Rosacea is a chronic inflammatory skin condition affecting an estimated 16 million Americans, yet it is frequently misdiagnosed as acne, allergic reaction, or simply “sensitive skin.”
What Is Rosacea?
Rosacea is characterized primarily by facial redness, typically across the cheeks, nose, chin, and forehead. It is a vascular and inflammatory condition involving abnormal blood vessel reactivity and immune activation in the skin. It is not contagious, not caused by poor hygiene, and not the same as acne.
The Four Subtypes
Erythematotelangiectatic rosacea (ETR): Flushing, persistent redness, and visible blood vessels. No papules or pustules.
Papulopustular rosacea: Acne-like breakouts combined with redness, the subtype most often confused with acne.
Phymatous rosacea: Skin thickening, typically around the nose (rhinophyma). More common in men.
Ocular rosacea: Affects the eyes, redness, irritation, and eyelid inflammation. Present in up to 20% of rosacea patients.
Common Triggers
- Sun exposure (the most universal trigger)
- Heat, hot beverages, spicy foods
- Alcohol, especially red wine
- Exercise and emotional stress
- Certain skincare products containing alcohol or fragrance
Treatment Options
Topicals: Metronidazole, azelaic acid, brimonidine (for redness), and ivermectin cream (for papulopustular rosacea) are well-established first-line options.
Oral medications: Low-dose doxycycline for its anti-inflammatory properties in more severe cases.
Laser and light therapies: Pulsed dye laser and IPL reduce visible blood vessels and background redness.
Rosacea is not curable but is highly manageable with appropriate treatment and trigger avoidance.
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