Rosacea

Suffering from rosacea? You’re not alone. Get all the facts about rosacea’s symptoms, triggers, and solutions, including the skin-care products and in-office procedures that doctors and RealSelf members recommend for this common condition. 

Suffering from rosacea? You’re not alone. Get all the facts about rosacea’s symptoms, triggers, and solutions, including the skin-care products and in-office procedures that doctors and RealSelf members recommend for this common condition. 

Medically reviewed by Kimberly Butterwick, MDDermatologic Surgeon, Board Certified in Dermatology
Written byKaryn RepinskiUpdated on July 6, 2021
RealSelf ensures that an experienced doctor who is trained and certified to safely perform this procedure has reviewed this information for medical accuracy.You can trust RealSelf content to be unbiased and medically accurate. Learn more about our content standards.
Rosacea 754x484
Rosacea 754x484

Rosacea is a chronic skin condition that first appears as flushing or subtle redness in the midface, often looking like blushing or a sunburn. While they usually come and go, rosacea symptoms can progress over time until the mild redness becomes ruddier and more permanent, involving most of the face, and tiny, dilated blood vessels called telangiectasias appear.

Anyone can get rosacea, but it’s most common among women with fair skin and of northern European descent. Typically, it affects adults between the ages of 30 and 50. It’s frequently referred to as adult acne (and sometimes called acne rosacea), but it often shows up for people who never experienced teenage acne. The telling difference between acne vulgaris and rosacea is that rosacea lacks blackheads. 

According to the American Academy of Dermatology, there are four subtypes of rosacea.

  • Erythematotelangiectatic rosacea is commonly identified by symptoms of redness, flushing, and the appearance of small blood vessels. 
  • Papulopustular rosacea results in redness, with the addition of swelling and acne-like breakouts. 
  • Phymatous rosacea can thicken facial skin, most commonly on the nose—a condition known as rhinophyma. 
  • Ocular rosacea can affect the eyes, causing redness, burning, and itching that may lead to or resemble blepharitis.

The exact cause of rosacea isn’t yet known, although many risk factors have been identified. 

  • Bacteria on the skin There’s some evidence that flares of rosacea are triggered by bacteria that live within tiny mites called Demodex folliculorum on the skin. This bacteria is quite common in small amounts and not usually harmful but may aggravate preexisting conditions like rosacea. You’re more likely to develop a flare-up if you have a family history of the condition. 
  • UV exposure The sun can also be a major culprit in creating the extra blood vessels that cause flushing and in triggering a flare-up. “Anything from sunlight to hairspray—imagine that—can cause an unexpected flare that can last for hours, causing your face to sting, burn, or itch for what feels like an eternity,” says Dr. Rebecca Duff, a dermatologist in Hattiesburg, Mississippi. 
  • Hormone changes Hormonal fluctuations can also play a role. Some women first experience rosacea or see it get worse during pregnancy. Others have a flare-up during menopause. 
  • External factors Other common rosacea triggers are spicy food; hot drinks; alcohol; exercise; stress; products that sting or feel tingly when applied; and extreme temperatures, including hot baths and showers. Factors like these that cause a flare-up may not have any effect on another person, so it’s important to know what aggravates your condition. “Knowing your triggers and making simple changes in your daily life can dramatically reduce rosacea flare-ups,” says Dr. Duff.

Lasers, light therapy, retinoids like Retin-A, and even Botox can reduce the facial redness and flushing of rosacea. 

The best treatment for you will depend on the type of rosacea symptoms you have, but doctors, dermatologists, and RealSelf members say these treatment options can deliver real results.

IPL (Page Image)IPL

nonsurgical

Retin-A (Page Image)Retin-A

nonsurgical

Pulsed Dye Laser (Page Image)Pulsed Dye Laser

nonsurgical

Worth It Rating79%100%74%
Average Cost$650$75$725
DowntimeOne week of social downtimeNo downtimeLittle to no downtime
AnesthesiaNo anesthesia Topical anesthesia
  • Intense pulsed light (IPL), often called a photofacial, uses a broad arc of light that penetrates all layers of skin in order to treat broken capillaries and general facial flushing at the same time. The size of the IPL device’s head allows for the rapid treatment of large areas—a plus for patients with widespread redness. BroadBand Light (BBL) and Sciton’s new BroadBand Light Hero are two of the most popular IPL treatments available for rosacea patients. Find doctors who offer IPL photofacials
  • Retin-A may seem counterintuitive as a useful treatment for rosacea, given how irritating it can be, but dermatologists say it’s an effective solution. “Studies have shown that Retin-A is quite beneficial in the treatment of rosacea,” says Dr. Arnold Oppenheimer, a retired dermatologist in Virginia Beach, Virginia. Tazorac, another prescription retinoid, is an alternative to Retin-A and is often prescribed by doctors for acne patients as well. Find doctors who offer Retin-A
  • Pulsed dye lasers like the Vbeam are considered by many doctors on RealSelf to be the gold standard for treating visible blood vessels. A pulsed dye laser treatment can coagulate the vessels that cause flushing and shut down the pathways for the blood that makes skin red. “The Vbeam is my go-to laser for treating facial erythema [patchy redness],” says NYC dermatologist Dr. Michele Green. “It’s one of the most-used lasers in my practice.” Find doctors who offer pulsed dye laser treatments

RealSelf Tip: Botox may also help by preventing blood vessels from dilating and blocking immune cells involved in the inflammatory response. In one study, rosacea sufferers noticed decreased flushing, redness, and inflammation within one week, with results continuing for up to six months after microdroplet injections of Botox. However, Botox isn’t approved by the U.S. Food and Drug Administration (FDA) for this purpose (physicians may use it off label), and RealSelf members haven’t yet rated the effectiveness of Botox for rosacea.

