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The ultimate guide to rosacea, from causes to treatments

Here’s how you can manage pesky redness and bumps from rosacea.

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We’re here to tell you what we know, but don’t take it as medical advice. Talk to your medical provider about your specific health concerns.
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For many people, facial redness is a fact of life—like taxes, or that baby animals are adorable. But if you experience significant redness, very dilated blood vessels, or swollen, acne-like bumps, you might actually have rosacea. And you’re definitely not alone! Rosacea affects over 14 million people in the United States alone, across age, gender, and ethnicity.¹ Here’s everything you need to know about the common skin condition—and what you can do about it.

What is rosacea?

Rosacea (pronounced roe-ZAY-sha) is a chronic facial skin condition that can cause frequent redness and flushing and may cause blood vessels to become visible. It primarily affects the central face around the nose and cheeks, but it may also show up in other areas, like your ears, chest, and neck.²,³ If left untreated, rosacea can feel uncomfortable—and be really annoying to cope with! 

What is rosacea - Everything you need to know about rosacea benefits and treatmnents

Common rosacea symptoms

We wish it were simple to say "yes, you have rosacea" or "no, you don't," but the condition's a bit more complicated than that. There are many possible characteristics of rosacea, and a medical provider will need to discuss and observe signs and symptoms when making a rosacea diagnosis. 

Symptoms they'll be looking for include (but aren't limited to)⁴:

  • Central facial redness that periodically gets worse

  • Flushing 

  • Papules and pustules (small, raised acne-like bumps)

  • Visible dilated or broken blood vessels (aka telangiectasias) 

  • Skin thickening (aka phymatous changes)

Symptoms differ based on the severity and characteristics of your rosacea, but they generally occur in cycles—called flare-ups—when symptoms might appear for days or weeks at a time, then disappear, then reappear, and so on.

Woman with rosacea on cheeks

Facial redness (erythema), involvement of the midface

Example of rosacea - rednness, broken capillaries, and small raised bumps

Facial redness (erythema), involvement of the central face, broken capillaries (telangiectasias), and small raised bumps

Rosacea vs. skin redness: what’s the difference?

Certain symptoms of rosacea can be misdiagnosed as other conditions, especially acne. Flushing every once in a while doesn’t automatically mean you have rosacea. It can be a normal bodily reaction to high-emotion situations, excessive heat, exercise, spicy food, alcohol, and more. But if you notice a lot of flushing, or if your skin is constantly red, you might want to check in with your Curology provider or an in-person healthcare provider.

How is rosacea diagnosed? 

If you think you may have rosacea, talk to your medical provider. Don’t start any medications or treatment without your provider’s approval. Your provider should examine your skin and may ask questions about your lifestyle or skincare routine. 

What causes rosacea?

We’re not quite sure what exactly causes rosacea. It might be a combination of genetics, certain microorganisms (like Demodex mites), immune dysfunction, and environmental factors.⁵

If you have any of the following characteristics, you might be more likely to get rosacea⁶:

  • Age 30-50: There isn’t a concrete answer to why rosacea usually starts in this age group because medical science hasn’t quite yet cracked the code on what causes rosacea.

  • Fair-skin, blonde hair, blue eyes: Rosacea most commonly affects fair-skinned individuals who have blonde hair and blue eyes.

  • A family member with rosacea: Many people who get rosacea have family members who have rosacea. There is a possible genetic component to rosacea.

  • Celtic or Scandinavian ancestry 

  • Immune dysfunction: Individuals with acne-like rosacea often react to a bacterium (singular for bacteria) called bacillus oleronius. This may cause an overreaction of their immune system. More research is still needed to confirm this, though.⁷ 

Rosacea occurs a bit more frequently in women than men, but men are more likely to have severe rosacea than women. 

Acne Rosacea Face Mapping

So how can you treat rosacea?

Wondering if rosacea is curable, and if so, how you can cure it? We’ve got good news and bad news. Unfortunately, there’s no cure for rosacea, but you can try a rosacea-friendly skincare routine or treatment to can help control and reduce the symptoms.

Topical medications for rosacea

The U.S. Food and Drug Administration (FDA) has approved five topical medications for mild-to-moderate rosacea symptoms. Some of these are available over-the-counter, but others require a prescription from a medical provider.⁸ 

  • Metronidazole: Helps with redness and inflammation, available by prescription only

  • Azelaic acid: Helps with redness and inflammation, available both over-the-counter and by prescription (depending on the form and strength)

  • Brimonidine: Helps with redness, available both over-the-counter and by prescription (depending on the form and strength)

  • Ivermectin: Helps with inflammation, available both over-the-counter​​ and by prescription (depending on the form)

  • Sulfacetamide/sulfur: Helps with redness and inflammation, available by prescription only

Keep in mind that not all of the ​​​​​​​​strengths and formulas of the ingredients mentioned above are FDA-approved to treat rosacea. Talk to your healthcare provider to learn what specific strengths and formulations of each ingredient are indicated for rosacea—and what may work for you! 

