If you’re experiencing redness in the face, first things first: It’s not necessarily rosacea. And if you’re experiencing acne-like breakouts, it’s not necessarily acne. 

Yes, that’s right! While they’re both inflammatory skin conditions and share some similar symptoms, acne and rosacea are different. Acne happens when pores clog with excess sebum, dead skin cells, and bacteria. Rosacea causes acne-like pimples sometimes, but its causes may stem from an inflammatory response triggered by an overactive immune system, genetics, skin mites, intestinal bacteria,¹ or something else. Truth is, the exact cause of rosacea is still unknown.

Rosacea, like acne, isn’t curable, but just like acne, it can be managed—hence the importance of knowing what’s reddening your skin. A rosacea diagnosis may seem like a bummer—but it’s not the end of the world! Managing rosacea is all about learning what your triggers are, avoiding them, and treating symptoms. 

But first, how can you tell if the redness is actually a sign of rosacea?

How to know if you have rosacea

Redness caused by rosacea may look similar to rashes caused by perioral dermatitis, contact dermatitis or seborrheic dermatitis. Unlike other skin conditions that cause redness, rosacea symptoms often occurs in cycles called flare-ups. Many people who experience rosacea often notice recurring symptoms—like redness—that go away on their own only to later reappear. Sound familiar? If so, consider keeping a diary to document your symptoms, including when and where they appeared as well as any possible triggers (more on those in a bit). This will help your healthcare provider determine whether what you’re experiencing is actually rosacea.

Five symptoms of rosacea

One of the most common symptoms of rosacea is persistent redness in the central face across the nose and cheeks, as well as the forehead and chin. It can also appear on the neck, scalp, ears, and chest, although it’s not as common. You may also experience a burning or stinging sensation, and your skin can feel dry.

Here are other common symptoms of rosacea to watch for: 

• Frequent blushing or flushing. Blushing or flushing is redness across the face that can happen almost instantaneously when exposed to a trigger, like hot drinks or spicy foods. 

• Acne-like lesions. Papules and pustules are acne-like lesions that occur in areas of redness. Blackheads and whiteheads are not a symptom of rosacea, however—that’s acne.

• Visible blood vessels (aka telangiectasias). Dilated or broken blood vessels near the surface of the facial skin are another common symptom of rosacea. 

• Eye irritation. Symptoms can include dry, irritated, and swollen eyes and eyelids. The white part of the eye may also appear red and inflamed, and a honey-colored crust may also form around the edge of the eyes. It’s possible to experience eye-related symptoms without having any other rosacea symptoms on your skin.

• Skin thickening (phymatous changes). eat-thickened-skin-caused-by-rosacea/.In more severe cases, rosacea can lead to hardened or thickened skin in the affected area. The skin may also appear dry and rough.

Getting the right diagnosis

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Rosacea treatment by a dermatologist is important, but unfortunately, there’s no specific medical test to diagnose it. Your dermatology provider may perform tests to rule out the possibility of other skin conditions like seborrheic dermatitis, which can occur independently or concurrently with rosacea. They may also refer you to an eye doctor if you have eye symptoms related to rosacea. Pictures of your symptoms can greatly help with an accurate diagnosis, along with that diary you’ve been keeping. Ultimately, your dermatology provider will rely on their evaluation of your skin, your history, and your symptoms to determine whether it’s rosacea. Any additional info you can provide plays a vital role in that process.

If you are misdiagnosed or prescribed medication that seems only to worsen your condition, don’t give up! Rosacea symptoms can become more extreme with age, but proper treatment can help prevent it from progressing. Addressing it early is key! 

Triggers and treatments for rosacea

Treatment of rosacea focuses on identifying triggers and then minimizing the symptoms that follow—figuring out the triggers gives you more leverage in controlling the effect! That’s why identifying the triggers that lead to rosacea flare-ups (and then avoiding them) is the most effective way to help prevent flare-ups in the first place.

“Treating rosacea also means dedicating yourself to a gentle skincare routine. Use a non-comedogenic cleanser and moisturizer containing ingredients like hyaluronic acid, glycerin, and ceramides to help soothe irritated skin,” says Meredith Hartle, a board-certified physician at Curology. 

As far as topical treatments go, several over-the-counter and prescription options exist, but here are five that dermatology providers often recommend, depending on what specifically triggers your rosacea symptoms:

• Metronidazole helps reduce redness and inflammation in moderate and severe cases of rosacea.³

• Brimonidine in over-the-counter and prescription-strength gels helps reduce persistent redness.⁴

• Ivermectin helps reduce rosacea lesions and inflammation. Although it’s available both through a prescription and over-the-counter, not all strengths are indicated for rosacea.

