Understanding Rosacea: Why It Happens and How to Manage It

Reviewed by Aesthetic Dr. Hala Mahfoud, Md, MRCOG, DipGum, MFSRH

Written by Dimah Ghanem BSc., MSc.

If you’ve ever noticed redness, flushing, or visible veins on your cheeks, chin, nose, or forehead, you’re not alone. These are common signs of rosacea, a chronic skin condition that affects millions of people worldwide.

For some, rosacea appears only occasionally and fades, while for others it cycles through flare-ups and calm periods. Sometimes rosacea even affects the eyes, leading to ocular rosacea, which can cause irritation, soreness, and watery eyes.

The important thing to know is this: rosacea is not just sensitive skin. Persistent redness is a medical condition. And while there’s no cure, the right treatment plan can make a huge difference in reducing flare-ups and calming your skin.

Summary

• Rosacea is a long-term skin condition with no single cause or cure. It can be triggered by genetics, sensitive skin, blood vessel reactions, or tiny skin mites.

• Management, rather than cure, is the focus. A combination of gentle skincare, sun protection, and avoiding personal triggers can significantly reduce flare-ups.

• Treatment plans should be individualized. Options may include topical creams, oral medications, or procedural interventions in cases of thickened skin or rhinophyma.

• A consistent homecare routine alongside medical management is essential. Gentle cleansing, regular moisturizing, and avoiding irritants helps maintain skin health and prevent flare-ups.

• Ongoing care is key. Even when symptoms improve, regular home care and check-ups help keep rosacea under control.

Why Do We Get Rosacea and Why There’s No “Cure” for it

You might be wondering, “Why do I have rosacea?” The truth is, Rosacea isn’t a one-cause, one-solution condition. Instead, it develops from a mix of factors:

First, your skin’s immune system may overreact to small triggers, which can cause redness and inflammation. Your blood vessels might also be more sensitive, so they widen easily, leading to flushing and visible redness.

Genetics play a role too, if someone in your family has rosacea, you might be more likely to develop it. Sometimes, the skin’s natural barrier isn’t working properly, which makes it extra sensitive and reactive. And then there are tiny mites called Demodex mites that live near hair follicles. Almost everyone has them, but in people with rosacea, the skin can react more strongly, causing bumps or irritation.

It’s worth mentioning that rosacea can look a little like acne, red bumps or pus-filled spots are common.

But unlike acne, it doesn’t come from oily skin or clogged pores, and you won’t necessarily see blackheads or whiteheads.

Types of Rosacea, Symptoms, and how to spot them?

Rosacea doesn’t always look the same for everyone, and that can be confusing. Doctors usually group rosacea into four main types, but here’s the catch: many people don’t fit neatly into just one box. It’s pretty common to have a mix of symptoms. Let’s go through each type together so you’ll know what to look out for in your own skin:

The first type is Erythematotelangiectatic Rosacea, which is just a fancy way of saying “vascular rosacea.” This is the one where your face looks constantly red, and tiny blood vessels become more visible over time.

You might also feel a burning or stinging sensation when it flares up, sometimes out of nowhere.

The second type is Papulopustular Rosacea, also called inflammatory rosacea. At first glance, it can look a lot like acne because of the red bumps and pus-filled spots.

But here’s the difference: rosacea breakouts usually stick to the middle of your face, your cheeks, nose, chin, and forehead. And unlike acne, you won’t necessarily see blackheads or whiteheads as we mentioned before. Instead, the skin just feels hot, flushed, and extra sensitive.

The third type is Phymatous Rosacea. This one is less common but more noticeable.

It causes the skin to thicken and become bumpy and affects the nose, making it look enlarged or bulbous. That’s called rhinophyma, and it happens more often in men.

The fourth type is Ocular Rosacea, which affects the eyes instead of the skin. If your eyes feel sore, watery, bloodshot, or sensitive to light, this could be the cause. Sometimes eye symptoms even show up before any redness or bumps appear on the skin, which can make it harder to connect the dots.

Now, let’s talk about a less common type called Granulomatous Rosacea. This one doesn’t show up as the usual flushing or redness you might expect. Instead, it appears as firm bumps, yellow, brown, or red, that can sometimes get quite big and even leave scars. They tend to pop up on the cheeks, around the nose, mouth, or eyes.

Then there’s a very rare but dramatic type called Rosacea Fulminans. This one doesn’t sneak in slowly, it shows up all at once, with painful red spots, pus-filled bumps, and even cysts across the face. It’s intense, and doctors have noticed it can sometimes be connected to conditions like bowel disease or even appear during pregnancy.

