Rosacea: Symptoms, Causes and Treatment Methods
Rosacea is a chronic skin condition characterized by persistent facial redness, enlarged blood vessels, acne-like bumps and, in some cases, eye-related symptoms. Although there is no definitive cure, symptoms can often be significantly controlled by avoiding triggers, using proper skin care, topical and when necessary oral medications, and laser/light-based treatments. Current dermatology guidelines recommend personalizing treatment according to the patient’s dominant clinical signs, known as phenotype.
Rosacea, also known as “gül hastalığı” in Turkish, is a chronic and recurrent skin disease that affects the face. It is more commonly seen after the age of 30 and in people with fair skin, but it may occur in all skin types. Rosacea is not contagious; however, it may progress over time and, when left untreated, can negatively affect quality of life, self-confidence and social life. In this article, we discuss the symptoms, subtypes, causes, triggering factors and treatment options for rosacea based on current dermatology guidelines.
What Are the Subtypes (Phenotypes) of Rosacea?
Current classifications consider rosacea not as a single uniform disease, but as a condition in which different clinical findings, or phenotypes, may appear together or separately:
- Erythematotelangiectatic type: Characterized by persistent facial redness, sudden flushing episodes and visible fine blood vessels on the skin, known as telangiectasia.
- Papulopustular type: Red bumps (papules) and pus-filled lesions (pustules) similar to acne may be seen; comedones, or blackheads, are typically absent.
- Phymatous type (rhinophyma): Usually presents with skin thickening, enlarged pores and tissue overgrowth around the nose; it is more commonly seen in men and advanced cases.
- Ocular rosacea: Presents with eye dryness, stinging, redness, watering and stye formation; eye involvement may occur even when skin findings are mild.
More than one phenotype may be present in the same patient at the same time. Therefore, current treatment guidelines recommend planning diagnosis and treatment not only according to a fixed “type,” but according to the dominant findings present at that time.
What Causes Rosacea?
Although the exact cause of rosacea is not fully known, several mechanisms are thought to play a role in its development:
- Immune system dysregulation: Excessive activation of the skin’s innate immune response may lead to redness and inflammation.
- Vascular changes: Excessive dilation and irregular reactivity of facial blood vessels may cause persistent redness and flushing.
- Demodex mites: An increased density of these microscopic mites, which naturally live on the skin, has been shown in rosacea-prone skin.
- Genetic predisposition: Rosacea is more common in people with a family history of the condition.
- Neurovascular sensitivity: Overreaction of nerve endings to stimuli such as heat and spicy foods may trigger flushing episodes.
Factors That Trigger Rosacea
According to a large survey conducted by the National Rosacea Society among 1,066 rosacea patients, the most common triggers that worsen symptoms in the majority of patients are:
Trigger | Percentage of Affected Patients |
Sun exposure | 81% |
Emotional stress | 79% |
Hot weather | 75% |
Wind | 57% |
Intense exercise | 56% |
Alcohol consumption | 52% |
Hot baths/showers | 51% |
Cold weather | 46% |
Spicy foods | 45% |
Humidity | 44% |
Hot beverages, irritating ingredients in skin care products and some cosmetics are also among the frequently reported triggers. Since each patient’s trigger profile may differ, keeping a symptom diary can help identify individual triggers.
Treatment Methods Used for Rosacea
There is no definitive cure for rosacea; however, current guidelines show that symptoms can often be largely controlled with proper management. Treatment is personalized according to the patient’s dominant phenotype:
1. Topical Treatments
In mild to moderate papulopustular rosacea, creams/gels containing metronidazole, azelaic acid and ivermectin are used as first-line treatment. For the control of persistent redness (erythema), topical agents with vasoconstrictive effects, such as brimonidine and oxymetazoline, may be preferred.
2. Oral Treatments
In moderate to severe papulopustular rosacea, oral agents such as low-dose doxycycline and minocycline, which are used mainly for their anti-inflammatory effect rather than their antibiotic effect, may be combined with topical treatment. A new oral minocycline formulation approved in 2024 for inflammatory rosacea lesions in adults has been added to current treatment algorithms. If sufficient response is not achieved within 8–12 weeks with topical treatment, switching to a different topical agent or systemic treatment may be recommended.
