Rosacea: the four types and how to calm each one

Rosacea is a long-lasting inflammatory skin condition that causes flushing, ongoing redness on the central face and sometimes acne-like bumps. There is no permanent fix yet, but most people can keep it well controlled once they know their pattern and their triggers.

Quick answer: Use a gentle, fragrance-free routine, wear a mineral sunscreen every day, and learn your own triggers. Cosmetic ingredients like azelaic acid and niacinamide may help the look of mild redness. For lasting redness, bumps or eye symptoms, see a dermatologist: prescription creams, gels, tablets and light treatments can work well, and each type responds to different ones.

What rosacea is

Rosacea mainly affects the cheeks, nose, chin and forehead, and it tends to come and go in flares. The NHS notes that it is more common in women and in people with lighter skin, but symptoms can be worse in men. Doctors don't know the exact cause; genes, the immune system and blood vessels that react easily all seem to play a part. It is not caused by poor hygiene, and it is not contagious.

Early signs include redness that comes and goes, a feeling of warmth, and burning or stinging when you use water or skincare. Later, the redness can stay, small blood vessels can become visible, and bumps can appear.

On brown and black skin, redness can be harder to see, or look purple or brown, so burning, stinging, dryness or bumps may be the main signs. This is one reason rosacea is often missed in darker skin tones. See redness-prone skin for other causes of facial redness.

The four types of rosacea

Rosacea is often described as four types. Many people have features of more than one, and dermatologists now often describe each person's individual signs rather than a single type.

Common triggers

Triggers vary from person to person. The NHS and the American Academy of Dermatology (AAD) list:

• Sunlight
• Heat, hot baths and hot drinks
• Spicy food and alcohol
• Hot or cold weather, wind and humidity
• Aerobic exercise, such as running
• Emotional stress
• Skincare that stings or burns

Keep a simple diary for a few weeks. Note each flare, what you ate and did, the weather and any new products. Patterns usually show up, and you only need to avoid the triggers that affect you.

A gentle routine for rosacea-prone skin

Rosacea-prone skin often has a weaker barrier, the outer layer that keeps water in and irritants out, so less is more.

Morning

1. Rinse with lukewarm water or use a mild, soap-free cleanser. Use your fingertips, not washcloths, sponges or scrubs.
2. If you tolerate it, a calming serum such as niacinamide or a low-strength azelaic acid product.
3. A fragrance-free moisturizer.
4. A broad-spectrum sunscreen, SPF 30 or higher, with zinc oxide or titanium dioxide. Tinted mineral formulas avoid a white cast on darker skin.

Evening

1. Mild cleanser.
2. Prescription cream, if your doctor gave you one.
3. Moisturizer.

Green-tinted primers and color correctors can tone down redness under makeup. Read more about mineral sunscreens, azelaic acid, niacinamide and soothing ingredients. These cosmetic products can make skin more comfortable and calmer-looking, but they do not treat rosacea itself.

Ingredients and habits to avoid

The AAD advises people with rosacea to avoid products that contain:

• Alcohol
• Camphor and menthol
• Fragrance (choose "fragrance-free", not just "unscented")
• Glycolic acid and lactic acid
• Sodium lauryl sulfate, a strong foaming cleanser
• Urea

It also suggests skipping astringents and toners, and not scrubbing the face. Fragrance and essential oils can irritate or cause allergic reactions in some people. Before using a new product on your face, the AAD suggests testing it on a small patch on the inside of your arm every day for 7–10 days.

Prescription treatments a dermatologist may offer

A dermatologist chooses treatment based on your signs. Common options include:

• Creams and gels for bumps: azelaic acid, ivermectin or metronidazole.
• Creams or gels for lasting redness: they narrow small blood vessels. The AAD notes they can fade redness for up to about 12 hours, and the color then gradually returns.
• Antibiotic tablets: used for their calming effect on inflammation, for bumps or eye rosacea.
• Lasers and intense pulsed light: can reduce visible blood vessels and lasting redness over a few sessions. Results and safety depend on a qualified professional.
• Eye treatments: eyelid care, and drops or other medicines from a doctor or eye specialist.

Creams can sting at first, and tablets can have side effects such as stomach upset or more sun sensitivity. Talk to your doctor about what to expect. If you are pregnant or breastfeeding, tell your doctor, as some rosacea medicines are not suitable.

What not to mix

• Retinoids and strong exfoliants during a flare. The AAD notes retinoids can irritate rosacea-prone skin.
• Steroid creams on the face. Long-term use can cause rosacea-like redness and can make rosacea worse. Use them only if a doctor tells you to.
• Benzoyl peroxide. A common acne ingredient, but it can irritate sensitive skin and is usually avoided in rosacea.
• Several new products at once. You won't know which one caused a flare.

How long until you see results

Prescription creams for bumps usually need several weeks to show improvement. Redness gels work within hours, but only for that day. Lasers and IPL usually need more than one session, and redness can return over time. Rosacea needs ongoing care, even when your skin looks clear.

When to see a doctor

See a dermatologist or doctor for a diagnosis, because several conditions can look like rosacea, including acne, eczema and some types of dermatitis. Book an appointment if:

• Redness, flushing or bumps don't settle with gentle care.
• The skin on your nose or cheeks is getting thicker.
• Your eyes often feel gritty, dry or watery, or your eyelids are sore or swollen.

Get urgent help the same day if you have eye pain, blurred vision, sensitivity to light or a red eye. The NHS notes these could be signs of keratitis, an inflammation of the clear front of the eye, which can be serious if not treated quickly.

FAQ

Is rosacea the same as acne?

No. Rosacea can cause bumps, but it does not cause blackheads, and it needs different treatment. Some acne products, such as strong exfoliants, can make rosacea worse.

Can I use retinol if I have rosacea?

Retinoids can irritate rosacea-prone skin. Some people tolerate a gentle one once their rosacea is calm; ask your dermatologist first, start slowly, and use sunscreen every day. If you are pregnant or breastfeeding, ask your doctor before using it.

Does diet matter?

Only your personal triggers matter. Spicy food, hot drinks and alcohol bother many people, but there is no single rosacea diet that works for everyone.

Will rosacea go away on its own?

It usually comes and goes in flares rather than disappearing. Avoiding triggers and getting treatment early can keep it calm.

Sources

• Rosacea (NHS)
• Rosacea: Diagnosis and treatment (American Academy of Dermatology)
• Rosacea treatment: How to treat the redness (American Academy of Dermatology)
• Rosacea treatment: Eye problems (American Academy of Dermatology)
• 7 rosacea skin care tips dermatologists recommend (American Academy of Dermatology)