Rosacea: Triggers, Treatment, and Long-Term Management

Rosacea is a chronic inflammatory skin condition affecting roughly 1 in 10 adults, most commonly in people with lighter skin tones, though it occurs across all ethnicities. It is frequently misdiagnosed as acne or "sensitive skin." Understanding rosacea means understanding that there are four distinct subtypes, each with different presentations and treatments — and that the most common skincare advice (use more actives, exfoliate, try this serum) often makes rosacea worse.

The four subtypes

• Erythematotelangiectatic (ETR): persistent redness, visible blood vessels, flushing. Most common subtype.
• Papulopustular: red bumps and pustules that look like acne — but are not. Often misdiagnosed and treated with acne products, which worsen it.
• Phymatous: skin thickening, especially on the nose (rhinophyma). More common in men.
• Ocular: eye symptoms — dryness, burning, sensitivity to light. Often accompanies other subtypes.
• Common triggers: UV exposure, heat, alcohol, spicy food, hot drinks, stress, exercise, and some skincare ingredients (alcohol, fragrance, menthol, strong acids).
• Treatment: azelaic acid (15–20% prescription) and metronidazole (topical) for papulopustular. Brimonidine gel for persistent redness. IPL or laser for visible vessels. Isotretinoin for severe phymatous subtype.
• Skincare philosophy for rosacea: the fewer products the better. Fragrance-free, minimal ingredient lists, physical sunscreen only (mineral filters are less reactive).