Look in the mirror, and closely examine your skin. Do you always look like you have a mild sunburn, despite religious SPF use? Maybe your skin has a rough, bumpy texture that just won’t smooth out, no matter how many exfoliants you try, take a deep breath and put down the scrub. You might just have a common — and frequently underdiagnosed — condition: rosacea.
At least 16 million people in the United States have rosacea, and many of them don’t even realize it. That’s because rosacea can tend to look like adult acne, with tiny little pustules appearing on the nose and cheeks. However, despite some similarities, the two skin concerns can’t be treated the same way. And, just like acne, rosacea can be notoriously challenging to manage — but it’s not hopeless. We consulted two dermatologists to help shed some light on what causes rosacea, what some of the common triggers are, and what the best skincare regimen looks like. Plus, you’re about to start keeping a diary, but not in the way you might think!
What is rosacea?
There’s still much we have yet to learn about rosacea. What we do know is that genetics may play a pivotal role in whether or not someone develops the skin condition, says Deanne Mraz Robinson, MD, a board-certified dermatologist and co-founder of Modern Dermatology® of Connecticut. Those with Irish, English, Scottish, Scandinavian, or Eastern European heritage seem to be especially prone to developing rosacea compared to others with darker skin tones.
We also know that rosacea often presents as pronounced flushing or visible blood vessels on the central part of someone’s face — including cheeks, nose, forehead, and chin. Although the aforementioned symptoms are what we commonly associate with rosacea, Dr. Robinson says there are actually four primary types.
The first is papulopustular rosacea, which presents as redness, swelling, and acne-like breakouts. Then, there’s erythematotelangiectatic rosacea — it looks like persistent redness with visible blood vessels. Phymatous rosacea looks like thick skin that also has a bumpy texture. And lastly, ocular rosacea, which manifests as inflammation and redness of the eyes, and swollen eyelids. (Those with this type may also be more prone to developing a sty or other ocular issues.) That said, it’s possible to experience all of the above symptoms if you have rosacea, while some people may only experience minor flushing.
How can I tell if I have rosacea?
If you’re not sure whether you have rosacea or not, redness and sensitive skin are common tell-tale signs, notes Hadley King, MD, a board-certified dermatologist based in New York City. “You may find many topical products irritating, and you may experience redness in the central face and/or episodic flushing that may be accompanied by a feeling of warmth, burning, or stinging,” she explains. You may also experience small pimples that come and go more than regular acne. Furthermore, you’ll observe that your rosacea appears worse at some times than others. That’s because rosacea is easily triggered by external factors.
What triggers a rosacea flare-up?
Your love of pinot noir, buttery croissants, and once-a-quarter trips to Bermuda may be feeding your soul but harming your skin. As it turns out, the most common rosacea triggers include emotional stimuli, hormonal changes, sun exposure, temperature changes, hot beverages, spicy foods, alcohol, and chocolate. The same goes for your skincare: your beloved coffee bean-infused face scrub could be the rosacea culprit. According to Dr. King, certain skincare products, particularly those with exfoliating properties or aggressive actives, may also cause flare-ups.
While this list of triggers can seem overwhelming, don’t get defeated just yet. Not all of these stimuli are bound to trigger your specific case of rosacea. Start keeping a daily diary to track your flare-ups and see if there is a correlation with what you’ve eaten or what you’ve experienced, so you can learn to avoid your specific triggers in the future. The National Rosacea SocietyTM offers a template on its website that asks about the weather conditions, food, and beverages you’ve consumed (including spicy meals!), and activities you’ve completed (such as heavy exercise or an overly hot bath). Seeing all of this data in one place may help you see correlations between your daily behaviors and your skin.
What is the best skincare routine to manage and soothe my rosacea?
Gentle products that bolster your skin’s moisture barrier are key for anyone battling rosacea — they’ll not only help restore much-needed hydration to your skin, but also protect your complexion from the elements. “This includes gentle cleansers that are free of detergents and fragrances, as well as high-quality moisturizers that contain ceramides or other emollients,” says Dr. King.
As you look for new products, seek out gentle herbal ingredients, like chamomile and calendula. You can find these in the Paula's Choice® Softening Cream Cleanser ($18) and Eminence® Organic Skin Care Calm Skin Chamomile Cleanser ($42). Another ingredient to seek out is azelaic acid, which Dr. King notes is a powerful anti-inflammatory and antimicrobial ingredient. We’re fond of The Ordinary® Azelaic Acid Suspension 10% ($8), which features a high percentage of the ingredient to help smooth out skin’s texture.
Dr. King adds that there are a variety of topical prescription medications that can be helpful for rosacea, and some people will find certain ingredients more helpful than others. “There are topical products like brimonidine and oxymetazoline, which help decrease redness by constricting superficial blood vessels in the skin, and we sometimes use oral doxycycline for its anti-inflammatory effects,” she says. “Topical ivermectin is a newer treatment that is an antiparasitic agent, but the exact mechanism of action by which it works for rosacea is not clear.” Another mainstay rosacea treatment is metronidazole cream or gel, which boast anti-inflammatory and antimicrobial properties.
[Editor's note: Metronidazole shouldn't be used by women who are pregnant, considering getting pregnant, or nursing. As always, talk to your doctor before starting any new treatment or medication.]
Finally, devices such as IPL (intense pulsed light) and pulsed dye lasers can also be helpful in minimizing the appearance of redness. Learn more about how pulsed dye lasers (like VBeam®) can help reduce the look of broken capillaries here.
While the above advice comes straight from the mouths of experts, you should still consult with your own dermatologist to figure out a treatment plan. He or she can work with you to help identify triggers and devise a customized routine that allows you to repair your skin and manage rosacea flare-ups.
Dr. Deanne Mraz Robinson is a paid Allergan® consultant.