A detailed close-up of a person’s lower face showing early signs of rosacea, visible redness, small bumps, and uneven skin texture on the cheeks and chin, commonly associated with rosacea flare-ups.

Close-Up of Mild Rosacea on Cheek and Chin Area

Our skin is often the first place we notice signs of aging; it can develop wrinkles and fine lines, changes in appearance and texture, or even start to feel looser or saggy. But that’s nothing new. What’s less commonly known is the fact that as we enter our mid-twenties, we’re also more susceptible to developing rosacea, an inflammatory skin condition that most commonly affects fair-skinned individuals aged 25 to 39. 

While rosacea affects about 5% of the worldwide population (an estimated [415 million individuals](https://www.rosacea.org/blog/2018/april/415-million-people-affected-by-rosacea-worldwide)), it’s rarely part of the skincare conversation. In fact, you might have it and not even realize it. Let’s break down what rosacea is, the symptoms to look out for, and a few ways to manage it effectively.

## **WHAT ARE THE DIFFERENT TYPES OF ROSACEA?**

First, what is rosacea? Rosacea is a chronic skin condition that causes facial redness and visible blood vessels, sometimes with raised, pimple-like bumps. Researchers have yet to definitively determine the exact cause of rosacea, but family history (aka genetics) and environmental factors seem to both play a role. There are four main types of rosacea:

- **Erythematotelangiectatic Rosacea (ETR):** usually the initial stage of rosacea, this subtype is marked by persistent facial redness that can easily be confused with a sunburn. Individuals with ETR might also experience flushing, visible blood vessels, and dry or sensitive skin.

- **Papulopustular Rosacea:** often mistaken for acne, this subtype of rosacea has the same symptoms as ETR but with acne-like red bumps, with or without pus.

- **Phymatous Rosacea:** primarily affecting the nose, phymatous rosacea causes the oil glands to enlarge and the hair follicles to dilate, resulting in noticeably bumpy skin. This type of rosacea can sometimes also affect the chin, forehead, or ears, and is more commonly seen among men. 

- **Ocular Rosacea:** The last type of rosacea differs because it doesn’t primarily affect the skin—it targets the eyes. Known as ocular rosacea, it typically causes redness, dryness, irritation, and, in some cases, swollen eyelids or blurred vision.

## **HOW CAN YOU TELL IF YOU HAVE ROSACEA VS. ACNE?**

The truth is that you might not be able to tell the difference between rosacea and acne! Acne and rosacea symptoms can look pretty similar, especially if someone is experiencing papulopustular rosacea. If you think you might have rosacea, you should schedule a visit with your board-certified dermatologist to evaluate your skin condition. At your appointment, they’ll likely ask you a few questions about your family history with rosacea (i.e., does anyone in your family suffer from the condition?), how long you’ve had the redness, and if you’ve noticed any patterns around what makes your symptoms better or worse. 

Rosacea tends to flare in response to triggers and is thought to be genetically linked, while acne is more tied to hormones and clogged pores. The doctor will also consider the location and features of any bumps. Rosacea only affects the face, and the bumps typically do not have any blackheads or whiteheads, unlike acne. It can be hard for an untrained eye to see the difference, but a skilled dermatologist will be able to diagnose fairly quickly.

## **CAN PREGNANCY CAUSE ROSACEA OR MAKE IT WORSE?**

Yes, pregnancy can trigger or worsen rosacea because there are such extreme hormonal changes and fluctuations. But, a [small 2023 study](https://pmc.ncbi.nlm.nih.gov/articles/PMC10617829/) found that some women can actually see improvements in their skin condition during pregnancy. Not every medication for rosacea is considered safe during pregnancy, so women who are pregnant or trying to get pregnant should meet with their board-certified dermatologist to align on a safe rosacea treatment plan. 

## **WHAT TRIGGERS ROSACEA FLARE-UPS?**

A key part of managing rosacea relies on limiting potential triggers. While everybody responds differently, the National Rosacea Society suggests that certain foods, alcoholic beverages, skin care products, and medications can cause flare-ups along with extreme temperatures and stress ([see full list here](https://www.rosacea.org/patients/rosacea-triggers/factors-that-may-trigger-rosacea-flare-ups)). According to a survey of 1,000 rosacea patients, the [top five most common triggers](https://www.rosacea.org/patients/rosacea-triggers/rosacea-triggers-survey) are sun exposure, emotional stress, hot weather, wind, and heavy exercise.  

