Rosacea: causes, symptoms and how to control it

In short

• Rosacea is long-term; the goal is control, not a one-time fix.
• Sunlight is a common trigger, so daily sunscreen with SPF 30 or higher matters.
• Rosacea is not acne, and acne products can make it redder and more irritated.
• Long-term prescription-strength cortisone cream on the face can trigger flares.
• Eyes are often involved, and eye pain or vision changes need prompt attention.

What rosacea is and who gets it

Rosacea is a long-term inflammatory skin condition, usually showing up as redness and a rash on the nose and cheeks. The exact cause is unknown. Inflammation, sensitive skin, ultraviolet light, skin microbes and genetic and environmental factors are all thought to play a part. It is more common in middle-aged and older adults, in women (though men tend to have more severe cases) and in people with fair skin. It may be underdiagnosed in darker skin, where redness is harder to see.

It is not caused by poor hygiene and it is not contagious. Scrubbing harder does not help and often makes it worse.

Signs and symptoms

• Flushing that starts as temporary redness across the nose, cheeks, forehead or chin and can become persistent.
• A stinging or burning feeling when you use water or skin products.
• Small pink or red bumps, sometimes pus-filled, that resemble acne.
• Small visible blood vessels, usually on the cheeks and nose.
• Thickened skin, mostly on the nose, in some people.
• Dry, gritty, red or irritated eyes and eyelid problems.

Rosacea is not a form of acne. If you have been treating redness and bumps with over-the-counter acne products, they may dry out and irritate rosacea-prone skin and cause more redness. A health professional can tell the two apart, and other conditions such as dermatitis or lupus can also look similar.

Triggers: keep a diary

• Sun exposure and heat.
• Temperature extremes, wind, and dry or humid air.
• Hot drinks and spicy food.
• Alcohol, especially red wine.
• Intense exercise.
• Stress and strong emotion.
• Cosmetics with fragrance, alcohol or abrasive ingredients.

Triggers differ from person to person, so you do not need to give up everything on the list. For two weeks, note what you ate and drank, the weather, your activity and when a flare happened. Then drop the one or two most frequent culprits and see what changes. That is more useful than following a generic list of bans. Some medicines can also trigger flares, so tell your provider about everything you use.

Everyday skin care

1. Cleanse gentlyUse a mild, non-drying cleanser without alcohol or astringents, and avoid rubbing, scrubbing and over-washing.
2. MoisturizeUse a gentle moisturizer made for sensitive skin, especially in winter.
3. Protect from the sunUse a daily broad-spectrum sunscreen with SPF 30 or higher, wear a hat and avoid the strongest midday sun.
4. Avoid irritantsSkip scrubs, alcohol-based toners and products with fragrance or abrasive particles.
5. Add one product at a timeIntroduce new products slowly, one at a time, so you can tell which one causes a reaction.
6. Cover up if you likeCamouflage makeup can hide redness and bumps; remove it gently.

In cold weather, cover your face, and try to avoid heat and humidity where you can. Managing stress also helps some people.

Treatment options in general terms

Treatment is matched to your main symptom and is often combined. A primary care provider can start it, and a dermatologist is the next step if it is not working. Medicines are used as prescribed by a doctor.

• For bumps and pimples: prescription creams or gels, such as azelaic acid, metronidazole or ivermectin.
• For temporary redness: a prescription gel that narrows blood vessels.
• For more severe or stubborn cases: a course of oral antibiotics for several weeks, or other oral medicines for severe disease.
• For visible blood vessels and redness that do not respond to other treatment: laser therapy.
• For thickened skin on the nose: laser resurfacing or surgery.
• For eye symptoms: daily eyelid cleaning and care from an eye doctor.

One safety point: long-term use of prescription-strength cortisone creams on the face can trigger flares, a pattern known as steroid rosacea, and can worsen existing rosacea. If you have used a steroid cream on your face and the redness is getting worse, talk to your doctor before you stop or change anything.

Rosacea and your eyes

More than half of people with rosacea may have eye symptoms. These include bloodshot, gritty or dry eyes and itchy or flaky eyelids, and untreated eye involvement can damage the eye. Sometimes eye problems appear before skin changes, so tell your provider about recurring styes or irritated lids.

Eye pain, blurred vision, sensitivity to light, a red eye or a gritty feeling can be signs of keratitis, which can be serious. That calls for same-day attention from an eye doctor or urgent care, not a wait-and-see approach.

Myths and facts

• Myth: rosacea means dirty skin. Fact: it is an inflammatory condition, and aggressive cleansing makes it worse.
• Myth: treat it like acne. Fact: acne products can irritate rosacea, and the approach differs.
• Myth: a red face means heavy drinking. Fact: alcohol can set off flushing, but people who never drink get rosacea too.
• Myth: it is only cosmetic. Fact: rosacea can affect quality of life, and eye disease can threaten vision.

When to see a doctor

Red flags: go to an emergency department or call 911 for sudden vision loss. Get urgent care the same day for eye pain, blurred vision, light sensitivity or a red, gritty eye.

Make a routine appointment with your primary care provider or a dermatologist if you have symptoms of rosacea, because it does not go away on its own and can worsen without treatment. Go back sooner if the redness has not responded to gentle care, the skin on your nose is thickening, a flare followed the use of a cortisone cream, or the condition is affecting your mood or social life.

Questions for your dermatologist

• Is this rosacea or another facial skin condition?
• Which of my symptoms should treatment target first?
• Which cleanser, moisturizer and sunscreen suit my skin?
• Should I see an eye doctor?
• Would laser treatment of the blood vessels make sense for me?
• How long before I should expect results?

Questions and answers

Sources

1. NIAMS — Rosacea
2. MedlinePlus — Rosacea
3. NHS — Rosacea
4. NHS — Rosacea: treatment
5. Canadian Dermatology Association — Rosacea

Sources checked on 29 October 2026.