Rosacea Treatment

Rosacea is a common skin condition that affects the face, causing persistent facial redness, visible blood vessels, and sometimes pus filled pimples that can resemble acne. Rosacea is a common chronic condition estimated to affect around 5% of adults worldwide, and it is more common in fair-skinned people aged between 30 and 50 years old[1][5].

Rosacea typically begins any time after age 30 as flushing or redness on the cheeks, nose, chin, or forehead that may come and go. The redness associated with rosacea tends to become ruddier and more persistent over time if left untreated. The symptoms of rosacea can vary substantially from one individual to another, ranging from mild facial flushing to severe rosacea with skin thickening, facial swelling, and eye involvement[1][2].

Managing rosacea involves identifying personal triggers, using a gentle skincare routine, and employing targeted medical treatments. At Prescription Skin, we prescribe custom-compounded topical formulations that target rosacea at its source, helping to reduce redness, calm skin inflammation, and control flare ups.

Signs and symptoms of rosacea

The signs and symptoms of rosacea can vary widely between individuals. Some rosacea patients experience only mild facial redness, while others develop visible blood vessels, inflammatory papules, and burning or stinging sensations across the facial skin. Many people with rosacea find that certain factors trigger their symptoms, leading to cycles of flare ups and remissions[1][2].

Common symptoms of rosacea include persistent facial redness (especially across the central face), frequent blushing or facial flushing, small blood vessels becoming visible on the skin, stinging sensations and burning sensation when applying skin care products, and inflammatory papules or pus filled pimples that can resemble acne. In severe cases, rosacea can also cause skin thickening, facial swelling, and raised red patches on the surrounding skin[1][4].

Rosacea can make you feel embarrassed, particularly if it is left untreated. In surveys by the National Rosacea Society, nearly 90% of rosacea patients said this condition had lowered their self-confidence and self-esteem. Rosacea can cause significant social and emotional distress, leading individuals to avoid public contact or cancel social engagements[8]. Over 70% of rosacea patients reported that medical treatment improved their emotional and social well-being.

Rosacea subtypes and clinical features

Rosacea is classified into several subtypes based on the clinical features present. Understanding which type of rosacea affects you helps determine how your rosacea is treated[1][2].

Erythematotelangiectatic rosacea

Erythematotelangiectatic rosacea is the most common subtype, characterised by persistent facial redness, transient erythema (flushing), and visible blood vessels (telangiectasia) on the central face. Rosacea patients with this subtype often report frequent blushing, burning or stinging sensations, and sensitive skin that reacts to many skin care products[1][5].

Papulopustular rosacea

Papulopustular rosacea presents with persistent facial redness combined with inflammatory papules and pus filled pimples across the facial skin. This subtype can closely resemble acne, which is why rosacea is often misdiagnosed. The key difference is that papulopustular rosacea does not typically involve blackheads or comedones. Papulopustular rosacea responds well to topical prescription treatments including azelaic acid, metronidazole, and ivermectin[9][10].

Phymatous rosacea

Phymatous rosacea involves skin thickening and excess tissue, most commonly on the nose (rhinophyma). Phymatous rosacea is more common in men and represents a more advanced stage where the skin becomes thickened, bumpy, and enlarged. This subtype may require procedural intervention alongside topical treatment to manage the excess tissue[1][18].

Ocular rosacea

Ocular rosacea affects the eyes and can occur independently of facial skin involvement, or alongside other signs of rosacea. Ocular rosacea may cause dry, gritty, irritated, or bloodshot eyes and swollen eyelids, along with eye irritation and a sensation of something in the eye. Untreated eye rosacea can lead to serious complications including corneal damage. If you experience symptoms of ocular rosacea, you should see an eye doctor for assessment. Untreated eye rosacea can lead to permanent damage if left untreated[4].

Rosacea does not typically affect children, though rare cases have been reported. Rosacea can affect all segments of the population and all skin types, but it is more frequently diagnosed in women and tends to be more severe in men[5].

What causes rosacea and risk factors

The exact cause of rosacea is unknown, but it may involve a combination of genetic and environmental factors. Research in clinical dermatology continues to investigate the cause of rosacea. Rosacea is not caused by poor hygiene and is not contagious[5].

Possible factors contributing to rosacea include immune system dysfunction, an overpopulation of the Demodex mite (a microscopic mite that lives naturally on human skin), cathelicidin protein malfunction, H. pylori bacteria, and vascular issues. The Demodex mite has been found in significantly higher numbers on the facial skin of rosacea patients, and research suggests that an inflammatory reaction to the microscopic mite may play a role in skin inflammation[3][6][7].

Dysfunction in the innate immune system, particularly involving cathelicidin and mast cells, drives the redness and skin inflammation seen in rosacea. The small blood vessels in the facial skin become hyper-reactive, leading to persistent redness and the development of visible blood vessels over time[3][4].

Individuals with fair skin who tend to flush or blush easily are believed to be at greatest risk for developing rosacea. People with fair skin, blue eyes, Celtic or northern European descent, and a family history of rosacea are also at higher risk. These risk factors suggest a strong genetic component and may help explain why certain individuals develop rosacea while others do not[5].

