All About Rosacea: A Dermatologist Guide to Causes, Triggers, and Treatments

By Heather D. Rogers, MD, FAAD, Double Board-Certified Dermatologist

Rosacea commonly causes facial redness, flushing, bumps, and heightened skin sensitivity due to chronic inflammation.  Although there is currently no cure for rosacea, most people can achieve long-term control with consistent treatment, trigger control, gentle skincare, prescription treatments, and laser therapy.

Rosacea most commonly affects the central face, including cheeks, nose, chin and forehead and is known to be recurring.

What Is Rosacea?

Rosacea is a chronic inflammatory skin condition that primarily affects the central face and causes persistent redness, flushing, visible blood vessels, and sometimes acne-like bumps or eye irritation. It affects an estimated 15 million people in the United States and is often mistaken for acne, sunburn, eczema, or an allergic reaction. While there is no cure, rosacea can be effectively controlled with consistent treatment and trigger management.

Most Common Signs and Symptoms

Rosacea most often affects the cheeks, nose, chin, and forehead but can also involve the eyes, neck, and chest.

Common signs and symptoms include:

• Persistent facial redness or flushing
• Visible blood vessels (telangiectasias)
• Red bumps or pustules
• Sensitive or burning skin
• Dryness and tightness
• Eye irritation
• Thickened skin of the nose (advanced cases)

Please note - Not everyone will experience every symptom listed above and severity can vary widely between cases. 

The Four Types of Rosacea

Inflammation is the driving force behind the four classical subtypes of rosacea, although in real life rosacea is often a combination of these.

Erythematotelangiectatic Rosacea (ETR)

This is the most common type. Small blood vessels under the facial skin become enlarged and cause persistent redness. It most commonly affects the cheeks, nose, and chin.

In early stages it may appear as visibly dilated blood vessels, but over time patients develop more persistent redness. Many patients report warmth, tingling, stinging, or swelling as the redness becomes more prominent.

Papulopustular Rosacea

This type is often referred to as acne rosacea because it appears as small red bumps that resemble acne. However, there are key differences. It tends to occur in an older demographic and primarily affects the mid-face. It is often accompanied by visible “spider veins". Unlike acne, rosacea does not include blackheads and whiteheads, only pimple-like lesions with surrounding redness and flushing.

Phymatous Rosacea

This type causes thickening of the skin, primarily on the nose but sometimes the chin. When untreated, skin becomes thick, spongy, and bumpy. Severe cases on the nose are called rhinophyma.

Ocular Rosacea 

Ocular rosacea affects the eyes and surrounding skin. It causes redness of the white part of the eye and eyelids. Symptoms include watery eyes, itching, burning, irritation, and sometimes blurred vision or light sensitivity. It is often confused with conjunctivitis, blepharitis, or styes. Visible blood vessels, redness, and swelling around the eyelids are common.

Many people with rosacea experience signs and symptoms of more than one subtype at the same time. 

Who Gets Rosacea? (Risk Factors)

The strongest known risk factor for rosacea is genetics. If family members have rosacea, the likelihood of developing it increases.

Risk factors include:

• Fair skin with light hair and eyes
• Age 30–50
• Female sex (men often have more severe disease)
• Abnormal blood vessel reactivity
• Demodex mite overgrowth
• Increased inflammatory peptides such as cathelicidins
• Possible association with Helicobacter pylori

It is important to note that risk factors influence who develops rosacea, while triggers cause flare-ups in people with an existing rosacea condition. 

Common Triggers

Not everyone has the same triggers, so identifying yours is key.

Foods

• Spicy food
• Histamine-rich foods like tomatoes, citrus, avocado, chocolate

Beverages

• Alcohol (especially red wine)
• Hot drinks
• Coffee
  

Environment

• Sun exposure
• Heat
• Hot showers
• Saunas
• Wind
• Cold weather
• Vigorous exercise
  

Medications

• Topical steroids
• Certain blood pressure medications
• High-dose niacin
• Hormone therapy
  

Other

• Stress
• Over-exfoliation
• Irritating skincare products
  

To identify patterns and reduce the frequency of flare-ups, consider keeping a trigger diary. 