And finally, let’s look at Neurogenic Rosacea. This one has more to do with how the nerves and blood vessels in your skin react. People with it often describe really strong redness on their cheeks, paired with burning, stinging, or tingling. Heat and stress tend to make it worse. For some, the discomfort is so overwhelming that normal creams and medicines don’t give much relief. Living with this type can even make people nervous about blushing in public, which leads them to avoid social situations.

The truth is, many people have more than one type at the same time. What matters most is catching the signs early. The sooner you recognize what’s happening, the sooner you can get the right treatment and prevent flare-ups from taking over.

Common Triggers to Watch:

Finding your personal triggers can be a bit of trial and error, but most flare-ups happen when your face flushes. Some common ones include:

• Alcoholic drinks

• Hot beverages like coffee or tea

• Spicy foods

• Sun exposure

• Extreme heat or cold

• Stress

• Exercises

Maybe you have other triggers, for more detailed list you can check here

Keeping a small journal of things that trigger your redness or bumps can help you spot patterns and prevent flare-ups.

How to Protect Your Skin and Manage Rosacea:

While rosacea can’t be cured, it can absolutely be managed. Think of it as a long-term relationship with your skin, the more you understand it, the better you can keep flare-ups under control.

1) Identify Your Triggers: Noticing what makes your skin flare is step one. Avoiding triggers like sun, stress, extreme hot or cold weather, spicy foods or alcohol can reduce redness and flare-ups.

2) Sun Protection: UV exposure is one of the biggest rosacea triggers. Use a mineral-based sunscreen daily (zinc oxide or titanium dioxide), and wear hats or scarves for extra protection.

3) Gentle Skin Care: Rosacea-prone skin needs extra care. So in order to reduce irritation and inflammation please follow these steps:

• Wash your face with a mild, fragrance-free cleanser.

• Use lukewarm water and gently pat your skin dry. Avoid hot or cold water.

• Moisturize regularly to prevent dryness, itching, and cracks.

• Avoid products containing alcohol, menthol, fragrances, mint, eucalyptus, or harsh exfoliants.

4) Over-the-Counter Options: Some products are helpful to manage Rosacea. Creams with azelaic acid or niacinamide is a good example to reduce redness. Also, Green-tinted or skin-friendly concealers to cover flushing without irritating your skin.

5) Medical Treatments: If lifestyle changes and gentle care aren’t enough, your doctor may recommend:

• Topical creams or gels: brimonidine, ivermectin, azelaic acid, or metronidazole.

• Oral antibiotics: like doxycycline for more persistent or severe rosacea.

• Severe cases: including rhinophyma (changes to the nose) may require oral medication or surgery.

6) Emotional Wellbeing: Rosacea isn’t just skin deep. The redness and bumps can affect confidence, but it’s important to remember: rosacea is not your fault. it’s influenced by your skin, your immune system, and your environment. Talking with a professional and finding support can help ease the stress that often worsens flare-ups.

The Honest Bottom Line

Rosacea may not have a cure, but it does have solutions. With the right care, most people can manage their symptoms, reduce flare-ups, and regain confidence in their skin.

Think of it less as “fixing” your skin and more as “working with” it.

Gentle daily care, professional treatments when needed, and knowing your triggers are the keys to calm, balanced skin.

Ask Anything About Rosacea

References:

(1) Maden, S. (2023). Rosacea: An Overview of Its Etiological Factors, Pathogenesis, Classification and Therapy Options. Dermato, 3(4), 241-262. https://doi.org/10.3390/dermato3040019

(2) Farshchian, M. and Daveluy, S. (2023) Rosacea, U.S. National Library of Medicine. Available at: https://www.ncbi.nlm.nih.gov/books/NBK557574/?utm.com.

(3) Overview: Rosacea (2023) InformedHealth.org. Available at: https://www.ncbi.nlm.nih.gov/books/NBK279476/.

(4) Sharma, A., Kroumpouzos, G., Kassir, M., Galadari, H., Goren, A., Grabbe, S., & Goldust, M. (2022). Rosacea management: A comprehensive review. Journal of cosmetic dermatology, 21(5), 1895–1904. https://doi.org/10.1111/jocd.14816

(5) Kang, C. N., Shah, M., & Tan, J. (2021). Rosacea: An Update in Diagnosis, Classification and Management. Skin therapy letter, 26(4), 1–8.

(6) Wilkin, Dr.J. (2025) Factors that may trigger rosacea flare-ups, Rosacea.org. Available at: https://www.rosacea.org/patients/rosacea-triggers/factors-that-may-trigger-rosacea-flare-ups.