## **WHAT ARE THE BEST OVER-THE-COUNTER PRODUCTS FOR ROSACEA?**

To better understand how to treat each type of rosacea, and when it’s time to seek professional care, we spoke to [AEDIT Founder and board-certified Head and Neck Surgeon, Dr. William Kennedy](https://aedit.com/provider/william-kennedy-md-26292), for his expert insights: 

- **Erythematotelangiectatic Rosacea (ETR):** “For patients struggling with erythematotelangiectatic rosacea, I would typically recommend starting with gentle over-the-counter anti-inflammatory products for about 4 to 6 weeks. A fragrance-free cleanser, an anti-inflammatory moisturizer, and a product containing Azelaic Acid (10%) would be great options,” says Dr. Kennedy. “However, if the patient is experiencing consistent redness early on, I would advise moving directly into a topical prescription or Intense Pulsed Light Therapy (IPL) to help alleviate their symptoms.”

- **Papulopustular Rosacea:** “When a patient is experiencing papulopustular rosacea, I typically recommend starting with an over-the-counter regimen. If inflammation and breakouts persist, then I often move to recommending topical treatments like metronidazole or ivermectin, both are designed to reduce inflammation and improve the microbial imbalance.”

- **Phymatous Rosacea:** “For those dealing with phymatous rosacea, I would recommend bypassing the over-the-counter regimen and moving directly into prescription topical treatments. However, in extreme cases, I would recommend surgical or laser-based interventions like CO2 Laser to address the progressive tissue changes.”

- **Ocular Rosacea:** “If you’re struggling with ocular rosacea, I would also recommend moving directly into prescription treatments. Since ocular rosacea affects the eyes and eyelids, I recommend early intervention with prescription drops or oral antibiotics to help manage symptoms.” 

## **WHEN SHOULD YOU SEE A DERMATOLOGIST FOR ROSACEA?**

The tricky thing about rosacea is that it’s easily confused with other conditions, like acne or sunburns. If you’ve noticed that your symptoms align with the characterizations of rosacea and are quite persistent, it’s time to make an appointment with your dermatologist. Unfortunately, rosacea does not go away on its own, so it will need to be managed under professional care. 

## **ARE THERE PRESCRIPTION TREATMENTS OR IN-OFFICE PROCEDURES THAT HELP?**

There are a number of rosacea skincare products, like prescription topicals and oral antibiotics, available today. Dr. Kennedy shared his insights on the most effective options:

"Depending on the **subtype of rosacea and severity**, I would typically recommend starting with a topical medication for mild to moderate cases, and if inflammation is more widespread, I would escalate to oral antibiotics. Each medication will target different aspects; therefore, choosing the right one is key.”

“The most recommended go-to for **mild to moderate papulopustular rosacea** is Azelaic Acid (15%). This topical treatment is an anti-inflammatory known for reducing redness and pustules with minimal irritation.” 

“For a patient seeking **long-term maintenance**, I would suggest Metronidazole (0.75% or 1%). I typically recommend this topical treatment for sensitive skin types, as it’s especially effective in gently calming inflammation and reducing redness.”

“If a patient **doesn’t see improvement after several weeks** using Azelaic Acid or Metronidazole, I would typically escalate the treatment to Ivermectin, which is particularly effective for moderate to severe papulopustular rosacea.”

“I would recommend Winlevi for **younger patients dealing with hormonal imbalances and oil production** that are contributing to their rosacea. Although primarily prescribed for acne, Winlevi has been shown to improve the side effects of rosacea.”

“Oral antibiotics should be reserved for more **severe cases** when topical treatments haven’t been effective or a patient is seeking faster reduction in symptoms. I would generally prescribe Doxycycline as a low dose to reduce inflammation without the risk of bacterial resistance, which can be a long-term side effect.” 

“Minocycline or Tetracycline would make great additional options for patients who don’t tolerate Doxycycline well. Both of these would be better reserved for **stubborn or recurring flare-ups**,” says Dr. William Kennedy.

Depending on the individual, dermatologists sometimes also recommend a few **laser treatment sessions to minimize redness**. “For patients struggling with persistent redness, especially erythematotelangiectatic rosacea, I often recommend [Intense Pulsed Light (IPL)](https://aedit.com/procedure/ipl#google_vignette); this treatment can offer broader improvements of overall redness and skin tone,” says Dr. Kennedy. “However, for patients struggling with phymatous rosacea, I would recommend the CO2 laser, best known for resurfacing skin and improving texture. Laser treatments are often considered cosmetic and, therefore, are not typically covered by insurance. Lastly, it is important to note that laser therapies are not permanent solutions, but rather tools to help manage symptoms.” While lasers can be effective, it’s important to note that they can be quite expensive and, unfortunately, are rarely covered by insurance. 