Laser and light therapy for rosacea

Laser and light therapies (e.g., KTP lasers, pulsed dye lasers, and intense pulsed light)⁹ can often help certain symptoms of rosacea, including thickened skin and visible blood vessels.¹⁰ Keep in mind that there is no cure for rosacea. These therapies are often considered cosmetic procedures that likely won’t be covered by insurance. Talk to your healthcare provider to find out what’s right for you!

Prebiotics and probiotics for rosacea

Research indicates the possible role of a gut-skin connection in rosacea: your microbiome of “good” bacteria that live in both the skin and GI tract may be a possible factor in the disease. Does that mean taking probiotics can help reduce redness? It’s not proven — but studies do support the idea that a healthy gut contributes to healthy skin.

If you’ve heard of probiotics but are scratching your head at prebiotics, don’t worry — you’re probably getting them in your diet. Prebiotics are food ingredients that stimulate the growth and/or activity of beneficial GI microbes; many dietary plant fibers act as prebiotics. Foods rich in prebiotics include asparagus, Jerusalem artichokes, bananas, oatmeal, and legumes. Consuming a wide variety of dietary fibers, in sufficient quantity, will encourage the growth of a diverse and healthy gut microbiome, which in turn may decrease rosacea symptoms. You can also buy probiotic supplement pills that contain prebiotics to get both in a single dose.

Can rosacea be prevented? 

Unfortunately, you can’t prevent rosacea. You can, however, improve your chances of avoiding a flare-up by identifying triggers, like diet, stress, and sun exposure. Knowledge is power, and knowing what can cause a rosacea flare-up can go a long way! Once you understand your rosacea triggers, you can sidestep any lifestyle and environmental factors aggravating your flare-ups. 

Here’s a quick list of some of the most common rosacea triggers to be aware of¹¹:

  • Sun exposure

  • Emotional stress

  • Heat and/or hot weather

  • Wind

  • Exercise

  • Alcohol

  • Cold weather

  • Spicy food

  • Warm beverages

  • Certain cosmetics

  • Certain skincare products

  • Certain medications

This is not to say that we recommend that you never go outside or exercise again! But by keeping track of your rosacea flare-ups, you can try avoiding potential triggers to see if it helps your symptoms.

How do you know when to change your rosacea treatment? 

After starting medical treatment, you may see signs of improvement within 6-8 weeks (although this can vary significantly depending on the type of treatment used). Treatment is typically long-term, though, often lasting at least several months. If you feel your symptoms aren't well-managed with your current treatment plan, talk to your medical provider about your concerns! They'll be happy to help.

How to use Curology Custom Formula

Curology can help treat rosacea

Rosacea is just one of the many skin conditions that Curology can help treat. Your Custom Formula may contain active ingredients that treat rosacea. One of the ingredients is metronidazole which helps reduce redness and inflammation. The other is ivermectin, which can treat rosacea by helping reduce inflammation.

Get your personalized skincare routine with Curology

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If you’re interested in trying out either of these ingredients, we can help! Curology’s Custom Formula is made to match your skin’s unique needs—and your personalized formula can evolve as those needs change. You get a personal dermatology provider to check in and help you along your skincare journey, plus delivery straight to your door. Sign up for a 30-day free trial for just $4.95 + tax* (to cover shipping and handling). 

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

  1. American Academy of Dermatology. Rosacea: who gets and causes

  2. Oge', L. K., et al. Rosacea: Diagnosis and Treatment. American family physician. (2015).

  3.  Cleveland Clinic. Rosacea.

  4. 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. (2017). 

  5. Gallo, R. L., et al. Standard classification and pathophysiology of rosacea: The 2017 update by the National Rosacea Society Expert Committee. Ibid. 

  6. Ahn, C. S., & Huang, W. W. Rosacea Pathogenesis. Dermatologic clinics. (2018).

  7. American Academy of Dermatology. Rosacea: who gets and causes

  8. Daou, H., et al. Rosacea and the Microbiome: A Systematic Review. Dermatology and therapy. (2021).

  9. Oge', L. K., et al. Rosacea: Diagnosis and Treatment. Ibid.

  10. American Academy of Dermatology. Lasers and lights: How well do they treat rosacea?

  11. Oge', L. K., et al. Rosacea: Diagnosis and Treatment. Ibid.

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• • •
Our medical review process:We’re here to tell you what we know. That’s why our information is evidence-based and fact-checked by medical experts. Still, everyone’s skin is unique—the best way to get advice is to talk to your healthcare provider.
Nicole Hangsterfer Avatar

Nicole Hangsterfer, PA-C

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