Rosacea Bumps (Subtype 2)

This article is part of the Rosacea Theory Universe series.

Some have reported improvement in the redness and inflammation of subtype 1 when using a subtype 2 treatment. Rosacea is a concomitant disorder and solutions are not necessarily neatly categorized into subtypes.

Examples of Subtype 2

Mild papules and redness


Moderate papules, pustules, and redness


Severe papules, pustules, and redness


Kill the Bacteria

Bacterial infection and SIBO (small intestine bacterial overgrowth) have often been associated with rosacea1. For some patients, rosacea lesions are significantly improved or eradicated with antibacterial treatment. However, aggressive antibiotic treatment can desotry all good bacteria in the gut which can lead to long-term digestive problems.

Prescription Antibiotics

Oral Versions

I don’t recommend oral prescription antibiotics for rosacea unless you are willing to go through an aggressive protocol with a physician who specializes in SIBO and post-SIBO care. The use of multiple weaker antibiotics such as tetracycline and oral metronidazole rarely cure rosacea but can produce antibiotic resistance and a damaged gut.

For the stronger protocols, rifaximin is the traditional SIBO treatment of choice. In some cases, triple antibiotic therapy is used, one example being clindamyacin, metronidazole, and neomycin.

Topical Versions

If you (or your dermatologist) are determined to try antibiotics, then use a topical antibiotic over an oral version. A topical antibiotic will not damage your digestive system and is far less likely to cause resistance. The most common topical antibiotics are clindamycin and metronidazole creams.

Herbal Antibiotics

An interesting study was done showing that herbal therapy for SIBO was equivalent to prescription rifaximin treatment2. The study participants were treated with preparations of multiple herbs listed below. If you intend to undergo herbal therapy, you may need to combine several natural antibiotics to achieve the same strength as a prescription.

Oral Versions


An extremely potent herbal antibiotic that also inhibits bacteria biofilms3, berberine has a few side effects you should be aware of. Berberine lowers blood sugar and should not be combined with medications for type 2 diabetes such as Metformin. Stomach cramps and nausea have also been reported as a side effect of high doses of berberine—split your dose two or three times a day to avoid this. Lastly, berberine can interact negatively with prescription macrolide antibiotics such as azithromycin and clarithromycin. The berberine dosage to lower blood sugar is around 1500mg a day; your usage may vary for rosacea treatment.


An Aruyvedic herb, guduchi has shown antimicrobial activity against several strains of bacteria4. It has also been traditionally used for psoriasis and eczema. It can be constipating to those who are prone to sluggish bowels.


The above-ground parts of the horsetail plant, such as the stem, have been shown to have a broad spectrum of very strong antimicrobial activity5. Horsetail is most commonly taken in a bitter tincture which is usually more concentrated than capsules.

Lemon Balm

Lemon Balm is part of the mint family and exhibits antibacterial6 and antiviral7 activity due to caffeic acid, tannis, dimeric derivatives, and trimeric derivatives.

Oregano Oil

Another member of the mint family, the natural antibiotic oregano oil8 contains thymol and caravacrol both of which show antibacterial activity. Oregano oil should be ingested in softgels. The manufacturer should list the amount of carvacrol and thymol contained in each dose. If those ingredients are not listed then most likely the product does not contain either and will be ineffective.

Topical Versions

Lemon Balm

Lemon Balm is part of the mint family and exhibits antibacterial6 and antiviral7 activity due to caffeic acid, tannis, dimeric derivatives, and trimeric derivatives. Lemon balm salve or diluted lemon essential oil can be used a treatment for infected skin.

Tea Tree

One of the oldest used topical antibacterials, tea tree oil and derived products are easily obtainable. For the maximum antibacterial activity, I recommend getting 100% tea tree oil and diluting it yourself in your favorite cleanser or moisturizer.

One such product is tea tree oil (TTO), the volatile essential oil derived mainly from the Australian native plant Melaleuca alternifolia. Employed largely for its antimicrobial properties, TTO is incorporated as the active ingredient in many topical formulations used to treat cutaneous infections9.

Light Treatments

Bacteria is vulnerable to certain wavelengths of blue light. Formerly only offered in dermatology offices, blue light treatments are now available in the comfort of your own home. Although an at-home unit is a little pricey, it is far less expensive than regular treatments at the doctor’s office..

Because rosacea tends to be so widespread across the face, I do not recommend spot treatment units. Look for a unit that covers your whole face or a large area of the face at one time.

Kill the Mites

The role of mites in rosacea has recently been studied and confirmed by the general medical community. Demodex mites are commonly found in the skin of most humans in the world. Demodex brevis live in the sebaceous glands. Demodex folliculorum live in the hair follicles and eyelid glands. Although “normal skinned” people will never notice demodex mites, rosaceans seem to have either an overabundance of mites10 or an overreaction to their activity.

Part of the problem may still be bacterial. Demodex folliculorum are linked to a bacterium called Bacillus oleronius. The best antibiotics for rosacea tend to be those that attack Bacillus oleronius11 which leads us back to the mites as a culprit.

Many rosaceans plagued with papules and pustules have seen great success with anti-mite treatments, so it’s definitely worth a shot. But be prepared to exert a lot of patience and perseverance. The mites have a long growth cycle and the treatments generally kill the adults but don’t kill the eggs—so you’re looking at several months to kill them all as new litters of mites hatch.

Demodex mites are also particularly good at burrowing down into the skin where topicals can’t quite reach. The best time to use a demodex treatment is at night. This isn’t black magic–demodex mites only emerge in the dark12.