There’s currently no surefire way to get rid of rosacea permanently, but the inflammatory skin disease can be managed. Start by avoiding anything that causes your rosacea symptoms to flare. Skin care can also play a big role in managing the symptoms of rosacea.

  • Wear sunscreen daily. Ultraviolet light is the leading rosacea trigger, according to the National Rosacea Society. “Your first defense is a physical sunscreen every day, whether you’re going to be spending a lot of time outside or not,” says Grand Junction, Colorado, dermatologic surgeon Dr. Amy Paul. Sunscreens can irritate sensitive skin, so physical mineral formulations (look for titanium dioxide or zinc oxide) may be better tolerated.  
  • Wash and shower with lukewarm water. Heat causes blood vessels to expand, which induces flushing.
  • Use gentle, hypoallergenic skin-care products formulated for sensitive skin. Look for cleansers and moisturizers that are fragrance- and alcohol-free. Additionally, ingredients like licorice extract can reduce redness. “A good skin-care regimen provides a healthy environment for your skin. Then we add meds,” says San Francisco dermatologic surgeon Dr. Tracy Evans.

There’s no single best treatment for rosacea, but the earlier you start, the easier your condition will be to manage.

“Because the signs and symptoms of rosacea can vary from one patient to another, we customize treatments, based on each individual patient,” says New York City dermatologist Dr. Dennis Gross. “This can include a mix of topical treatments, including antibiotics and anti-inflammatory gels, and oral medications, including antibiotics, only if absolutely necessary.” 

Patients should try topical therapies for at least six weeks, to effectively review the response, say the authors of a recent review article on rosacea treatment. 

Here’s a rundown of treatments doctors and derms commonly use to help control rosacea and treat the redness and breakouts. 

  • Antibiotics are often prescribed, to help ease inflammation and reduce the papules (raised spots) and pustules (pimple-like bumps) that can develop.  Topical antibiotics are prescribed first. Metronidazole, which goes by the brand name Metrogel, is one of two topical medications approved by the FDA for rosacea treatment. The drug is generally well-tolerated, with few local adverse reactions, and is often the first line recommended for topical therapy.  Oral antibiotics are usually reserved for moderate to severe cases, and they’re often used in combination with topical treatments. There are concerns about long-term use of antibiotics then leading to resistant bacterial strains, and one strategy is to taper the dosage of oral antibiotics after the condition stabilizes or improves and transition to just topical agents. “The goal of oral therapy is to improve the rosacea to a point where control is achieved by topical therapies,” explained the authors of the aforementioned article.  Doxycycline, a type of tetracycline, is a frequently prescribed oral antibiotic for rosacea under the brand name Oracea. At 40 mg a day, the usual dose for rosacea, doxycycline doesn’t have antibiotic capabilities, so it works only as an anti-inflammatory drug—therefore, the risk of antibiotic resistance is low.  Photosensitivity is the main side effect of many of the oral antibiotics used for rosacea. While you’re using them, avoid too much exposure to UV rays (in sunlight or tanning beds) and always use sunscreen with an SPF of at least 30.
  • Azelaic acid. The second FDA-approved topical for rosacea, azelaic acid (brand names: Azalez and Finacea) works three different ways to reduce rosacea: it’s antibacterial, anti-inflammatory, and anti-keratinizing, which means it helps prevent the buildup of dead skin cells, so it doesn’t clog pores and contribute to acne outbreaks. Azelaic acid may cause skin irritation (try using it every other day at first), but it’s usually well-tolerated and can be used for long periods of time.  “Finacea is one of my favorite prescriptions,” says Dr. Rebecca Baxt, a dermatologic surgeon in Paramus, New Jersey. “It works really well for rosacea pimple-type breakouts, but it won’t help redness at all.” If it’s not covered by insurance, Rx azelaic acid is expensive, so many doctors will recommend that patients try over-the-counter products. 
  • Isotretinoin. If other medications don’t work, your doctor may recommend isotretinoin. Formerly known in the U.S. as Accutane, this prescription oral medication is a form of vitamin A that helps reduce the redness and acne-like breakouts associated with rosacea. Isotretinoin can cause serious birth defects, so it’s not an option for every patient. But research shows that it can be effective in select cases of severe and persistent rosacea. It often takes three to four months before you see a significant improvement, and continuous microdosing may be necessary to control flare-ups.

Updated July 6, 2021

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