 4 weeks of each other can cause redness. On skin care products and medicines, retinoids may be listed as retinol, tretinoin, adapalene, or tazarotene. You’ll also see the word “retinoid” listed on some skin care products.

  6. Apply the gel exactly as instructed. Many of the patients who had increased redness applied too much gel or applied it too often.

    If you’re unsure about how much to apply, check with your dermatologist.

    And be sure to follow your dermatologist’s instructions for starting brimonidine. You may be asked to apply less than the standard dose in the beginning. On the first day, you may be instructed to apply one pea-sized amount of gel. You’ll gradually increase the amount that you apply. This approach can help prevent increased redness.

  7. Wait until the gel has dried to apply sunscreen, moisturizer, other skin care products, or makeup. This helps avoid skin irritation, which could lead to redness.

  8. Understand that many people see redness when they first starting using this gel. People who continue to apply brimonidine gel tend to see the redness disappear.

If you continue to see redness after following these tips, be sure to tell your dermatologist. No one treatment works for everyone. Your dermatologist may be able to suggest other options that leave you seeing less redness.

Brimonidine gel, also known as Mirvaso®, is a prescription medication used to treat the redness of rosacea. It’s the first-and-only medicine that the U.S. Food and Drug Administration (FDA) has approved for this use.

More information

How to treat the redness of rosacea
Triggers could be causing your rosacea flare-ups
How to prevent rosacea flare-ups

Jackson JM, Knuckles M, et al. “The role of brimonidine tartrate gel in the treatment of rosacea.” Clin Cosmet Investig Dermatol. 2015 Oct 23;8:529-38.

Johnson AW and Johnson SM, “The Role of Topical Brimonidine Tartrate Gel as a Novel Therapeutic Option for Persistent Facial Erythema Associated with Rosacea.” Derm Ther (Heidelb). 2015 Sep;5(3):171-81.

Steinhoff M, Schmelz M, et al. “Facial erythema of rosacea: Aetiology, different pathophysiologies, and treatment options. Acta Derm Venereol. 2016 Jun 15;96(5):579-86.