• Azelaic acid can also help reduce the severity of redness and inflammation caused by rosacea. 

• Sulfacetamide/sulfur can help minimize redness and inflammation.

Laser therapy and laser resurfacing can also reduce the appearance of dilated blood vessels and thickened skin. However, in some cases, new blood vessels may form later on.⁵

Try to avoid the triggers

Triggers can vary from person to person, and some, like drinking hot beverages, can evoke immediate redness or flushing, while others can take time to manifest into symptoms. Also, symptoms can last anywhere from a few minutes to several days once triggered. 

Again, prevention is key. Common ways to avoid rosacea flare-ups include:

• Manage stress and anxiety. Create routines to limit stress and anxiety by prioritizing your emotional well-being. Breathing exercises center you in the present moment. Or try a stress-reducing hobby. 

• Avoid certain medications (if possible). Medications used to dilate blood vessels can redden the face, which include beta-blockers and niacin. Steroids can also trigger symptoms.⁶

• Use sunscreen. Sun exposure is a known trigger for rosacea. Wear sun-protective clothing, a broad-brimmed hat, and sunglasses whenever outside. And don’t forget the sunscreen! Use a SPF 30 mineral sunscreen for sensitive skin with broad-spectrum protection. Use the two-finger rule to ensure you applied enough, and reapply after swimming, sweating, toweling off, or after two hours have passed. 

• Stick to a gentle skincare routine. Most people with rosacea also have sensitive skin. Avoid using products that can irritate your skin, like those with witch hazel and alcohol. You may also want to avoid exfoliants like salicylic, lactic, and glycolic acid. Other potentially irritating ingredients to avoid include menthol and camphor. 

• Skip products with added fragrance. The fragrance comes in two forms: natural and synthetic. The natural fragrance comes from plants in the form of essential oils and extracts. Synthetic fragrance is manufactured in a lab. Even natural fragrances can be irritating due to their chemical profile, so in general, stick to fragrance-free products.⁷

• Limit spicy foods, alcohol, and hot beverages (if these are triggers for you). According to the National Rosacea Society, red wine, champagne, bourbon, and gin can lead to flare-ups. The same goes for spicy eats and hot drinks.⁸ Be sure to document which foods and drinks cause flare-ups for you in your rosacea diary. 

Can Curology treat rosacea? 

Yes! We can treat rosacea. Curology is service-first skincare, providing expert knowledge to guide you on your journey to healthier skin. That’s what makes us different. Founded in 2014 by Dr. David Lorschter, MD, a board-certified dermatologist, we’re dedicated to making personalized skincare accessible to all and to making sure what you get actually works for your unique skin! 

Get your personalized skincare routine with Curology

Get your personalized skincare routine with Curology

Start your skin quiz

To become a member, simply answer a few questions and snap a few selfies. If Curology is right for you, your licensed dermatology provider can create a personalized prescription formula using proven ingredients to help treat rosacea including azelaic acid, ivermectin, and metronidazole. We’re here for you every step to ensure your skincare routine works for you and to answer any questions you have. 

Curology is free for 30 days.* Just pay $4.95 (plus tax) to cover shipping and handling. 

P.S. We did the homework so you don’t have to:

1. American Academy of Dermatology. Rosacea: Who gets and causes. (n.d.).

2. Gallo, R. L., et al. Standard classification and pathophysiology of rosacea: The 2017 update by the National Rosacea Society Expert Committee. Journal of the American Academy of Dermatology. (2018). 

3. McClellan, K.J., et al. Topical metronidazole. A review of its use in rosacea.Ameican Journal of Clinical Dermatology. (May-June 2000). 

4. Abokwidir, M., at al. Rosacea Management.Skin Appendage Discord. (September 2016). 

5. American Academy of Dermatology. Laser and lights: How well do they treat rosacea? (n.d.). 

6. National Rosacea Society. Some drugs may worsen rosacea. (2003).

7. National Rosacea Society. Contact allergies maybe common in rosacea patients. (2018, September 17).

8. National Rosacea Society. Factors that may trigger rosacea flare-ups. (n.d.).

* Subject to consultation. Subscription is required. Results may vary.

Written by

Curology Team

Medically reviewed by

Kristen Jokela, NP-C