Rosacea

Rosacea Treatment at Prescription Skin

Rosacea is a long-term inflammatory skin condition that mainly affects the central face. It appears as persistent facial redness with fine, visible surface vessels, and may include acne-like bumps and pus-filled spots that come and go. Skin often feels hot, prickly, or stings after products or temperature changes, and it can be dry in places while still oily through the T-zone. The colour typically sits across the cheeks, nose, chin and mid-forehead in a fairly symmetrical pattern; in deeper skin tones it may look more dusky or violaceous rather than bright red. Some people also have eye symptoms such as dryness, grittiness, or irritated eyelids. The different features of rosacea can vary from person to person, and may include background redness, visible vessels, inflamed bumps, thickening over the nose or chin, and eye involvement. Rosacea tends to wax and wane over time, but it is very manageable and many people achieve a stable routine that lowers baseline redness and keeps the skin comfortable. Diagnosis is clinical, based on how the skin looks and feels, with your clinician ruling out look-alikes like acne, periorificial dermatitis, or seborrhoeic dermatitis and using photos to track progress [1][2].

Causes of rosacea

Rosacea happens when the skin’s blood vessels are extra reactive and the immune system is more “on alert” in people who are prone to it. Everyday triggers like heat, sun and stress make vessels open up more than usual, which is why flushing and background redness occur. Inside the skin, certain immune signals are turned up. A natural defense protein called cathelicidin can be processed into a form (LL-37) that encourages more vessel widening and inflammation and can switch on an inflammation pathway called the NLRP3 inflammasome. This helps explain burning, sensitivity and why some people get inflamed bumps [1][3][4][5]. Tiny Demodex mites that normally live on the skin are often more numerous in rosacea and can further stir up inflammation for some people, although this link varies from person to person [6][7].

Why do features differ between people?

Diagnostic phenotypes

Under the updated classification, rosacea has two diagnostic phenotypes: persistent central facial redness or phymatous tissue changes [1][2]:

• Persistent centrofacial erythema: Stable background redness across cheeks, nose, chin and central forehead, often with periodic intensification.
• Phymatous change: Skin thickening and irregular surface, most often on the nose (rhinophyma), but can involve chin, forehead, ears.

Major phenotypes

Many people show a mix of diagnostic and major phenotypes. Even if no diagnostic phenotype is present, rosacea can still be diagnosed when at least two major phenotypes are seen. The major phenotypes are papules and pustules, flushing, telangiectasia, and ocular involvement [1][2]:

• Flushing (transient erythema): Sudden warmth and redness that comes and goes, triggered by heat, alcohol, spicy food, emotion or exercise.
• Papules and pustules: Acne-like bumps on a red background, usually central face, without blackheads.
• Telangiectasia: Fine, visible surface vessels over the cheeks and nose, sometimes chin.
• Ocular involvement: Dry, gritty or watery eyes, lid margin inflammation, recurrent styes or chalazia; may occur with or without skin signs.

Secondary phenotypes

Secondary phenotypes can occur in rosacea but are not required for diagnosis. Recognised secondary phenotypes include:

• Burning or stinging after products or temperature changes.
• Oedema or skin sensitivity, sometimes with roughness or dryness between oily areas.

Patients with a dry-looking phenotype are also more likely to experience burning and stinging. Beyond the skin, rosacea is frequently linked with psychosocial burden, including increased rates of anxiety, low mood, worry and reduced overall well-being [8].

Ingredients that actually make a difference

Core prescription actives:

Azelaic acid calms inflammation, reduces redness and bumps, and helps fade post-acne marks without clogging [9][10]. Ivermectin quiets inflammatory bumps by targeting Demodex overgrowth and easing immune overactivity [11][12]. Metronidazole is a gentle anti-inflammatory that soothes irritated skin and reduces papules and pustules [13]. Sodium sulfacetamide with sulfur helps control bumps and surface oil while keeping the barrier relatively comfortable [14].

Barrier support and daily calm:

Niacinamide dials down inflammatory signalling and strengthens the skin barrier for less redness and sting. Ceramides, cholesterol and fatty acids replenish the skin’s lipid “mortar,” improving resilience and reducing dryness. Hyaluronic acid and glycerin draw water into the outer skin layers for comfortable, lightweight hydration [15].

Sunscreen, the non-negotiable:

Mineral broad-spectrum SPF 50 shields against UV and, when tinted or containing iron oxides, also helps block visible light that can worsen redness; fragrance-free formulas are usually best for sensitive skin [16][17].

Why Prescription Skin is better

Prescription-strength actives deliver study-backed improvements in the features that matter: redness, inflammatory lesions, sensitivity and ocular symptoms. They can be combined, sequenced and tapered to maintain control while minimising rebound. Over-the-counter options may help with comfort and triggers, but they rarely address the full neurovascular and innate-immune biology of rosacea.

How to get started with Prescription Skin

Tell us about your skin and goals, and we will confirm suitability in a quick consult before creating your custom formula. You will receive clear step-by-step instructions, plus check-ins before each refill so we can adjust strength, add or simplify companions and keep your skin progressing. If you are pregnant or breastfeeding, or have active skin disease, let us know so we can select safer alternatives and timing.

Start with a quick skin assessment →