Rosacea Explained
Rosacea is a chronic inflammatory skin condition that most commonly affects the cheeks, forehead, nose, and chin. It can present in various ways, including facial flushing, acne-like bumps, broken blood vessels, dry eyes, and textural nose changes. Rosacea is a prevalent skin condition affecting more than 14 million people in the U.S. Patients are often bothered by the cosmetic appearance, which can negatively impact self-esteem and quality of life. While there is no cure for rosacea, various treatments and lifestyle modifications can help manage its symptoms and help patients achieve clearer, calmer skin and improved confidence.
The exact cause of rosacea remains unknown, but it is not believed to be caused by a single factor. Rather, multiple factors likely contribute to its development in someone genetically predisposed. These factors include a dysregulation of blood vessels on the face, ultraviolet (solar) radiation, an immune response to microorganisms that live on our skin (bacteria and Demodex mites), and a skin barrier disruption. Many known environmental triggers play a role in exacerbating rosacea.
For most patients, rosacea waxes and wanes are severe, with varying duration of remission between flares. Some of the triggers that are known to cause flare-ups of rosacea include:
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Sun exposure
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Spicy foods
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Hot foods and drinks
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Exposure to extreme temperatures and temperature fluctuations
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Alcohol
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Stress
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Intense physical exercise
Both men and women are affected by rosacea. However, rosacea predominantly affects women with lighter skin, particularly those of Caucasian descent, aged 30 to 60. A family history of rosacea further increases the likelihood of developing the condition.
Rosacea varies in presentation from one patient to the next. Common symptoms of rosacea include:
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Facial flushing
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Persistent redness
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Dilated blood vessels
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Skin sensitivity
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Swollen, red bumps, sometimes pimple-like
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Dry or gritty sensation in the eyes (ocular rosacea)
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Enlarged, irregularly shaped nose
A diagnosis of rosacea is based on the patient’s history and symptoms as well as the clinical signs noted on the exam; there is no laboratory test for rosacea. An evaluation by a board-certified dermatologist is important to rule out other conditions with similar symptoms, including acne, seborrheic dermatitis, cutaneous lupus, and contact dermatitis. A thorough physical examination and medical history review are critical to distinguishing rosacea from these other conditions. If left untreated, rosacea can become more severe over time.
Rosacea treatment depends on the severity of the condition. A combination of therapies can help reduce rosacea symptoms. Key treatments include:
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Avoiding triggers: Identifying and avoiding factors that trigger rosacea can help manage symptoms.
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Sun protection: Daily sunscreen or protective measures against UV light are important to reduce skin irritation.
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Topical medications: Medications like metronidazole, azelaic acid, and ivermectin can reduce skin inflammation, while alpha-adrenergic receptor agonists such as oxymetazoline can temporarily decrease redness by constricting blood vessels.
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Oral Medications: In moderate to severe cases, oral antibiotics, such as doxycycline, can decrease inflammation. When other treatments have failed to improve symptoms, isotretinoin (approved for treating acne) can be considered.
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Laser therapy: Laser treatments effectively target and reduce permanent redness and visible blood vessels in the skin.
Treatment Options
Rosacea is a common but often misunderstood skin condition that causes facial redness, visible blood vessels, and acne-like breakouts. It tends to affect the central face—cheeks, nose, chin, and forehead—but in some cases, it can also affect the eyes or lead to skin thickening. Rosacea is chronic and can flare unexpectedly, often triggered by environmental, lifestyle, or internal factors.
Rosacea is a chronic inflammatory skin disorder that usually begins with a tendency to flush or blush more easily than others. Over time, this can evolve into persistent facial redness, prominent blood vessels, and intermittent flares of red bumps that resemble acne. Without treatment, rosacea can worsen and lead to long-term changes in skin texture and tone.
Rosacea can present in several forms, and many patients experience overlapping features:
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Erythematotelangiectatic Rosacea: Characterized by persistent facial redness, flushing, and visible capillaries (telangiectasias).
