The skin is the largest of the body’s organs, and—call us biased—but we think it’s pretty neat. Why? It’s incredibly adaptable and constantly changing in response to internal and external factors. But unfortunately, it’s not invincible and is susceptible to skin conditions like rosacea. Rosacea is a common and chronic skin condition with symptoms that include redness and flushing, most commonly on the nose, cheeks, and forehead. Other signs of rosacea include papules, pustules, and visible blood vessels. If rosacea is left untreated, a patient may also experience what’s known as phymatous changes, or rosacea thickened skin, and a bulbous appearance of the nose.¹

That may sound alarming if you have rosacea, but the good news is there are steps you can take to help improve skin texture. We’ll share those here, along with expert tips for helping prevent rosacea flare-ups in the first place. First, let’s take a look at phymatous changes from rosacea in greater detail. 

What are phymatous changes from rosacea?

It’s important to know that rosacea doesn’t cause phymatous changes overnight. Rosacea is a chronic condition, but its symptoms are initially transient—they appear during periods called flare-ups following a trigger like sun exposure or spicy food. If left untreated, persistent redness and swelling can occur, the latter of which can result in fibrosis. This obstructs the skin’s sebaceous glands, and over time, causes the skin to “thicken” and for the glands to form cysts.²,³ Symptoms of phymatous changes can include skin thickening on the forehead, nose, chin, ears, and cheeks. The nose can also appear larger, red, bumpy, and bulbous (a condition known as rhinophyma). These symptoms differ from those commonly associated with rosacea, which include frequent flushing, acne-like lesions, and dilated or broken blood vessels. 

Treating thickened skin caused by rosacea

The treatment plan for phymatous rosacea is not as simple as using over-the-counter or prescription-strength topicals, and how you treat thick skin on the face depends on the severity. Here are some of the options your medical provider may recommend:

• Ablative laser treatment works by removing the thin outer layer of skin or the epidermis. The laser heats the underlying skin, stimulating the production of collagen, a protein that creates the scaffolding for your skin. As the skin heals after treatment, the new skin layer appears smoother. Skin color changes may also occur. Ablative laser therapy presents a slight risk of scarring. 

• Oral isotretinoin (often referred to by its former brand name, Accutane), is a vitamin A derivative that is sometimes prescribed to help treat severe and persistent acne. It can also be used to help treat the symptoms of rosacea.⁴ To learn more about this prescription treatment, check out our blog post all about isotretinoin.

• Radiofrequency is a technique that uses energy waves to selectively heat target tissue without injuring the outer layer of the skin.⁵ This has been shown to help with larger telangiectasias and the smoothing of the skin.⁶ The procedure is quick and generally painless. Side effects may include temporary swelling, redness, and tingling. Patients with darker skin tones typically have a higher risk of side effects from a laser and radiofrequency treatments.⁷

• Surgical techniques are another rhinophyma treatment option to consider, but some (like total excision) are usually reserved for more severe cases. Results are generally positive, but there’s a low risk of recurrence.⁸ Additional surgical techniques include dermabrasion, scalpel excision, electrosurgery, and cryosurgery.

Lifecycle changes that can help reduce rosacea flare-ups

Rosacea often occurs in cycles called flare-ups. Certain lifestyle changes can help reduce flare-ups. The key is knowing what triggers your rosacea so you can avoid it. Here are some tips that might help reduce flare-ups. 

• Identify (and avoid) your triggers. Common triggers include spicy food, citrus, and hot drinks. Some who drink alcohol experience flares. Sun, extreme weather and skincare products can also trigger a flare-up. 

• Avoid sun exposure. Sunburn can increase inflammation and telangiectasias,⁹ so cover up, avoid the sun when possible, and always wear a broad-spectrum SPF 30+ sunscreen. 

• Use gentle skincare products. Many people with rosacea also have sensitive skin. Choose products free of added fragrances and known allergens. Look for products labeled non-comedogenic, meaning they won’t clog your pores. (Here’s how to deal with clogged pores should they happen.)

• Drink water. Water won’t prevent rosacea flare-ups—or other skin conditions or skin diseases. But staying hydrated is part of maintaining optimal health.

