Understanding Rosacea: Why Your Skin Flushes

If your face turns pink or red at the drop of a hat- a warm drink, a sunny day, a stressful deadline- you might not just have “sensitive skin.” You might have rosacea, a common but underappreciated chronic skin condition.

As a dermatologist, I see rosacea frequently. It’s not a hygiene issue or just “adult acne gone weird.” It’s a complex interplay of vascular, inflammatory, and environmental factors. Let’s get into what it is, how it shows up, what seems to provoke it (including some emerging research), and what actually helps.

What Is Rosacea?

Rosacea is a chronic inflammatory condition that primarily affects facial skin (nose, cheeks, forehead, chin). It involves hyperreactivity of blood vessels, persistent redness, and sometimes inflammatory bumps. It’s not contagious.

There are several subtypes (and many patients have overlap):

• Erythematotelangiectatic rosacea- persistent redness and visible small blood vessels (telangiectasia)

• Papulopustular rosacea- red bumps and pustules (can mimic acne, but it’s not classic acne)

• Phymatous rosacea- skin thickening, irregular texture (often on nose)

• Ocular rosacea- affects the eyes (burning, dryness, redness, irritation)

Rosacea is a “flare-remission” kind of disease. You may go weeks or months with minimal symptoms, then hit a flare period if a trigger comes into play.

When Does Rosacea Start?

Rosacea most often appears during adult life, typically in the 30s to 50s. It can, in some cases, start earlier, especially in those with lighter skin or a family history of flushing or sensitivity. Women are more frequently diagnosed than men, but men often present with more severe forms (especially the phymatous subtype).

It’s rare (though not impossible) for rosacea to begin in childhood. Usually, it shows up after puberty and becomes more evident in adulthood.

What Causes Rosacea & What Triggers Flares

Here’s where things get interesting. Rosacea doesn’t have a single cause. It’s multifactorial. Some underlying predispositions (genetic, vascular, immunologic) set the stage. Triggers kick off the visible flares.

Here are well-known triggers and some newer findings to keep on your radar:

Common Triggers

• Heat and temperature shifts: hot showers, saunas, ambient heat, sudden changes from cold to warm

• Sun exposure (even mild UV)

• Spicy foods, hot beverages

• Alcohol, particularly red wine

• Emotional stress, hot flashes

• Wind, cold weather

• Skin care / cosmetic ingredients: fragrances, alcohol, strong acids, certain essential oils

• Exercise that causes overheating

• Smoking / vaping (worsens vascular reactivity)

• Hormonal shifts: menstruation, perimenopause, hormone therapies

What Makes Rosacea Better (and How to Treat It)

Over-the-Counter & Supportive Skincare

The goal is to soothe, repair, and protect; not to bombard.

• Gentle, non-foaming, fragrance-free cleansers (no harsh surfactants)

• Moisturizers that support barrier function (look for ceramides, niacinamide, squalane)

• Mineral (physical) sunscreens (zinc oxide, titanium dioxide). Avoid stinging formulations

• Green-tinted or neutralizing primers to camouflage redness (used carefully)

• Anti-oxidants (vitamin C in gentle forms, niacinamide)

• Avoid irritating ingredients (alcohol, fragrance, high-concentration acids, menthol)

A minimalist regimen is often best during flares.

Prescription & Medical Treatments

If OTC measures aren’t enough, here are the options your dermatologist might consider:

• Topical therapies
   – Metronidazole
   – Azelaic acid (cream or gel)- good bonus: it may help with pigmentation
   – Ivermectin (e.g. Soolantra)
   – Topical vasoconstrictors: brimonidine (Mirvaso) or oxymetazoline (Rhofade)- reduce visible redness temporarily

• Oral medications
   – Low-dose doxycycline (subantimicrobial dosing)- anti-inflammatory more than antibiotic
   – In more severe cases, full-dose antibiotics or other systemic agents

• Procedural / energy-based
   – Pulsed dye laser (PDL or VBeam) targets blood vessels
   – Intense pulsed light (IPL)
   – Other vascular lasers or combination approaches

• Adjunctive strategies
   – Strict trigger avoidance
   – Barrier repair
   – Consistency (treatment takes weeks to months)