What Shouldn’t I Use During a Rosacea Flare?

Avoid anything that increases inflammation or irritation:

• Fragrance and essential oils
• Sodium lauryl sulfate
• Physical or chemical exfoliants
• Astringents and toners
• Witch hazel
• Alpha-hydroxy acids (AHAs) and Beta-hydroxy acids (BHAs)
• Menthol or camphor

Active products such as vitamin C, retinoids, bakuchiol, and exfoliating acids should be paused until the flare settles.

How Is Rosacea Treated?

Rosacea treatment is multifactorial and individualized. There will be calm weeks and difficult flare-up weeks. The goal is to maximize the number of calm weeks.

Lifestyle Optimization

• Identify and avoid triggers.
• Use a gentle skincare routine designed for sensitive skin.
• Choose a mild cleanser and a fragrance-free moisturizer with barrier-supportive ingredients like niacinamide.
• Protect skin from environmental triggers such as sun, wind, and cold.
• Use mineral sunscreen with zinc oxide, which can be calming for rosacea-prone skin.
• Optimize sleep and stress management.

For more details on choosing sunscreens for sensitive or rosacea-prone skin, see Sunscreen Guide 2025: Dermatologist Recommended Essentials. 

Topical Treatments

• Simplify and streamline skincare.
• Use a gentle cleanser and a barrier-supportive moisturizer with glycerin, squalane, niacinamide, or centella asiatica.
• Azelaic acid is particularly helpful because it is anti-inflammatory, antimicrobial, and can reduce bumps and redness. 

For a detailed breakdown of what to look for in a moisturizer, see What to Look For in a Face Moisturizer.

Prescription Options

• Metronidazole or sulfacetamide help reduce inflammation and pustules.
• Oxymetazoline and brimonidine temporarily constrict blood vessels to reduce redness.
• Ivermectin helps with inflammatory bumps and Demodex overgrowth.
• Calcineurin inhibitors such as pimecrolimus or tacrolimus may reduce inflammation in sensitive cases.
  

Oral Treatments

• Low-dose doxycycline or minocycline help reduce inflammation.
• Beta blockers can reduce flushing.
• Over-the-counter probiotics may support a less reactive skin microbiome. 
  

Procedures

Laser and light therapies are often the most effective treatments for persistent redness and visible vessels.

• Lasers for Red
  • Pulsed dye laser (PDL)
  • IPL or BBL
  • KTP or Nd:YAG
• Resurfacing lasers like CO₂ or Erbium for rhinophyma
  

Skincare for Rosacea-Prone Skin

 

Supportive skincare plays an important role in rosacea management by strengthening the skin barrier and minimizing irritation. Products should be fragrance-free, gentle, and designed with sensitive and reactive skin in mind. 

What to Look for in Rosacea-Safe Products

• Glycerin: A well-tolerated humectant that draws water into the skin and improves barrier function, helping reduce dryness-triggered redness and sensitivity.
• Centella asiatica (Cica): A plant-derived anti-inflammatory ingredient rich in compounds like madecassoside and asiaticoside that help calm redness, support barrier repair, and promote healing.
• Niacinamide (Vitamin B3): Helps reduce inflammation, strengthen the skin barrier, and improve redness over time; most rosacea-prone patients tolerate it well at moderate concentrations (2–5%).
• Squalane: A lightweight, saturated emollient that mimics skin’s natural lipids, helping reduce transepidermal water loss and support barrier repair without clogging pores or triggering irritation.
• Shea Butter: A richer emollient containing fatty acids that help soften skin, reduce water loss, and calm inflammation. It can be very helpful for dry, barrier-impaired rosacea skin.
• Castor Oil: Reduces water loss and supports healing in dry, reactive skin. It contains ricinoleic acid, which has anti-inflammatory properties that may help soothe irration during flares.

