Rosacea

Created: 09.01.2025

Updated 22.05.2026

Approved by: Consultant Dermatologist, Dr James Denny

What is Rosacea?

Rosacea is a chronic inflammatory condition affecting the facial skin. It most commonly develops between the ages of 30 and 50 and is more frequently seen in people with fair skin, although it can affect all skin types.

The exact cause is not fully understood. Current evidence suggests a combination of immune system dysregulation, vascular instability, genetic predisposition, and environmental influences. Rosacea is not contagious.

Symptoms often fluctuate and are influenced by specific rosacea triggers, including:

• Sun exposure
• Alcohol
• Spicy foods
• Hot drinks
• Emotional stress
• Cold or windy weather
• Heat and exercise

Early recognition and specialist-led management are important to prevent progression and long-term skin changes.

What are the symptoms?

Rosacea presents in several clinical patterns, and symptoms may range from mild symptoms of flushing to more persistent or severe symptoms affecting skin texture and eye health.

Common features include:

• Persistent redness on the cheeks, nose, chin, and forehead
• Visible small blood vessels
• Flushing episodes
• Small red bumps or pus-filled spots
• Burning or stinging sensation
• Sensitive or reactive skin
• Dry skin swelling and tightness

Unlike acne, rosacea does not typically cause blackheads.

Ocular rosacea

Some rosacea patients develop eye involvement. Symptoms include redness, dryness, irritation, and a gritty sensation. Early treatment is important to prevent complications.

Phymatous rosacea

In long-standing cases, thickening of the skin may occur, particularly on the nose. This condition is known as rhinophyma and is more common in men.

Who develops rosacea?

Rosacea patients often report a history of flushing or sensitive skin before persistent redness develops. A family history may increase risk.

The condition may be worsened by:

• Overuse of harsh skincare products
• Long-term topical steroid use
• Environmental exposure

Rosacea can affect confidence and quality of life, making accurate diagnosis and effective treatment essential.

How is rosacea diagnosed?

Diagnosis is clinical and based on the pattern of facial redness, visible vessels, and inflammatory lesions.

Dermatology assessment helps distinguish rosacea from:

• Acne
• Perioral dermatitis
• Seborrhoeic dermatitis
• Lupus

Early specialist input ensures correct diagnosis and prevents inappropriate treatments that may aggravate the condition.

How do we treat rosacea?

There is no permanent cure, but it is possible to treat rosacea effectively and control symptoms long term.

Treatment is tailored according to severity and dominant symptoms.

Topical treatments

Topical therapies are commonly used for mild to moderate disease. These may include:

• Metronidazole
• Azelaic acid
• Ivermectin
• Brimonidine or oxymetazoline for persistent redness

These treatments reduce inflammation and improve the appearance of the skin.

Oral treatments

For more persistent inflammation or widespread lesions, oral antibiotics such as doxycycline may be prescribed for their anti-inflammatory effects.

In resistant cases, oral isotretinoin may be considered under specialist supervision.

Laser and light therapy

Laser or intense pulsed light treatments are effective in reducing visible blood vessels and persistent redness.

These treatments are particularly helpful for patients with vascular-dominant rosacea.

Managing triggers

Identifying and avoiding individual rosacea triggers is essential. Rosacea patients benefit from:

• Daily broad-spectrum sunscreen
• Gentle, fragrance-free skincare
• Avoiding extreme temperatures
• Limiting alcohol and spicy foods if they provoke flushing

Severe rosacea and specialist care

In cases of severe symptoms, including significant inflammation, ocular involvement, or skin thickening, early dermatology referral is recommended.

Specialist care allows:

• Individualised treatment plans
• Access to advanced therapies
• Monitoring for complications
• Management of psychological impact

What is the prognosis?

Rosacea is a chronic condition with periods of flare and remission. With appropriate treatment and lifestyle adjustments, most patients achieve good symptom control.

Untreated rosacea may progress from flushing to persistent redness and structural skin changes. Early intervention significantly improves long-term outcomes.

Frequently Asked Questions

What are the most common rosacea triggers?

Common rosacea triggers include sun exposure, alcohol, spicy foods, hot drinks, stress, cold wind, and heat. Triggers vary between individuals, so keeping a symptom diary can help identify personal patterns.

Can rosacea be cured permanently?

There is currently no cure for rosacea, but it can be effectively controlled. With appropriate treatment and trigger management, most rosacea patients achieve long-term improvement and fewer flare-ups.

How is rosacea different from acne?

Although rosacea can cause red bumps and pustules, it does not typically cause blackheads. Rosacea mainly affects the central facial skin and is associated with flushing and visible blood vessels, whereas acne involves clogged pores and can affect multiple body areas.

When should I see a dermatologist for rosacea?

You should seek specialist advice if redness is persistent, symptoms are worsening, you experience eye irritation, or over-the-counter treatments are not helping. Early assessment helps prevent severe symptoms and long-term skin changes.

Can rosacea cause dry or sensitive skin?

Yes. Many people with rosacea experience dry skin, swelling, burning, or stinging sensations. Using gentle, fragrance-free skincare and daily sun protection is important to protect sensitive facial skin.