## **IS ROSACEA CURABLE OR JUST MANAGEABLE?** 

Sadly, there is no cure for rosacea. That being said, there is a high success rate among patients in managing the condition. An experienced board-certified dermatologist can help prescribe or recommend the proper treatments, whether it be creams, oral medications, or laser therapy, while also helping to identify any lifestyle changes that could help minimize flare-ups. 

## **CAN DIET OR LIFESTYLE IMPACT ROSACEA?** 

Diet and lifestyle can absolutely impact rosacea. There are a number of different rosacea causes and triggers. It’ll vary from person to person, but generally speaking, rosacea sufferers will want to limit alcohol consumption, skip foods classified as common triggers, use fragrance free skin products (note: this is different than unscented), manage stress, apply sunscreen regularly, and avoid extreme temperatures (e.g. hot baths, showers, or saunas). 

## **HOW CAN I SOOTHE ROSACEA-PRONE SKIN NATURALLY?** 

If you’re having a rosacea flare-up, assess your diet and lifestyle to see if there are any potential triggers you can eliminate. From there, you can try natural remedies for rosacea, like applying products with ingredients that are known to have healing properties, like aloe, chamomile, green tea extract, or colloidal oatmeal. You can also try applying a cold compress or taking omega-3 fatty acid supplements (for ocular rosacea) to bring down any inflammation. While some of these natural remedies can be helpful, they don’t work for everyone. It’s best to work with your board-certified dermatologist to discuss how to treat rosacea naturally.

## **THE BOTTOM LINE** 

Rosacea is an inflammatory skin condition that can easily be confused with acne or even a sunburn. If you’ve noticed persistent facial redness, you’ll want to schedule a visit with your dermatologist right away. While there’s no current cure for rosacea, it can be managed with a combination of natural remedies, over-the-counter medications, prescription drugs, in-office laser therapy, and certain lifestyle or dietary changes. 


Expert Opinion

Discover everything you need to know about rosacea—from the four main types to common triggers and the most effective treatments. Learn how to manage this complex skin condition with expert-backed tips and skincare insights.

Rosacea 101: Types, Triggers & Treatments | Complete Skin Care Guide

Rosacea 101: Types, Triggers & Treatments 

shutterstock 626140784-min

As long as she could remember, Linda had beautiful skin (you know, the glowy and youthful kind you receive compliments on). But everything changed during a particularly stressful time in her life two years ago. At age 57, small blood vessels began reddening her cheeks and nose, and her facial skin grew so sensitive and painful that she dreaded even washing it. “It was really hard to look at myself in the mirror and accept that I was having this extreme redness,” she shares.

Linda sought out doctor after doctor — some of whom even tried to prescribe antidepressants to treat her skin condition — until, after seven agonizing months, a dermatologist finally diagnosed her with rosacea. The skin disorder, which impacts an estimated 16 million Americans, has symptoms ranging from facial redness and extreme sensitivity to pimply bumps (a.k.a. papulopustular rosacea) and irritated eyes (i.e. ocular rosacea).

## **Why Treating Rosacea Is Difficult**
The exact cause of rosacea is unknown, and flare-ups can be triggered by exposure to stress, heat, hormones, spicy foods, alcohol, and even caffeine. In Linda’s case, her constant worrying about her complexion definitely wasn't helping matters. “Because I was so stressed out about it,” she says, “I’m sure I was making it worse.”

Dermatologists usually treat rosacea symptoms with a combination of lifestyle modifications, light and [laser therapies](https://aedit.com/procedure/ablative-fractional-lasers), specialized skincare routines, and antibiotics, but many patients find it difficult to obtain coverage for these treatment options because insurance companies categorize the skin condition as “cosmetic.”

Frustrated by the lack of results from doctor-prescribed meds, Linda sought out a naturopath, who helped balance her hormone levels with supplements and an anti-inflammatory diet. But she still wanted more. Extensive research led Linda — a Minnesota resident — to West Hollywood’s [Jason Emer, MD](https://aedit.com/provider/jason-emer-md-722), a board certified cosmetic dermatologist who specializes in laser technologies.

Since there is no cure for rosacea, Dr. Emer opts for a multi-modality approach to managing it. He likens its chronic nature to having diabetes or high blood pressure. "You’re always going to have it, so you have to maintain treatment for it,” he says. He employs a regimen of in-office lasers, facial treatments, and light therapy, as well as various at-home therapies, to help patients keep their condition under control.

The treatment program is intensive at first. Linda, for instance, made monthly trips to Southern California for the first six months before switching to quarterly visits. Now two years into her journey, Linda invited The AEDITION to experience firsthand what it’s like to undergo one of her laser treatments.