3. Laser and Light-Based Treatments
For the treatment of persistent redness and visible blood vessels (telangiectasia), systems such as pulsed dye laser (PDL), intense pulsed light (IPL) and KTP laser are effective and safe options; they are especially prominent in the erythematotelangiectatic type. In the phymatous type (rhinophyma), ablative CO2 or Er:YAG lasers are preferred to reduce tissue thickening. Current studies show that laser treatment provides better results when combined with topical/oral medications.
4. Skin Care and Lifestyle Measures
- Using gentle, fragrance-free and alcohol-free cleansers,
- Applying a broad-spectrum sunscreen with at least SPF 30 every day, preferably with physical (mineral) filters,
- Avoiding individual triggers as much as possible, such as hot beverages, spicy foods, alcohol, extreme heat/cold and stress,
- Avoiding aggressive peeling, scrubbing and alcohol-based products that may irritate the skin,
- Supporting the skin barrier with regular moisturization.
Important Points and Realistic Expectations
- Rosacea is a chronic condition; treatment can greatly control symptoms, but it does not guarantee a permanent “cure.”
- Symptoms may recur when treatment is interrupted or exposure to triggers continues; therefore, maintenance care is important.
- Confusing rosacea with acne and applying aggressive acne treatments on your own, such as strong peels or irritating products, may worsen the condition; a dermatologist’s evaluation is essential for accurate diagnosis.
- If ocular findings are neglected, permanent damage to the ocular surface may occur; patients with eye complaints should be followed together with an ophthalmologist.
Frequently Asked Questions About Rosacea
Does rosacea go away completely?
Rosacea is a chronic condition and has no definitive cure. However, with the right treatment and trigger control, symptoms can be significantly reduced and long-term remission, meaning symptom-free periods, may be achieved.
Are rosacea and acne the same thing?
No. Papulopustular rosacea may visually resemble acne, but it does not include comedones, such as blackheads or whiteheads, and develops through a different mechanism. Since some acne treatments may worsen rosacea, accurate diagnosis is important.
Which foods should I avoid?
This varies from person to person; however, hot beverages, spicy foods and alcohol are among the most frequently reported food-related triggers. Keeping a symptom diary is the most reliable way to identify your own triggers.
Why is sunscreen so important in rosacea?
Sun exposure is the most common trigger that worsens symptoms, reported by approximately 81% of patients. Daily use of a broad-spectrum, high-SPF sunscreen is essential for treatment success.
How many laser treatment sessions are needed, and are the results permanent?
The number of sessions varies according to the intensity of redness and visible vessels; generally, a protocol consisting of several sessions is applied. Results may be maintained for a long time, but because rosacea is chronic, new visible vessels may develop over time and maintenance sessions may be required.
Does rosacea only appear on the face?
Rosacea most commonly appears on the face, especially the cheeks, nose, forehead and chin; however, similar findings may also occur in areas such as the neck, upper chest and back in some patients. Eye involvement, known as ocular rosacea, is also a common condition.
Does wearing makeup worsen rosacea?
Properly selected, non-irritating and non-comedogenic products usually do not cause problems; in fact, green color-correcting bases may help cover redness. Products containing alcohol or irritating ingredients should be avoided.
Rosacea Evaluation at Dr. Seher Arı Clinic
It is not possible to create the right treatment plan without evaluating the phenotype of rosacea, your triggers and your skin characteristics. At Dr. Seher Arı Aesthetic Dermatology Clinic in Göktürk, Istanbul, a personalized treatment and skin care plan is created after examination. You may contact the clinic for appointments and further information.
Legal Notice: This content is for informational purposes only, does not replace healthcare services and cannot be used for diagnosis or treatment. Please consult a dermatology specialist for personalized evaluation.
References
- National Rosacea Society. “New Survey Pinpoints Leading Factors that Trigger Symptoms.” Rosacea Review. https://www.rosacea.org/rosacea-review/2002/summer/new-survey-pinpoints-leading-factors-that-trigger-symptoms
- National Rosacea Society — Classification of Rosacea (phenotype-based classification). https://www.rosacea.org/physicians/classification-of-rosacea
- “Rosacea: An Update in Diagnosis, Classification and Management.” Skin Therapy Letter. https://www.skintherapyletter.com/rosacea/update-diagnosis-management/
- “Updated Rosacea Treatment Algorithms Put Phenotypes First.” https://www.medscape.com/viewarticle/updated-rosacea-treatment-algorithms-put-phenotypes-first-2025a10008ci
- “Laser-Based Therapies in Rosacea: A Comprehensive Review of Mechanisms, Clinical Efficacy, and Future Directions.” PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC12986484/