Brimonidine vs Oxymetazoline for Redness

Brimonidine (Mirvaso) and oxymetazoline (Rhofade) are topical prescription medications designed to temporarily reduce the background redness seen with rosacea. They work by constricting the small blood vessels in the face. Please note that Rhofade is not widely available in the United Kingdom.

Which works best?

Both can produce a significant, though temporary, reduction in redness for several hours. Some patients find one works better than the other. Brimonidine often has a faster onset and may produce a more dramatic initial effect, but it also carries a higher risk of side effects.

Differences in rebound and tolerance

The main difference is in their side effect profiles. Brimonidine (Mirvaso) has a higher risk of "rebound flushing," where the redness returns even worse than baseline several hours after application as the medicine wears off. It can also sometimes cause a patchy or pale appearance. Oxymetazoline (Rhofade) has a lower risk of rebound flushing, making it a better option for many patients. However, neither is a cure, and both are best used for specific occasions such as presentations or meetings and I do not recommend either of these for long term control of rosacea.

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Dr. Magnus Lynch, Consultant Dermatologist

About Dr Magnus Lynch

I am a London-based Consultant Dermatologist and Dermatological Surgeon. I am highly experienced in skin cancer diagnosis, Mohs micrographic surgery, acne, rosacea, acne scarring and laser treatments. I studied at the Universities of Cambridge and Oxford, and completed my dermatology training and Mohs fellowship at the prestigious St John’s Institute of Dermatology. I graduated from medical school in 2003 and have worked exclusively in Dermatology since 2012.

I lead a research team at King’s College London investigating the molecular biology of skin cancer. In recent years I have been involved in Media Appearances, including the Channel 5 series 'Skin A&E', where I perform skin surgeries and treat various skin conditions. Filming for the next series has recently completed and the series will be released later in 2025.

My NHS practice is at Guy's Hospital. I consult with private patients at the London Bridge Hospital, OneWelbeck (near to Bond Street station) and on Harley Street. A new consultation is £250. Book A Consultation.

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