## **Using Lasers and Light Therapy To Treat Rosacea**
When I met Linda in the reception area of Dr. Emer’s new Sunset Boulevard facility, the first thing I notice is her skin: It looks healthy and porcelain-hued, with no sign of the redness or inflammation I’d expected to see. Dr. Emer’s staff leads us into a treatment room, where a nurse applies a topical numbing cream to Linda’s face, before leaving the two of us to chat for about 40 minutes as the lotion takes effect.

Over the steady buzz of the laser machine warming up, Linda tells me that one of the hardest parts about having rosacea is the impact avoiding her triggers has had on her previously active lifestyle. “I like to ride my bike, kayak, walk,” she says. “But now I can’t just go out without thinking about it — I have to be careful.” Going out to eat can also be a challenge due to her dietary restrictions. “I can’t just have a glass of red wine with friends,” she shares, “because it’s not worth having to deal with the consequences.”

The nurse returns to remove Linda’s numbing cream in preparation for her treatment, and Dr. Emer arrives to calibrate the laser before getting started. In the past, he explains, the standard rosacea treatment was light therapy in the form of [intense pulsed light (IPL)](https://aedit.com/procedure/ipl), which just wasn’t that effective. Dermatologists were reluctant to combine technologies for fear that using lasers, light, and peels would overly irritate sensitive skin. “As it turns out,” he says, “[non-ablative lasers](https://aedit.com/procedure/nonablative-laser-skin-resurfacing) — ones that don’t burn the skin but just heat the underlying surface — actually help.”

Depending on the patient’s skin tone, Dr. Emer uses different lasers with an array of wavelengths. In Linda’s case, he combines the Vbeam® vascular laser (which exclusively targets the skin’s blood vessels) with the [Clear + Brilliant®](https://aedit.com/procedure/clear-brilliant) laser (which works on the skin’s surface to help decrease inflammation). According to Dr. Emer, just two or three sessions with these tools (coupled with a program of facials, skincare, and at-home light therapy) can help many patients achieve up to a year of remission. 

But are there any risks to doing all of this at once? Dr. Emer says that, when used incorrectly, the heat from the vascular lasers can damage the skin. He advises patients seek treatment with a board certified dermatologist for mild cases of rosacea and a cosmetic dermatologist (i.e. someone with extensive training in these advanced therapies) for more severe cases.

And what about the cost? On average, one session with a vascular laser ranges from $250 for a spot treatment to between $500 and $750 for larger areas like the face. Clear + Brilliant® runs about $500 per session, depending on the doctor and location.

As Dr. Emer prepares to apply the laser beam to Linda’s face, he places metal shields over her eyes and requires everyone else in the room to slip on purple-hued glasses to protect the blood vessels in our eyes (this laser can cause blindness). As the procedure begins, the handheld device imparts a dime-sized green light that glows on the skin in the moments before each high-pitched laser pulse. It sounds painful, but Linda seems unfazed. “They always say it feels like a rubber band snap,” she explains, “but I’ve never been super uncomfortable, no matter what he’s done.”

Partway through Linda’s treatment, Dr. Emer re-calibrates the Vbeam®, honing the focus to target her visibly dilated blood vessels. “This laser attracts the blood in the blood vessels. So, it heats it up and the vessel starts to spasm, which causes inflammation,” he says of the eight-minute procedure. “Then the body comes in and eats up the blood vessels.”

Next up: the Clear + Brilliant® treatment. The machine is considerably smaller than the Vbeam® — and much quieter, too. The nurse gives Linda a small, handheld fan to cool her face, as Dr. Emer carefully glides the device back and forth along every section of her skin. “By combining the deeper, vascular laser with the lighter, superficial laser, you actually get more improvement,” Dr. Emer says.

Minutes later, Linda's face is flushed but otherwise smooth and plump looking. She says her skin feels hot from the laser, and the nurse applies a crystal-fiber cooling mask to soothe it. After letting it sit for five minutes, the nurse follows it up with a 10-minute red LED light treatment to further soothe the inflammation. Post-treatment, things get worse before they get better — Linda says the redness usually persists for a few days and calms down over time.

Finished with her light therapy, Linda bids me farewell, still peppy and positive in spite of the afternoon’s scrutiny. She realizes how fortunate she is to have the means to make traveling for treatment a possibility. “For me, coming to Dr. Emer is more than worth it,” she says of her regular trips. “I have to take time off work to fly out here, but I see the results. I know I’m going to have rosacea for the rest of my life, but there is hope.”

She says her journey with rosacea has made her passionate about being her own health advocate. “Don’t take ‘no’ for an answer,” she shares. “There are things that can be done — you just have to find the right person to help you.”

Patient Perspective

An estimated 16 million Americans have rosacea. Here, one patient chronicles her experience with the skin condition and invites The AEDITION to join her for a laser treatment with her cosmetic dermatologist. 