Ivermectin (Soolantra)

The use of ivermectin for rosacea increased dramatically once a major medical pharmaceutical company created a prescription cream called Soolantra. However rosaceans around the world had been using ivermectin long before Soolantra came onto the scene. Soolantra can cost you anywhere from $80 to $300 a tube depending your insurance coverage or lack of.

If you’d rather not sell your house to afford a tiny tube of mite cream, try the ivermectin first. I have personally used both, yet achieved identical results using generic ivermectin fluid manufactured for farm animals. You can use a paste or an “injection fluid” and safely apply it to your skin. I find the injection fluids to generally be clear and invisible on the skin, while the cheaper paste can be a bit nasty to apply.


An older prescription cream that also kills demodex13, permethrin has largely been overshadowed by costly Soolantra. I once read a study that stated permethrin cream killed adult mites and mite eggs, while ivermectin only killed adult mites. I can’t find that study again for the life of me—but if I’m remembering correctly, that would make permethrin a superior treatment.

Tea Tree Oil

In one study, demodex count went to zero in 7 out of 9 patients after 4 weeks of using a solution of 50% tea tree oil14. It was also shown that demodex is killed in 15 minutes of 100% tea tree oil in a test tube. The in vivo study actually treated ocular rosacea using a tea tree oil eyelid scrub, so it is possible that more persistent or intense treatment is needed for the face. Slightly diluted tea tree oil or a cream left on for at least 15 minutes (more ideally overnight) will be more effective than a cleanser.

Sulfur and Zinc Oxide

Sulfur or zinc oxide may be able to kill  mites by suffocating them15. Use a thick cream all over the face and make sure to cover the eyelids and the base of the eyelashes where demodex mites like to hide. Leave the cream on overnight for several months. Zinc oxide is relatively inert and can be used for as long as you like. Sulfur cream is drying and sloughs away skin cells, so you would need to rotate it with zinc oxide to prevent over exfoliating and irritating the face. The sulfur cream should be at least 10% sulfur, but more sulfur is not necessarily better at mite killing. It is more important that the cream is applied in a very thick layer over the entire face to suffocate the mites. Only use higher sulfur content if you want a stronger exfoliating effect.



PARODI A, PAOLINO S, GRECO A, et al. Small Intestinal Bacterial Overgrowth in Rosacea: Clinical Effectiveness of Its Eradication. C. 2008;6(7):759-764. doi:10.1016/j.cgh.2008.02.054
Chedid V, Dhalla S, Clarke JO, et al. Herbal Therapy is Equivalent to Rifaximin for the Treatment of Small Intestinal Bacterial Overgrowth. G. 2014;3(3):16-24. doi:10.7453/gahmj.2014.019
Yinan Yin RX. Berberine: A Medicinal Compound for the Treatment of Bacterial Infections. C. 2014;03(03). doi:10.4172/2327-5073.1000150
Ghosh S, Saha S. Tinospora cordifolia: One plant, many roles. A. 2012;31(4):151. doi:10.4103/0257-7941.107344
Radulović N, Stojanović G, Palić R. Composition and antimicrobial activity ofEquisetum arvense L. essential oil. P. 2006;20(1):85-88. doi:10.1002/ptr.1815
Mimica-Dukic N, Bozin B, Sokovic M, Simin N. Antimicrobial and Antioxidant Activities ofMelissa officinalisL. (Lamiaceae) Essential Oil. J. 2004;52(9):2485-2489. doi:10.1021/jf030698a
Herrmann E, Kucera L. Antiviral substances in plants of the mint family (labiatae). 3. Peppermint (Mentha piperita) and other mint plants. Proc Soc Exp Biol Med. 1967;124(3):874-878. [PubMed]
Sienkiewicz M, Wasiela M, Głowacka A. [The antibacterial activity of oregano essential oil (Origanum heracleoticum L.) against clinical strains of Escherichia coli and Pseudomonas aeruginosa]. Med Dosw Mikrobiol. 2012;64(4):297-307. [PubMed]
Carson CF, Hammer KA, Riley TV. Melaleuca alternifolia (Tea Tree) Oil: a Review of Antimicrobial and Other Medicinal Properties. C. 2006;19(1):50-62. doi:10.1128/cmr.19.1.50-62.2006
Zhao Y, Peng Y, Wang X, et al. Facial dermatosis associated with Demodex: a case-control study. J. 2011;12(12):1008-1015. doi:10.1631/jzus.b1100179
Lacey N, Delaney S, Kavanagh K, Powell FC. Mite-related bacterial antigens stimulate inflammatory cells in rosacea. B. 2007;157(3):474-481. doi:10.1111/j.1365-2133.2007.08028.x
Rather P, Hassan I. Human Demodex Mite: The Versatile Mite of Dermatological Importance. I. 2014;59(1):60. doi:10.4103/0019-5154.123498
Kocak M, Yagli S, Vahapoğlu G, Ekşioğlu M. Permethrin 5% Cream versus Metronidazole 0.75% Gel for the Treatment of Papulopustular Rosacea. D. 2002;205(3):265-270. doi:10.1159/000065849
Gao Y-Y. In vitro and in vivo killing of ocular Demodex by tea tree oil. B. 2005;89(11):1468-1473. doi:10.1136/bjo.2005.072363
Liu J, Sheha H, Tseng SC. Pathogenic role of Demodex mites in blepharitis. C. 2010;10(5):505-510. doi:10.1097/aci.0b013e32833df9f4
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