How is rosacea diagnosed?

Rosacea is diagnosed clinically in the majority of cases based on specific diagnostic criteria. Diagnosis of rosacea requires at least one diagnostic sign or two major signs of the condition. Persistent facial erythema lasting for at least three months is the primary feature of rosacea. Your doctor will review your medical history, examine the clinical signs on your facial skin, and assess the pattern and severity of your rosacea symptoms[1][2].

Differential diagnosis

A differential diagnosis is important because rosacea is often misdiagnosed due to its overlapping symptoms with other skin conditions. Other conditions that could present with similar features to rosacea include seborrhoeic dermatitis, periorofacial dermatitis, acne, and systemic lupus erythematosus. Rosacea can resemble acne because of the inflammatory papules and pus filled pimples, but the absence of comedones and the pattern of persistent facial redness help distinguish rosacea from acne[2].

In patients with darker skin types, greater emphasis may be placed on other signs and symptoms for diagnosis due to difficulty in visualising erythema and telangiectasia on the surrounding skin. Individuals who suspect they may have rosacea are urged to see a dermatologist or qualified physician for diagnosis and appropriate treatment.

When you complete a Prescription Skin assessment, our doctors use your photos and medical history to diagnose rosacea, classify the subtype, and determine how your rosacea should be treated. With your rosacea diagnosed, we create a personalised treatment plan matched to your specific clinical signs and triggers.

How rosacea is treated at Prescription Skin

How rosacea is treated depends on the subtype, the severity of the symptoms of rosacea, and how the facial skin responds over time. The outcomes of treatment for rosacea depend on which triggers are most active and how consistently the treatment is followed. Custom-compounded prescription skincare treatments for conditions like rosacea can be obtained through telehealth platforms like Prescription Skin, providing convenience and professional oversight[9].

Azelaic acid

Topical azelaic acid is one of the most effective treatments for papulopustular rosacea. It reduces the inflammatory papules, calms redness, and has anti-inflammatory properties that help control the skin inflammation driving rosacea. According to clinical trials, azelaic acid 15% gel produces significant improvement in rosacea symptoms including inflammatory lesions and persistent redness[10].

Metronidazole

Topical metronidazole is commonly prescribed for rosacea treatment. It reduces redness, inflammatory papules, and the burning or stinging sensations associated with rosacea. Metronidazole is well tolerated on sensitive skin and is one of the most widely studied treatments for rosacea[13].

Ivermectin

Ivermectin cream is used to control Demodex mites, which are associated with rosacea. According to clinical trials, ivermectin 1% cream is effective for papulopustular rosacea and may be superior to metronidazole in reducing inflammatory lesions. It targets the microscopic mite overpopulation that contributes to skin inflammation in many rosacea patients[11][12].

Topical brimonidine

Topical brimonidine is a treatment that can temporarily reduce facial redness in rosacea. Brimonidine works by constricting the small blood vessels in the facial skin, reducing the persistent redness and facial flushing that rosacea patients find most distressing. It can be used alongside other rosacea treatments to reduce redness on days when it is most bothersome[18].

Niacinamide and barrier support

Use of niacinamide, hyaluronic acid, and green tea extract can help reduce inflammation and strengthen the skin barrier. Rosacea patients often have a compromised skin barrier, which makes sensitive skin worse and increases burning or stinging when applying treatments. Barrier repair formulations help support the skin and improve tolerability of prescription actives[15].

Oral antibiotics

Oral antibiotics like doxycycline are often used to reduce inflammatory lesions associated with rosacea. Low-dose doxycycline has anti-inflammatory effects at sub-antibiotic doses and is used for moderate to severe rosacea with significant inflammatory papules. Oral treatment is typically time-limited and used alongside topical medications[9].

Long-term use of topical steroids can worsen rosacea, and harsh exfoliants can damage the skin barrier. If you have been using topical steroids on your face, let your prescribing doctor know so they can plan an appropriate withdrawal.

Rosacea triggers and flare ups

Many people with rosacea find that certain factors trigger their symptoms of rosacea. Certain environmental and lifestyle factors can trigger rosacea flare ups by increasing blood flow to the skin's surface. Identifying triggers is an individual process, as what causes a flare up in one person may have no effect on another[4].

Common triggers of flushing in rosacea include hot drinks, hot food, spicy foods, alcohol, sun exposure, cold temperatures, extreme temperatures, and intense exercise. Emotional stress and certain medications can also worsen rosacea symptoms and trigger facial flushing. Keeping a diary of daily activities can help rosacea patients identify their personal triggers[5].

Sun exposure is one of the most reported triggers. Using broad spectrum sunscreen daily is recommended for rosacea patients to protect their skin from UV-induced flare ups. Look for a mineral sunscreen that is gentle on sensitive skin and does not cause additional burning or stinging sensations. Rosacea patients should also avoid skin care products that sting, burn, or cause additional redness[16][17].