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Papulopustular Rosacea: Often mistaken for acne, this subtype causes red bumps (papules) and pus-filled lesions (pustules).
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Phymatous Rosacea: A more advanced subtype marked by thickened, uneven skin—most often on the nose (rhinophyma).
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Ocular Rosacea: Affects the eyes and eyelids, causing redness, irritation, and a gritty sensation.
Accurate diagnosis is important because the right treatment plan depends on the specific type or combination of rosacea subtypes.
Rosacea is a multifactorial condition, meaning it doesn’t have one specific cause, but rather several contributing factors have been identified:
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Genetics contribute a background predilection for rosacea, with a higher incidence among people of Northern European descent
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Environmental and lifestyle triggers, such as sun exposure, spicy foods, heat, alcohol, and stress
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Abnormal immune response and inflammation in the skin
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Abnormal blood vessel reactivity and blood flow
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Demodex mites, which are microscopic organisms that live on the skin and may be more prevalent in those with rosacea
Rosacea is not caused by poor hygiene, and while it cannot be cured, it can be successfully managed with the right combination of medical treatments and lifestyle strategies.
We believe rosacea care should be as individual as your skin. We combine clinical expertise with a personalized approach to help you achieve long-term control.
Topical Medications
Topical therapies are often the first step in managing mild to moderate rosacea. These help to reduce redness, inflammation, and breakouts:
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Metronidazole: An anti-inflammatory and antimicrobial agent
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Azelaic acid: Helps unclog pores and reduce redness
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Ivermectin: Targets inflammatory lesions and reduces skin mites
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Oxymetazoline or Brimonidine: Vasoconstrictive agents that temporarily reduce facial redness by narrowing blood vessels
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Oral Medications -
When rosacea causes more widespread or stubborn inflammatory lesions, oral therapy may be recommended:
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Low-dose doxycycline or minocycline: An oral antibiotic that acts primarily as an anti-inflammatory agent
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Isotretinoin: A powerful option for severe, treatment-resistant cases of rosacea (used selectively and with close monitoring)
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Laser-Based Treatments -
For redness and visible blood vessels that don’t respond to medication alone, laser therapy can offer dramatic improvement. Laser treatments are particularly effective for reducing flushing, telangiectasias, and persistent erythema—and they can significantly enhance cosmetic outcomes and patient satisfaction.
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Vbeam® Pulsed Dye Laser (PDL) is a well-respected laser therapy that addresses dilated blood vessels and background redness by delivering pulses of light that selectively destroy vascular lesions with minimal damage to surrounding skin.
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For more significant or persistent cases of acne, oral medications may be prescribed.
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Oral Antibiotics: Oral antibiotics reduce the bacteria contributing to acne and decrease inflammation. They are typically used for moderate to severe acne.
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Hormonal Treatments: For women, oral contraceptives or anti-androgen medications (spironolactone) can help regulate hormone levels and reduce breakouts.
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Isotretinoin (Accutane): Isotretinoin is a powerful medication for severe cystic acne that hasn’t responded to other treatments. It works by reducing the size of the oil glands, decreasing oil production, and preventing clogged pores.
If you are struggling to manage acne and want to explore effective treatment options, schedule a consultation with board-certified dermatologist Dr. Michael Tee. Dr. Tee is widely regarded as one of the best dermatologists in Seattle.
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Dr. Michael Tee
Clinical Director & Founder
Dr. Michael Tee focuses on helping patients manage a comprehensive range of skin conditions that can significantly impact daily comfort and confidence. He works extensively with patients experiencing skin changes during pregnancy, helping them navigate the complex dermatological shifts that occur during this important time. His practice also centers on mole evaluation and management, including atypical moles that require careful monitoring and assessment. Dr. Tee regularly treats patients dealing with acne, seborrheic dermatitis, and various forms of eczema, conditions that can affect both appearance and quality of life.