Rosacea: symptoms, causes, treatments

Rosacea is more than facial redness and flushing. It is a common, chronic (long-lasting) skin condition that affects an estimated 16 million Americans. While anyone can get rosacea, it is most common in middle-aged women with fair skin (Huynh, 2013).

There is no cure for rosacea, and because it is visible, it can impact a person’s quality of life and self-esteem. However, you can reduce the signs and symptoms of rosacea with skincare and prescription medications. 

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Rosacea is a common skin disease, producing facial redness (erythema), flushing, and visible blood vessels. Like other skin conditions, it typically goes through flare-ups followed by periods of clearer skin.

In addition to facial blushing, symptoms of rosacea may include (Farshchian, 2021):

• Acne-like breakouts

• Thickened skin

• Oily skin

• Eye problems

• Burning sensation

• Bumpy skin texture (rhinophyma)

• Pus filled pimples (pustules) 

• Red bumps (papules)

Because rosacea affects multiple areas of the face (cheeks, chin, nose, eyes, forehead) and has a variety of signs and symptoms, dermatologists have broken rosacea down into four different subtypes, including (IQWiG, 2020; Farshchian, 2021):

• Type 1 (vascular rosacea): Vascular rosacea produces red facial patches and the appearance of small blood vessels.

• Type 2 (inflammatory rosacea): Inflammatory rosacea produces inflamed red and pus-filled spots on the face. It is also called acne rosacea or papulopustular. 

• Type 3 (phymatous rosacea): Phymatous rosacea results in thick and bumpy skin, causing oily skin and pores to look large. This often happens on the nose (rhinophyma) but can also affect your chin, cheeks, and forehead.

• Type 4 (ocular rosacea): Ocular rosacea results in inflammation of the eye and eyelids, causing various symptoms, including redness, blurry vision, dry eye, and itchiness. 

Since rosacea symptoms vary from person to person and might include a combination of subtypes, these categories are used only as a guide for dermatologists. 

Skin experts are unclear about what exactly causes rosacea. However, researchers believe it is linked to family history, immune system response, and environmental factors (Farshchian, 2021).  

Common triggers of rosacea include (Huynh, 2013; Farshchian, 2021):

• Spicy foods or hot beverages

• Stress

• Hot and cold weather

• Hair follicle mites called Demodex folliculorum

• Sun exposure

• Drinking alcohol

While anyone can get rosacea, certain risk factors make someone more likely to develop this skin disease.

The most common risk factors linked to rosacea include (van Zuuren, 2021):

• People between the age of 30 and 50

• Having fair skin, blond hair, and blue eyes

• Celtic & Northern European ancestry

• Family history of rosacea

• Having severe acne

A licensed dermatologist can help determine if your facial redness or flushing is caused by rosacea during a routine skin exam and by taking a detailed medical and family history. 

While no specific medical test can diagnose rosacea, your dermatologist may want to first rule out other skin conditions with similar symptoms, such as acne, lupus, psoriasis, and seborrheic dermatitis (Farshchian, 2021). 

When talking with your healthcare provider, make sure to mention:

• When and how you experience redness and flushing

• If you spend a lot of time in the sun (and if you burn easily)

• If you experience facial skin burning, swelling, itchiness, or irritation

• How these symptoms affect your social and work-life

You may be referred to an eye doctor for evaluation and treatment if signs of rosacea involve eye symptoms. 

Since rosacea affects everyone differently, your dermatologist will recommend a treatment plan customized to your skin type and symptoms. In some cases, your healthcare provider may recommend a combination of therapies. 

The first goal of treating rosacea is to find your triggers and minimize exposure to prevent flare-ups.

Prescription medications

Dermatologists frequently prescribe topical medications to treat rosacea. The type of medication is determined by the severity of rosacea symptoms you are experiencing.

Topical cream and gel medications frequently used for mild rosacea include (Farshchian, 2021):

• Brimonidine gel (used to treat redness) 

• Oxymetazoline hydrochloride cream (used to treat redness)

• Azelaic acid, metronidazole, and ivermectin (used to control pimples and reduce nodules)

If you have moderate-to-severe rosacea or your rosacea doesn’t respond to topical creams, your healthcare provider may prescribe oral antibiotics. 

One study found that people who took low-dose doxycycline (antibiotic) had significantly reduced inflammation and lesions after 12 weeks. Similarly, minocycline is a commonly prescribed oral antibiotic used to clear up acne breakouts and redness (Nardo, 2016; Farshchian, 2021). 

For severe phymatous and acne rosacea, a dermatologist may prescribe isotretinoin, a potent retinoid that may slow the progression of thickened skin and clear up acne. However, isotretinoin cannot clear up skin that has already thickened—surgery or laser therapy can help with that (Farshchian, 2021).

Laser treatment 

Laser therapy treats enlarged blood vessels, making them less visible on the face. 

Intense pulse light therapy (IPL) uses light energy to treat mild rosacea. Studies suggest that it may be effective, but more research is needed (van Zuuren, 2015). 

Because laser therapy to treat rosacea is often considered cosmetic, insurance rarely pays for the expensive procedure. A licensed dermatologist can let you know if you are a good candidate for laser treatment. 

Skincare routine

Lifestyle changes and maintaining a consistent skincare routine can help reduce rosacea symptoms for many people.

Since sun exposure triggers symptoms in around 81% of people with rosacea, it is critical to wear at least an SPF 30 sunscreen on your face daily. Some people with rosacea find chemical sunscreens to be irritating—if that sounds familiar, look for mineral sunscreens, like zinc oxide (Kar, 2020; Farshchian, 2021).

Other ways to minimize sun exposure include:

• Wear a wide-brimmed hat when outdoors.

• Seek shade.

• Avoid sun in the middle of the day.

Using skincare products designed for sensitive skin can also help reduce redness and minimize rosacea symptoms. 

Skincare experts suggest maintaining a consistent skincare routine in managing rosacea symptoms that includes (Kar, 2020):

• Using a mild cleanser to wash your face

• Only using your fingertips to apply facial products 

• Rinsing with lukewarm or cool water

• Gently patting your face dry with a clean towel (avoid washcloths) 

• Applying a silicone-based moisturizer daily

Home remedies 

In addition to a skincare routine for sensitive skin, practicing good self-care at home and using over-the-counter products can also help reduce rosacea symptoms. 

Effective ways to reduce redness and protect your skin every day include:

• Avoid environmental triggers. 

• Wear sunscreen every day.

• Try not to rub or touch your face. 

• Use green-tinted makeup to hide redness.

According to limited research, the anti-inflammatory properties of a few herbal ingredients have also shown promise in treating rosacea symptoms. However, it would help if you informed your dermatologist about the over-the-counter products you are using (Wu, 2006).

Herbal ingredients that may help reduce inflammation include (Wu, 2006):

• Oatmeal 

• Licorice

• Feverfew 

• Green tea

• Lavender

• Chamomile

• Tea tree oil

• Camphor oil

Living with rosacea can be frustrating and embarrassing, but treatment options are available.

While there is no cure for rosacea, there are ways to successfully reduce symptoms and help manage the skin disease daily, including trying prescription medication, laser treatments, and home remedies.  

If you are experiencing rosacea symptoms, it is critical to meet with a dermatologist to create a treatment plan that is best for your skin type. Identifying and avoiding your triggers is the best way to minimize flare-ups and allow you to enjoy life without stressing about your skin.  

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Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

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Current version

June 14, 2022

Written by

Amy Isler

Fact checked by

Chimene Richa, MD

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About the medical reviewer

Chimene Richa, MD

Dr. Richa is a board-certified Ophthalmologist and medical writer for Ro.