Do You Have Rosacea?

Rosacea is often misdiagnosed as acne because papules can show up as the condition progresses. Even though the pustules and papules of rosacea are not acne, acne can show up on your face at the same time as rosacea. 

Rosacea presents on the skin in many different ways. While redness and flushing is very common, how can you be sure that it’s rosacea? Especially when there are so many types of rosacea, how do you know which one you have and how to treat it.

Let's look into the different types of rosacea, its different presentations, and how to live with it. We'll also discuss how you can avoid rosacea triggers, get OTC treatments, and how you can better understand your rosacea skin. 

What is rosacea?

Rosacea is a chronic, vascular condition. Vascular means that the condition is related to blood vessels. Rosacea can happen at any age, but it primarily occurs in women between the ages of 30 and 50.

Rosacea is usually coupled with dry skin on lighter fitzpatrick levels. The fitzpatrick scale is something that is used in dermatology to determine genetic skin traits, and lighter skin tones are more prone to rosacea. Moreover,Rosacea is currently considered by most authors as a disease of the immune system, an inflammatory process including innate and then adaptive immune responses, which gets out of control resulting in vascular, inflammatory, and hypertrophic symptoms. More simply, rosacea can be viewed as an over-dramatic response from your immune system. 

What causes rosacea?

While rosacea is primarily genetic, environmental triggers of rosacea are common. If you are eating really warm, spicy, or cold food, that can make rosacea flare-up. Rosacea can also be triggered by the consumption of caffeine and alcohol. 

Heat, exercise, and sun exposure can also trigger rosacea. The UVB rays from the sun have actually been shown to increase the number of vessels that your skin has. And given that rosacea is a vascular condition, the sun can make it worse. 

Furthermore, demodex mites are natural organisms that work to remove dead skin on your face. They are stationed within the pilosebaceous units. However, some people with rosacea have too many, and this can cause the worsening of rosacea.

What are the symptoms of Rosacea?

In order to determine whether or not you have rosacea, it’s really important to look at the appearance of your skin and to look at triggers. Are you seeing redness or flushing when exposed to triggers like stress, anxiety, diet changes, weather, or temperature fluctuation? Is your skin showing these symptoms when you eat something really hot or cold? Additionally, when rosacea flares up, it can burn and sting.

The National Rosacea Society (NRS) expert committee states that rosacea symptoms primarily happen around the middle of the face. There are four primary rosacea symptoms:  flushing, persistent erythema (redness), papules and pustules, and telangiectasia (dilated and visible blood vessels under the skin). 

Normally, more than one symptom happens at the same time.  

What are the types of rosacea?

Type 1: Mild Rosacea

Mild rosacea is not very noticeable. It can look like flushing on the nose and the cheek area, and it's normally in the middle of the face. It comes and goes, but then it might stick around. 

Type 2:  Inflammatory/papulopustular Rosacea 

Inflammatory rosacea presents these little blood vessels that are red and spidery. Oftentimes, they don’t go away. Its key symptom is chronic redness of the face, as well as an outbreak of red bumps and pimples. These bumps, known as pustules and papules, are different from actualacne and require a different treatment.

Type 3: Rhinophyma 

When left untreated, rosacea can worsen and can lead to the third type, phymatous rosacea. A bulbous, lumpy, and very red nose is the classic symptom of this type of rosacea. This overgrowth of thickened skin on the nose is known as rhinophyma, and it most often occurs in men. 

Rhinophyma causes the thickening of the dermis and the degradation of collagen and elastin in the skin. In turn, scar tissue also becomes inflamed.

Type 4: Ocular Rosacea

Some people form ocular rosacea. Ocular rosacea is when the eyes are inflamed. It can feel like there are granules in the eyes, the eyes can be pink, and the eyes can be swollen. You can have blepharitis which is inflammation of the eyelid.  You can also experience watery eyes, granules, and swollen eyelids.

What are treatments for rosacea?

Rosacea has a multitude of symptoms. Every person with rosacea may not have each one. Furthermore, while two people can have the same type of rosacea, the symptoms may be different for each person. Below, treatments are separated according to the symptom they can help.