Doctor Rogers Skin Care

Doctor Rogers Skin Care products were formulated with a focus on barrier repair and created with minimal ingredients designed to be well tolerated by sensitive and rosacea-prone skin. 

• Doctor Rogers Face Cream: Formulated with Squalane, Shea Butter, Niacinamide, Glycerin, and Centella Asiatica to help support the skin barrier and improve the appearance of redness. Recognized by Harper’s Bazaar, Forbes, and The Wall Street Journal for its suitability for sensitive, reactive, and dry skin.
• Doctor Rogers Face Wash: Formulated with Aloe Barbadensis Leaf Juice, Glycerin, and  Leuconostoc/Radish Root Ferment Filtrate to gently cleanse and support irritated, sensitive skin.
• Doctor Rogers Healing Balm: Formulated with Castor Seed Oil, Glycerin, and Hydrogenated Castor Oil to provide extra moisturization and protection to irritated, dry skin. 

Key Takeaways

• Rosacea is common and manageable
• Inflammation and vascular reactivity drive symptoms
• Gentle skincare is foundational
• Mineral sunscreen is essential
• Prescription treatments and lasers are highly effective

Rosacea FAQ

What causes rosacea?

Genetics, inflammation, vascular reactivity, and environmental triggers.

Is rosacea curable?

No, but it is highly controllable.

What is the best treatment?

Gentle skincare, trigger avoidance, prescription topicals, and laser therapy.

Should I stop retinol or vitamin C?

During flares, yes. Reintroduce slowly once calm.

Does sunscreen help rosacea?

Yes. Mineral sunscreen helps reduce inflammation and prevent flares.

Featured Articles & Press Coverage

• Harper’s Bazaar: Featured in The 15 Best Rosacea Creams to Keep Redness at Bay
• Forbes: Named one of the Best Face Creams to Soothe Dry Skin
• The Wall Street Journal: Recognized in We Tested 50 Face Moisturizers to Find The Best
• Camille Styles: Highlighted in Rosacea-Friendly Skincare: The Best Products for Redness, Irritation, and Flare-Ups
  

References

• Steinhoff M, Schauber J, Leyden JJ. New insights into rosacea pathophysiology: A review of recent findings. Journal of the American Academy of Dermatology. 2013;69(6 Suppl 1):S15–S26.
  
• Two AM, Wu W, Gallo RL, Hata TR. Rosacea: Part I. Introduction, categorization, histology, pathogenesis, and risk factors. Journal of the American Academy of Dermatology. 2015;72(5):749–758.
• Van Zuuren EJ. Rosacea. New England Journal of Medicine. 2017;377(18):1754–1764.
• Del Rosso JQ, Thiboutot D, Gallo RL, et al. Standard management options for rosacea: The 2019 update by the National Rosacea Society Expert Committee. Journal of the American Academy of Dermatology. 2020;82(6):1501–1510.
  

About the Author: Dr. Heather D. Rogers, MD

Dr. Heather D. Rogers, MD is a double board-certified procedural dermatologist and Mohs surgeon and the co-founder of Modern Dermatology in Seattle, where she sees patients full-time. She is nationally recognized for her expertise in skin health, aging, and skin cancer prevention, and for her clear, evidence-based skincare guidance. Dr. Rogers serves on the American Academy of Dermatology Media Team, the Credo Beauty Council, the Sorette for Motherhood Scientific Advisory Board, and the NewBeauty Brain Trust.

She is the founder of Doctor Rogers Skincare, a dermatologist-developed line reflecting her less-is-more, science-backed approach to healthy skin. Dr. Rogers is a graduate of Stanford University, the University of Washington School of Medicine, and completed her dermatology training at Columbia University Medical Center.

Instagram: @drheatherrogers
Practice: mdinseattle.com
Skincare: doctorrogers.com

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