Rosacea

Rosacea is a common and chronic skin condition that mainly affects the face. It causes redness, flushing, visible blood vessels and sometimes acne-like bumps. Rosacea tends to come and go in flares, and can become more persistent without effective management. There is no cure, but the right treatment can keep it under control. In this guide we explain what rosacea is, the different types and how it differs from acne. We also cover what causes it, how it presents in different skin tones and the treatments that help.

City Skin Clinic is an online skincare clinic. We provide prescription-strength topical skin treatments but do not offer in-clinic procedures such as chemical peels, lasers or energy-based devices. However, we have explained all the options below because we believe the public deserve clear, evidence-led information without commercial bias.

What is Rosacea?

Rosacea is a chronic inflammatory skin condition that centres on the middle of the face. It usually affects the cheeks, nose, chin and forehead. The main signs are flushing, lasting redness, fine visible blood vessels and inflamed bumps. Some people also develop eye irritation or thickened skin. Rosacea is not contagious, and it has nothing to do with poor hygiene. It is one of the most common skin conditions, affecting around 5% of adults. Symptoms come and go in flares, often set off by things like heat, sunlight or stress. Left untreated, rosacea tends to become more persistent over time, which is why early treatment helps.

What are the Different Types of Rosacea?

Traditionally, rosacea is divided into four types but many people have features of more than one. That’s why doctors often describe rosacea in a patient by the main features they present with rather than fixed subtypes. The four recognised types of rosacea are:

• Erythematotelangiectatic rosacea (ETR): This type causes persistent facial redness, flushing and visible blood vessels. The skin often feels sensitive and may sting or burn. It mostly affects the cheeks and central face.
• Papulopustular rosacea: Often called acne rosacea, this type brings redness with acne-like papules and pustules. Unlike acne, it does not produce blackheads. It most commonly affects middle-aged women.
• Phymatous rosacea: This type thickens the skin and gives it a bumpy texture. It can enlarge the nose, a change known as rhinophyma. It is more common in men.
• Ocular rosacea: This type affects the eyes, causing dryness, irritation, redness and a gritty feeling. The eyelids may also swell. Severe, untreated cases can affect vision, so eye symptoms always need medical review.

What’s the Difference Between Rosacea and Acne?

Rosacea and acne are often confused, because both cause red, inflamed bumps on the face. They are separate conditions, though, and they need different treatment. The clearest difference is that rosacea does not cause blackheads, whilst acne typically does. Rosacea also brings flushing, persistent redness and visible blood vessels, which are not features of acne. Acne tends to start in the teens, whereas rosacea usually appears after the age of 30. The two can also occur together, which makes diagnosis harder. However, accurate diagnosis is important because some acne treatments can irritate rosacea and make it worse.

What Causes Rosacea?

The exact cause of rosacea is not fully understood. It seems to come from a mix of genetic, immune and environmental factors. The immune system appears to overreact, which drives inflammation and redness. An overgrowth of a harmless skin mite called Demodex may also play a part. Abnormal blood vessels in the skin add to the flushing and visible vessels. Rosacea does not flare on its own. Instead, certain triggers set it off by increasing blood flow to the skin. Common rosacea triggers include:

• Sun exposure and hot weather
• Hot drinks and spicy food
• Alcohol, especially red wine
• Stress and strong emotions
• Intense exercise
• Harsh skincare and topical steroids

Who Gets Rosacea?

Rosacea can affect anyone, but some people are more prone to it. It most commonly appears in fair-skinned adults between the ages of 30 and 50. Women are diagnosed more often than men. However, men tend to develop more severe disease, possibly because they seek help later. A family history of rosacea raises the risk, so genetics clearly play a role.

How Does Rosacea Affect Skin of Colour?

Unfortunately, rosacea is often missed in darker skin tones, partly because redness is harder to see. In skin of colour, it may show up as dusky brown or purple patches rather than obvious redness. The skin can feel warm, sensitive or tender, and it may sting with certain products. Papules and pustules are often easier to spot than the underlying redness. These inflamed spots can also leave post-inflammatory hyperpigmentation, which lasts long after a flare settles. As a result, rosacea in darker skin is frequently mistaken for acne or treated too late.

How is Rosacea Treated?

There is no cure for rosacea but several treatments can help keep it under control and prevent flares. The right choice depends on the type and severity. The main rosacea treatments are:

• Skincare and trigger control: A gentle, fragrance-free routine and daily sunscreen calm the skin and reduce flares. Identifying and avoiding personal triggers is one of the most effective steps. This forms the basis of every rosacea plan.
• Prescription topicals: Topical treatments are first-line for most rosacea. They include metronidazole, azelaic acid and ivermectin, which reduce the bumps and redness. A separate option, brimonidine, can temporarily ease persistent flushing.
• Oral medication: Moderate to severe rosacea often needs tablets. Low-dose oral antibiotics such as doxycycline work mainly by calming inflammation rather than fighting infection. Doctors may sometimes use low-dose isotretinoin for more stubborn cases of acne rosacea.
• Treatments for visible blood vessels & rhinophyma: Laser, intense pulsed light and minor surgery can reduce visible vessels and reshape a thickened nose. These must be done in clinic by an experienced medical practitioner.

Effective rosacea treatment takes time, and most people need ongoing maintenance to stay clear. It is worth sticking with a routine for several weeks before judging whether it helps.

Can Rosacea Be Cured?

Rosacea cannot be cured, but it can be controlled very well. It is a long-term condition that flares and settles over the years. The aim of treatment is to clear the spots, calm the redness and prevent flares. Many people keep their skin clear with ongoing maintenance and good trigger control. Treating rosacea effectively early also helps stop it progressing to more advanced stages, such as rhinophyma.

Can You Prevent Rosacea Flare-ups?

You cannot prevent rosacea itself, but you can reduce how often it flares. The key is to learn your own triggers and avoid them. A simple trigger diary can help spot patterns over a few weeks. Alongside targeted rosacea treatment, sunscreen is one of the most important steps, as sun is a very common trigger. A gentle routine without harsh or fragranced products also keeps the skin calm. Avoiding topical steroids on the face matters too, since they can trigger or worsen rosacea.

At City Skin Clinic, our doctors create personalised skincare to control rosacea and reduce redness and breakouts. Where appropriate, we use prescription actives like metronidazole, ivermectin and azelaic acid. Every plan starts with an online consultation built around your skin and your goals. Start your online consultation today. The journey towards great skin starts here.

This article is intended for general informational purposes only and is not a substitute for medical advice, diagnosis or treatment. Always consult a qualified medical professional with any concerns about your skin or treatment options.