Treatments for Inflammation

Azelaic acid

To help treat dry skin and rosacea, exfoliation is important. However, exfoliants can be harsh on rosacea skin and lead to further irritation. 

Azelaic is a great option for those with rosacea because it's very gentle. It is far gentler than glycolic acid, salicylic acid, and even lactic acid.

Because it is so gentle, azelaic acid can take a fair bit of time before you see results especially if the treatment is OTC. Azelaic acid from a dermatologist will probably come at 15%, but OTC normally comes at 10%.

Furthermore, azelaic acid is safe for pregnant women so if you are an expecting mother with rosacea, you Fragrance-freecan use it too.


Finacea gel - 15% Azelaic Acid (Prescribed)

The Ordinary Azelaic Acid - $7.90


Paula’s Choice Azelaic Acid 10% Booster - $28.80

Hydrating, fragrance-free topicals.

Fragrance free and hydrating topicals that have gentle actives and mild antioxidants like green tea and ester vitamin Cs are good. It's better to go with vitamin Cs that are esters for rosacea skin because they are less irritating.  Vitamin C esters like calcium ascorbate are water-soluble, and they are well absorbed 

Holifrog Galilee Antioxidant Dewy Drop - $48

This moisturizer also contains azelaic acid.




Niacinamide won’t transform rosacea, but it regulates oil production. It can help create more ceramides. Ceramides are crucial to having a healthy skin barrier and reducing irritation and damage. So, applying them to rosacea skin is helpful.

The Ordinary Niacinamide 10% + Zinc 1% - $5.90


Tea tree oil 

For papulopustular rosacea, tea tree is helpful because it's antimicrobial. However, you should not use 100% tea tree oil as this could be irritating. Moreover, you want to avoid essential oils or anything with a lot of fragrance


A trigger for rosacea is irritation so you'll want to use a mineral/physical sunscreen or inorganic sunscreen. People with rosacea may become irritated by chemical sunscreens so using a physical sunscreen with zinc oxide and titanium dioxide is. Also, consider wearing a hat.

The Ordinary SPF 30 With Antioxidants - $7.90

Australian Gold Botanical Sunscreen Tinted Mineral Lotion SPF 50 - $13.99


Sulfur has antibacterial properties and can combat helicobacter pylori, staphylococcus epidermis, chlamydia pneumoniae, and Bacillus oleronius, the bacteria associated with demodex mites. Sulfur can combat these bacteria known to irritate rosacea.

Treatments for Demodex Mites

Solantra (Prescribed)

Solantra is a prescribed medication that is  very potent in taming the overgrowth of demodex mites

Salicylic acid

When it comes to taming an overpopulation of demodex mites,clinicians have reported the therapeutic efficacy of salicylic acid. 

Paula’s Choice 2% Liquid Exfoliant - $23.60

Topical antibiotics

Rosacea does not have open comedones or blackheads nor is it caused by p acnes bacteria. However, dermatologists still prescribe things like antibiotics to treat the bacteria associated with rosacea. The prescriptions are very helpful for papulopustular rosacea.


Metronidazole (Prescribed)

Erythromycin (Prescribed)

Tetracycline (Oral, Prescribed)

Doxycycline (Oral)

You can go on Apostrophe and get prescription medicines like doxycycline online from a real dermatologist.

Treatments for dilated veins and thick skin

Brimonidine (Prescribed)

Rosacea can cause redness and broken blood vessels. This treats dilated blood vessels and persistent redness


Retinol is an OTC vasoconstrictor and can help with vascular rosacea. 

The Ordinary Retinol .5% in squalene - $5.80



“Laser treatments for rosacea have been clinically proven to significantly improve the appearance of rosacea symptoms like redness and thickened skin. Some patients who undergo laser treatment see as much as a 50 to 75 percent reduction in their rosacea symptoms” (Derm Collective, 2019). 


Dermatologists treat phymatous rosacea by shaving off the extra layers of skin. It takes about a week to heal from this surgery

For more info, on rosacea click here.