Many people strive for healthy, vibrant skin, but for those living with rosacea, that can feel especially challenging. Affecting an estimated 415 million people worldwide, rosacea is a chronic inflammatory skin condition often marked by persistent facial redness, visible blood vessels, and, at times, acne-like bumps. Because it’s frequently mistaken for skin sensitivity or irritation, it’s easy to misidentify — which makes it challenging to treat.
The causes of rosacea are complex, with experts pointing to genetics, environmental triggers, and underlying inflammation as contributors to its development and flare-ups. Understanding what rosacea is — and how to manage it properly — can make a significant difference in your skin’s health and appearance.
Here, I break down the common symptoms of rosacea, what can make it worse, and strategies for treatment and everyday care.
Rosacea, Explained
Rosacea tends to intensify and subside in cycles. You might notice your skin flaring up for a stretch, then calming down, only to flare again later. These shifts often occur in response to environmental triggers and a variety of internal factors, which is part of what makes rosacea difficult to diagnose and manage.
While the exact cause of rosacea is unclear, current research suggests it results from an abnormal immune response to environmental or physiological stimuli. It’s described as a multifactorial disease that involves genetic predisposition, immune system dysregulation, neurovascular alterations, skin barrier dysfunction, microbial influences, and environmental factors.
To better understand who’s at risk and treatment options, researchers look for patterns and shared traits among individuals with rosacea. Clinically, rosacea is characterized by persistent facial redness (erythema), inflammatory papules and pustules, and, in some cases, visible dilated blood vessels (telangiectasia). Rosacea usually appears on the cheeks, nose, forehead, and chin, though it can also affect the eyes, neck, and chest. In rare cases, it can appear on the scalp, trunk, and arms and legs.
Because rosacea and acne share some clinical features, people often mistake one for the other. But while acne develops when hair follicles clog with oil and dead skin cells, rosacea stems from different underlying causes.
Rosacea may also present with symptoms that resemble eczema, including redness and skin sensitivity. Both conditions involve inflammatory responses caused by environmental triggers. The difference lies in what triggers them. Eczema is primarily driven by immune dysregulation and damage to the skin barrier, leading to chronic inflammation and heightened sensitivity to irritants and allergens.
Who Rosacea Commonly Affects
Several factors influence your risk of developing rosacea, including a strong link to your genes: Family history has been shown to be a contributor.
Rosacea commonly develops around age 30, and it can continue to affect you throughout your life. Researchers think this timing is due to the accumulation of exposure to triggering factors over the years and how your immune system responds to them.
Rosacea also tends to affect women more often than men, likely due to the larger hormonal fluctuations they experience; hormones are believed to play a role in how the immune system responds to whatever triggers rosacea.
Fair-skinned people are more prone to rosacea, though it can affect people of every skin type and tone. Researchers hypothesize that it may come down to sun protection: Darker skin contains more melanin, the body’s natural pigment, which helps absorb and scatter ultraviolet rays. With less melanin, fair skin has less natural defense against UVA and UVB exposure. Over time, chronic UVA and UBV radiation can contribute to rosacea.
The 4 Subtypes of Rosacea
Rosacea is classified into four distinct subtypes, with genetic predisposition appearing to play a role in which subtype someone develops. For example, erythematotelangiectatic rosacea most often affects fair-skinned people with sensitive skin and prominent visible blood vessels. Phymatous rosacea, on the other hand, is more common in men, particularly those 65 and older. These associations have been documented consistently, though experts don’t yet fully understand the underlying reasons certain populations are more affected.
Every rosacea subtype involves skin inflammation, yet each presents with distinct clinical features. That’s why pinpointing the right subtype matters so much: The treatment approach is tailored to address the unique characteristics of each subtype.
Erythematotelangiectatic Rosacea (ETR)
This is the most common type. It presents as persistent facial redness, usually across the forehead, cheeks, and nose. In those with ETR, certain triggers can cause blood vessels to expand and fill with blood, pushing the blood vessels closer to the skin’s surface. This results in skin appearing red and flushed, with more visible blood vessels. The skin may also feel warm or sensitive, with stinging and burning.
Papulopustular Rosacea (PRP)
PRP typically appears as acne-like bumps and small whiteheads on the face. It can also show up as redness on the forehead, cheeks, and nose, like ETR. The key difference from acne is that these bumps lack open comedones (also known as blackheads).
Ocular Rosacea
Ocular rosacea affects the eyelids and the area around the eyes, showing up as red, watery eyes and inflamed eyelids. People often assume they’re suffering from allergies, but a distinct feature of ocular rosacea is the sensation of grittiness, as if there’s something like sand in your eyes.
Phymatous Rosacea
This is the least common type. Phymatous rosacea causes the skin to thicken and can take on a bumpy, wax-like appearance, most often over the nose and sometimes the ears, eyelids, chin, and forehead.