Patients are advised to avoid known triggers to reduce the frequency of their rosacea flare ups. Lifestyle changes, such as avoiding known triggers, can help manage rosacea symptoms alongside your prescription treatment.

Laser treatment and professional procedures for rosacea

Laser treatment can be effective for reducing visible blood vessels and persistent redness in rosacea patients. Laser treatments work by targeting the small blood vessels beneath the skin, helping to remove visible blood vessels and reduce the permanent redness that does not respond to topical treatments alone. Multiple sessions are typically needed, and results can be long-lasting[18].

For phymatous rosacea with excess tissue and skin thickening, laser treatment or surgical intervention may be required to reshape the affected area. These professional procedures complement your prescription skincare routine but do not replace the need for ongoing topical treatment to manage the underlying skin condition.

Rosacea is a chronic condition that typically requires long-term management. For long-term treatment rosacea management requires consistent topical prescription care as the foundation, while laser treatment can address visible blood vessels and permanent redness that do not respond to medication alone.

Gentle skin care routine for rosacea

A gentle skin care routine can help control rosacea symptoms and support your prescription treatment. Individuals with rosacea often find benefit in maintaining a consistent skincare routine that avoids irritants and focuses on hydration[15].

Use a gentle, fragrance-free cleanser that does not strip the skin barrier. Avoid harsh exfoliants, alcohol-based toners, and skin care products that contain known irritants. Patients with rosacea should use gentle skin care products specifically designed for sensitive skin to minimise burning or stinging.

Apply a broad spectrum sunscreen daily. Sun exposure is a major trigger for rosacea flare ups, and consistent sun protection helps prevent worsening of facial redness and visible blood vessels. Follow with a barrier-supporting moisturiser containing ingredients like niacinamide and hyaluronic acid to maintain skin hydration and calm the surrounding skin.

Getting started with Prescription Skin

Start with a quick online skin assessment. Our doctors will review your photos and medical history to determine how rosacea affects your skin, classify the subtype, and create a personalised prescription formula combining the right topical medications for your situation.

You will receive clear instructions and check-ins before each refill so we can adjust your treatment as your rosacea responds. Rosacea treatment depends on how your skin reacts over time, and our ongoing reviews ensure your formulation stays effective. If you are just starting on prescription skincare, our guide on the first 8 weeks gives you a realistic sense of what to expect.

Related reading

• Your first 8 weeks on prescription skincare
• Azelaic acid
• Niacinamide
• Acne

Frequently asked questions about rosacea

What are the first symptoms of rosacea?

Rosacea usually begins with frequent blushing or facial flushing that comes and goes. Over time, the redness becomes more persistent and visible blood vessels may appear on the central face. Some rosacea patients also notice burning or stinging sensations and increased sensitivity to skin care products. According to the National Rosacea Society, early treatment of rosacea can help prevent progression to more severe rosacea[1].

How is rosacea treated?

Topical medications such as metronidazole, azelaic acid, and ivermectin are commonly prescribed for rosacea treatment. Oral antibiotics like doxycycline may be added for moderate to severe cases. Topical brimonidine can temporarily reduce facial redness. Treatment for rosacea is tailored to the subtype and severity of the symptoms of rosacea[9][10].

Can rosacea be cured?

Rosacea is a chronic condition that cannot be cured, but it can be very effectively managed with the right treatment. Most rosacea patients achieve significant improvement in their rosacea symptoms with consistent use of prescription topicals and trigger avoidance. Rosacea can lead to serious skin and eye complications if left untreated, so ongoing management is important.

What triggers rosacea flare ups?

Common triggers include sun exposure, spicy foods, hot food and drinks, alcohol, cold temperatures, stress, and intense exercise. Possible rosacea triggers could include weather conditions, certain foods and beverages, and emotional stress. Keeping a diary of daily activities can help rosacea patients identify their personal triggers[4][5].

Is rosacea the same as acne?

No. While papulopustular rosacea can resemble acne because of the inflammatory papules and pus filled pimples, the two are different skin conditions. Rosacea involves persistent facial redness, visible blood vessels, and a different pattern of inflammation. It does not involve comedones (blackheads and whiteheads) and requires different treatment. An accurate diagnosis is important because some acne treatments can worsen rosacea.

What is ocular rosacea?

Ocular rosacea is rosacea that affects the eyes. It may cause dry, gritty, irritated, or bloodshot eyes and swollen eyelids. Ocular rosacea can occur independently of facial skin involvement. Untreated eye rosacea can lead to serious complications, so if you notice eye irritation alongside your rosacea symptoms, see an eye doctor for assessment[4].

Summary

Rosacea is a common chronic skin condition characterised by persistent facial redness, visible blood vessels, and inflammatory papules on the facial skin. The symptoms of rosacea vary between individuals and can range from mild facial flushing to severe rosacea with skin thickening and ocular rosacea. Prescription Skin makes personalised rosacea treatment accessible through an online skin assessment, custom-compounded prescription formulations including azelaic acid, metronidazole, and ivermectin, and ongoing medical support to help rosacea patients manage their condition and reduce redness long-term.