Rosacea: Symptoms and Treatment

Briefly, what you need to know

Rosacea is not contagious.

It can be mistaken for acne, but it is not acne.

Sunlight, temperature changes, and certain personal triggers can increase flare-ups.

Not every patient has the same triggers.

The eyes can also be affected.

The disease is usually kept under control rather than completely eradicated "so that it will never happen again.".

Proper skincare, sun protection, and treatment targeting the patient's primary symptoms are all important together.

How is rosacea diagnosed?

One of the most common findings is redness in the central part of the face. The cheeks, nose, forehead, and chin may be affected.

In some patients, the redness may come and go, but over time it can become more persistent.

Rosacea can cause one or more of the following:

Facial redness and flushing: A sudden reddening of the face and a feeling of warmth.

Persistent redness: Redness that persists, especially around the cheeks and nose.

Prominent capillaries: Small blood vessels close to the skin's surface become visible.

Papules and pustules: Red or inflamed bumps that may resemble acne.

Burning, stinging, and sensitivity: In some patients, the skin may become extremely sensitive.

Eye symptoms: Dryness, stinging, redness, or problems with the eyelid margins may develop.

Phymatous changes: Less frequently, thickening and irregular surface of the skin may develop; when this occurs in the nose, it is called rhinophyma.

The current approach to rosacea prefers to assess the condition by looking at which symptoms are present together, rather than trying to categorize the patient into a single "subtype".

What causes rosacea?

There is no single cause of rosacea.

Genetic predisposition, the inflammatory response of the immune system, changes in vascular regulation, the skin barrier, neurovascular interactions, and skin microbiota are thought to play a role in the development of the disease.

There is a link between rosacea and mites called Demodex, which can also be found on the skin of healthy people. However, it is not accurate to define rosacea solely as a "Demodex infection".

It is not accurate to explain rosacea as being caused by a single bacterium or mite; skin barrier, innate immune response, vascular reactivity, and Demodex-related mechanisms may all play a role.

What can trigger rosacea?

Triggers vary from person to person.

Among the frequently reported issues are:

sun,

hot air,

extremely hot environments,

hot drinks,

spicy foods,

alcohol,

intense exercise,

stress,

some cosmetic products

It can be found.

Instead of giving someone a long and generalized list of prohibitions, it is more useful for them to identify truly effective triggers by observing their own flare-ups.

What is the difference between rosacea and acne?

The two diseases can be similar, especially when papules and pustules are present.

However, in rosacea, facial redness, flushing, prominent veins, and tenderness may be more prominent. The characteristic open and closed comedones (blackheads and whiteheads) of acne are not a typical finding of rosacea.

Some people may have both diseases at the same time.

Therefore, starting self-treatment for acne simply because it "looks like a pimple" may not be the right approach.

Can rosacea affect the eyes?

Yes.

In ocular rosacea, the eyes are affected;

dryness,

burning or stinging,

redness,

sensation of a foreign body,

inflammation at the edge of the eyelid

Symptoms such as these may occur.

Ocular findings do not necessarily appear simultaneously with skin findings. Current treatment evidence for ocular rosacea is more limited compared to cutaneous rosacea; a 2024 systematic review also highlights the heterogeneity among studies.

In cases of significant eye complaints, evaluation by both dermatologist and ophthalmologist may be necessary.

How is rosacea diagnosed?

Rosacea is usually diagnosed through history and dermatological examination.

Not every patient requires a blood test or biopsy.

Further evaluation may be necessary if there is an atypical appearance or if differential diagnosis with other conditions such as lupus, seborrheic dermatitis, acne, or perioral dermatitis is required.

How is rosacea treated?

There is no single treatment for rosacea that works for everyone.

Treatment;

Is redness predominant? → Are papules/pustules predominant? → Are veins prominent? → Is there eye involvement? → Are there phymatous changes?

It is shaped according to the questions.

Papules and pustules

There is clinical trial data supporting the effectiveness of treatments such as topical ivermectin, azelaic acid, and metronidazole. Oral treatments may also be used in suitable patients with more widespread inflammatory disease. Systematic reviews from 2024 and 2025 support the effectiveness of these options in reducing inflammatory lesions.

Persistent redness

The goal of treatment differs from that of treating papules and pustules. In suitable patients, topical medications to reduce redness and targeted laser/light therapies may be considered.

Prominent veins

In suitable patients, light-based methods such as targeted vascular lasers or intense pulsed light (IPL) can be used.

In selected patients with prominent vascularity and persistent redness, laser and intense pulsed light treatments may also be considered.

Resistant or more severe rosacea

In selected and resistant cases, low-dose oral isotretinoin may be evaluated by a dermatologist. The 2024–2025 systematic reviews report supportive results regarding efficacy; however, studies on treatment regimens are heterogeneous and the context of use should be further evaluated.

Why is skincare important?

Skin affected by rosacea is often sensitive.

Therefore, in addition to treatment:

gentle cleaning,

proper moisturizing,

regular sun protection,

Avoid irritating products.

It is important.

“The "more active ingredients = better skin" approach can be particularly problematic in rosacea.

Uncontrolled exfoliations, the use of multiple acids together, or aggressive routines that disrupt the skin barrier can increase redness and sensitivity.

Does rosacea completely go away?

Rosacea is a chronic disease that can have flare-ups.

Symptoms can be significantly controlled with treatment; however, susceptibility may persist. Therefore, the goal of treatment should not only be to relieve current flare-ups but also to ensure long-term control of the disease.

When should you consult a dermatologist?

If facial redness becomes persistent, acne-like lesions recur, there is significant burning or sensitivity in the skin, prominent blood vessels, accompanying eye complaints, or if the products used worsen the condition, a dermatological evaluation is appropriate.

Frequently Asked Questions

Is rosacea contagious? No.

Is rosacea acne? No. They can look similar and sometimes coexist.

Does rosacea worsen with sun exposure? Sunlight is one of the most frequently reported triggers; therefore, sun protection is a fundamental part of rosacea care.

Is coffee off-limits for rosacea? It's not accurate to give everyone the same list of forbidden foods. Hot drinks and certain personal triggers can increase flushing; observing one's own individual relationship with the condition is more meaningful.

Can laser treatment be used for rosacea? Yes, suitable laser or light systems can be considered, especially in cases of specific findings such as persistent erythema and prominent veins. However, the choice of device should depend on which specific rosacea symptom is being treated.

Does rosacea recur? Yes. As it is a chronic disease, it can flare up periodically.