What Can Trigger Rosacea
While the underlying causes of rosacea are not yet fully understood, there are some known triggers for rosacea flare-ups. These reactions can occur right away or appear after several hours.
Trigger-induced flare-ups are most common with ETR and phymatous rosacea. They include eating spicy foods, alcohol consumption, physical exercise, and emotional stress.
Factors that promote vasodilation and may also exacerbate symptoms in those with ERT include sun and wind exposure, intense physical activity, hormonal fluctuations, hot weather, and heat-related environments such as saunas, steam rooms, and hot baths.
An overpopulation of tiny skin mites called Demodex, which are naturally present on human skin, may also cause flare-ups in some individuals. While researchers are still studying exactly how they fit in, many believe they may contribute to inflammation through interactions with the skin’s immune system.
A bacterium called Helicobacter pylori (H. pylori), which colonizes the stomach lining, has been implicated, too. Most people pick this up during childhood through person-to-person transmission, and it can persist for decades. Many with the bacterium are asymptomatic, while others may develop gastrointestinal symptoms.
While some studies have found higher rates of H. pylori infection among individuals with rosacea, research findings remain inconsistent. Most dermatologists don’t consider H. pylori to be a primary cause of rosacea but instead regard it as a potential contributing factor in certain people.
Because triggers and causes vary so much, rosacea can be a tricky condition to understand and manage. That’s why identifying your personal triggers is a valuable step. Try keeping a journal that tracks your flare-ups alongside factors like your meals, environment, stress levels, and other daily habits. Over time, patterns may emerge that can offer a clearer path toward managing and resolving symptoms.
Diagnosing and Managing Rosacea
If you suspect you may have rosacea, it’s important to meet with a professional like an esthetician, dermatologist, or medical provider. They can provide an appropriate diagnosis and advise you on treatment options. Although there’s no cure for rosacea, there are effective treatments, and many people can achieve significant improvement in their symptoms and overall skin appearance.
Treatment strategies are typically designed to reduce inflammation, control symptoms, minimize flare-ups, and improve quality of life. Treatment is rarely a one-size-fits-all approach due to the condition’s multiple subtypes and how it’s influenced by a wide range of potential triggers.
Effective management plans typically combine several strategies, such as the avoidance of triggers, appropriate skincare, prescription medications, laser or light-based therapies, and lifestyle modifications. Managing your rosacea may require ongoing adjustments to your treatment plan based on your symptom severity, rosacea subtype, and individual trigger patterns.
Strategies recommended may include:
- Avoiding known triggers: This can help you manage symptoms before they arise. Keeping a skin journal is helpful for understanding your triggers and how your skin reacts.
- Light therapy: If your rosacea shows up as redness and visible blood vessels, light and laser therapy can be helpful. Intense Pulsed Light (IPL), Broad Band Light (BBL), and other pulsed dye lasers can be effective, as the light causes selective damage to the overstimulated blood vessels, helping to reduce inflammation. Ongoing sessions may be necessary to keep symptoms in check.
- Topical treatments: Certain topical creams, ointments, or gels can help reduce redness and calm inflammation. Over-the-counter rosacea treatment products typically contain azelaic acid, a naturally occurring anti-inflammatory ingredient. A medical provider may prescribe medications such as metronidazole, ivermectin, or brimonidine.
- Oral antibiotics: Sometimes, an oral antibiotic may be necessary. Doxycycline is frequently used at low doses to treat rosacea and, in this case, acts primarily as an anti-inflammatory medication rather than an antibiotic.
Skincare for Those With Rosacea
Certain skincare ingredients can trigger or worsen rosacea symptoms, so it’s important to be mindful when choosing products. Because those with rosacea often have a compromised skin barrier and heightened skin sensitivity, gentle skincare practices are recommended to help minimize irritation and reduce the risk of flare-ups.
A basic skincare regimen includes a twice-daily gentle cleanser, followed by any prescribed topical medications or physician-recommended medical-grade skincare products. I often recommend the iS Clinical Cream Cleanser and the Revision Soothing Facial Rinse for those with rosacea; both are designed to effectively cleanse the skin while minimizing irritation.
Daily sun protection is particularly important for those with rosacea since UV exposure is one of the most common triggers. A broad-spectrum, mineral-based sunscreen is generally advised, as mineral formulations tend to be better tolerated by sensitive skin than chemical sunscreens. Revision Intellishade TruPhysical is an example of a mineral sunscreen that may be appropriate for rosacea-prone skin.
Your dermatologist or medical provider may suggest using additional skincare products in the evening to address persistent redness and support skin health. For example, vitamin K serums, like Revision Vitamin K Serum, are currently being studied for their potential benefits in vascular skin conditions like rosacea. Vitamin K has been shown to support blood vessel stability and reduce the visibility of superficial blood vessels.
Those dealing with rosacea should be careful to avoid products that contain alcohol, fragrance, and harsh exfoliants as they can further irritate the skin.