Looking for more info? Check out our guides to rosacea to better understand the difference between acne and rosacea, treatment options, and more.  

Improving skin texture with good skincare

In addition to trying rosacea skin thickening treatments like those mentioned above and identifying and avoiding your triggers, you can also help manage rosacea simply by dedicating yourself to a good skincare routine. Here are a few skincare tips we recommend:  

• Gently wash your face with a cleanser twice daily. Dermatology providers recommend a non-soap cleanser free of fats and alkaline by-products or a cleanser designed for your skin type. Splash lukewarm water on your face before using your fingertips to gently rub the cleanser into your skin. Rinse with lukewarm water and pat dry with a soft cotton towel! 

• Use a moisturizer after cleansing or after applying topical medications. Since many topical medications leave your skin photosensitive, we recommend using medicated creams at night. Nonetheless, if you’re just cleansing, you’ll apply moisturizer afterward. If you’re using a topical medication, apply that after cleansing, followed by moisturizer. Choose a hydrating moisturizer for sensitive skin with ingredients like hyaluronic acid, glycerin, and ceramides.  

• Always apply sunscreen before going outside. The sun is a common rosacea trigger, so be sure to use a broad-spectrum sunscreen with SPF 30+. Apply 15 minutes before sun exposure and reapply every two hours, after swimming, sweating, or toweling off. We often recommend choosing a mineral sunscreen (physical sunscreen), which uses zinc oxide or titanium dioxide as its active ingredient. 

• Cover-up from heat and cold—if these are triggers for you. Some people with rosacea are triggered in hot or cold weather. Use sunshades, broad-brimmed hats, and sun-protective clothing. In cold weather, wrap a scarf around your face or apply a thick protective moisturizer—and sunscreen! 

• Consider performing a patch test for new skincare products and makeup before applying them to your face. You want to make sure they won’t irritate your skin.

Curology can treat rosacea 

Curology was founded in 2014 by Dr. David Lorschter, MD, a board-certified dermatologist, to provide customized skincare that works. So, if you’re struggling with rosacea, Curology can help! Signing up is easy. Just take a short quiz and snap some selfies to help us get to know your unique skin. If Curology is right for you, we’ll pair you with one of our licensed dermatology providers. They’ll prescribe a personalized formula to treat rosacea using ingredients such as ivermectin, metronidazole, and azelaic acid—and guide you through your skincare journey every step of the way.

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Ready for clearer skin? Your first 30 days are free—just pay $4.95 (plus tax)* to cover shipping and handling. 

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

1. 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. (2108, January 1).

2. Gupta M., et al. Severe rhinophyma treated by shave excision and electrocautery.BMJ Case Reports. (2020, January 13).

3. Rivero, A.L., et al. An update on the treatment of rosacea. Australian Prescriber. (2018, February 1).

4. Rivero, A.L., et al. An update on the treatment of rosacea. Australian Prescriber. Ibid.

5. Gold, M.H. Noninvasive skin tightening treatment.Journal of Clinical and Aesthetic Dermatology. (June 2015).

6. Taub AF, Devita EC. Successful treatment of erythematotelangiectatic rosacea with pulsed light and radiofrequency.J Clin Aesthet Dermatol. (May 2008).

7. Battle, E., et al. Clinical evaluation of safety and efficacy of fractional radiofrequency facial treatment of skin type VI patients.Journal of Drugs in Dermatology. Ibid. 

8. Gupta M., et al. Severe rhinophyma treated by shave excision and electrocautery.BMJ Case Reports. (2020, January 13). 

9. Morgado-Carrasco, D., et al. Impact of ultraviolet radiation and exposure on rosacea: Key role of photoprotection in optimizing treatment.Journal of Cosmetic Dermatology. (November 2021). 

Nicole Hangsterfer is a licensed physician assistant at Curology. She obtained her masters in physician assistant studies at the Feinberg School of Medicine at Northwestern in Chicago, IL.

* Subject to consultation. Subscription is required. Trial is 30 days. Results may vary. 

Written by

Curology Team

Medically reviewed by

Nicole Hangsterfer, PA-C