Acne and Rosacea: Symptoms and Effective Treatments

Understanding Rosacea¹ ²

Rosacea is a chronic inflammatory skin condition characterised by various symptoms, including persistent redness, sudden flushing episodes (known as vasomotor flushes), visible small blood vessels beneath the skin (telangiectasias), and the appearance of papules or pustules. Primarily affecting the face, much like acne, it can also involve the eyes and significantly impair the quality of life.

Rosacea affects around 5% of the world’s population, although mild cases often go undiagnosed. It is most common in adults aged 30 to 50, with higher prevalence among women and individuals with fair skin.

The Mechanisms of Rosacea

Rosacea arises from several complex, interacting processes in the skin:

• Vascular dysfunction: Facial blood vessels may dilate excessively in response to triggers such as spicy foods or alcohol, resulting in flushing and persistent redness.
• Exaggerated immune response: An overactive skin immune system drives inflammation, producing mediators that worsen erythema and promote further vessel dilation.
• Microbial involvement: Some microorganisms, including the skin mite Demodex folliculorum and the stomach bacterium Helicobacter pylori, can exacerbate these inflammatory reactions.

Causes and Predisposing Factors of Rosacea

The precise cause of rosacea remains unknown, but several factors contribute:

• Genetic predisposition: A family history of rosacea is frequently observed.
• Environmental triggers: Exposure to UV radiation, rapid temperature changes, alcohol consumption and spicy foods can provoke flare‑ups.
• Microorganisms: Elevated numbers of Demodex mites in affected areas and H. pylori in the gut may exacerbate symptoms.
• Neurovascular dysregulation: Abnormal vessel responsiveness, combined with heightened neuronal reactions to external stimuli, contributes to redness and flushing. 

Identifying Symptoms and Subtypes of Rosacea¹ ³

Common Symptoms of Rosacea

Rosacea is a chronic inflammatory disease. Key facial signs of rosacea include:

• Persistent redness (erythema) on the nose, cheeks, forehead or chin
• Recurrent flushing episodes
• Visible small veins (telangiectasias)
• Papules and pustules that resemble acne but lack comedones
• Ocular symptoms in approximately 50 to 75% of cases—dryness, redness, burning sensations or blurred vision

Because rosacea predominantly affects the face, it can have a profound psychological impact, leading to embarrassment, social withdrawal and symptoms of anxiety or depression.

The Clinical Subtypes of Rosacea

Rosacea manifests in four main clinical subtypes, which may present individually or overlap:

• Erythemato telangiectatic rosacea: persistent redness with visible telangiectasias ( visible small veins under skin), often accompanied by flushing.
• Papulopustular rosacea: resembles acne, with inflammatory papules and pustules in the centre of the face.
• Phymatous rosacea: characterised by skin thickening and sebaceous gland enlargement , most notably on the nose (rhinophyma).
• Ocular rosacea: affects the eyes, causing irritation, dryness, and eyelid inflammation (blepharitis).

Subtypes can evolve, and dominant features may change over the course of the disease.

Treatment Options for Rosacea¹ ⁴

Management of rosacea aims to alleviate symptoms, reduce the frequency of flare‑ups and slow disease progression. While there is no definitive cure, tailored treatments can markedly improve patients’ quality of life. Each subtype requires a specific approach, combined with lifestyle adjustments to limit triggering factors.

General Measures and Skincare

The first step is identifying and avoiding personal triggers such as sun exposure, spicy foods, alcohol and extreme temperatures. Recommended skincare measures include:

• Gentle, pH-balanced cleansers to minimise irritation
• Broad‑spectrum sunscreens (SPF 30 or higher) formulated for sensitive skin
• Non‑comedogenic moisturisers suited to delicate skin
• Green‑tinted colour‑correcting cosmetics to camouflage redness
• Avoid irritating products and topical steroids, as these can worsen rosacea.

Topical Treatments

Topical agents—such as brimonidine, ivermectin, azelaic acid and metronidazole creams—target redness, papules and pustules. They reduce inflammation and improve skin appearance, making them especially useful for mild to moderate rosacea.

Systemic Treatments

In more severe or widespread cases, oral antibiotics, notably tetracyclines, may be prescribed to control inflammatory lesions. These systemic treatments also help manage persistent or local treatment‑resistant symptoms.

Surgical and Laser Interventions

For persistent redness, visible telangiectasias or rhinophyma, procedures such as intense pulsed light therapy, laser treatments and surgery can be considered. These interventions often yield significant aesthetic improvements. 

Treatment of Ocular Rosacea

Ocular rosacea, which affects the eyes and eyelids, requires specialised management to alleviate symptoms and prevent complications.

• Antibiotics and Ocular Care

Oral tetracyclines are the cornerstone of treatment. In some cases, tetracycline‑based eye drops may be used locally. For dry eye symptoms, preservative‑free artificial tears are recommended to hydrate and soothe the ocular surface.

• Eyelid Hygiene
  Regular, gentle eyelid care can reduce inflammation: 

- Apply a warm, damp compress to the eyelids for 10 minutes to soften crusts.

- Gently massage the eyelids—upward strokes on the upper lids and downward strokes on the lower lids.

- Rinse the eyes with a single‑use saline solution.

Medical Follow‑Up and Treatment Adherence

Adhere strictly to prescribed treatments—whether topical or systemic—without altering or discontinuing them without medical advice. Consistent use ensures optimal symptom control and minimises relapse risk.

Report any side effects or discomfort to your dermatologist promptly so that the regimen can be adjusted if necessary. Report any new symptoms as unusual redness or eye discomfort that could be burning sensation, redness, feeling of foreign body to ensure rapid and appropriate treatment. 

Avoid self‑medication, as certain medications can exacerbate rosacea. Always ask your doctor before starting a new treatment.

Identifying and Avoiding Triggers

Common precipitating factors include:

• Dietary triggers: Spicy foods, very hot beverages, alcohol, and, for some individuals, dairy products, tomatoes, citrus fruits, or chocolate.
• Climate: Protect your skin from cold, wind and humidity—use scarves or masks to shield the face.
• Sun exposure: Wear a wide-brimmed hat, UV-protective sunglasses, and high SPF sunscreen suitable for sensitive skin.
• Exercise: Opt for moderate activity to avoid overheating.

Skincare Routine

• Cleansing: Wash your face in the morning and evening with fragrance-free, non-irritating cleansers. Pat dry gently and apply a suitable non-comedogenic moisturiser.
• Avoid irritants: Steer clear of products that contain alcohol, heavy oils, or fragrances. Use makeup labelled “non‑comedogenic” to prevent pore blockage.
• Camouflage: Use corrective makeup to conceal visible redness and improve comfort.

Lifestyle and Prevention

Adopting new daily habits can reduce symptoms and flare-ups

• Identify your triggers and adapt your habits accordingly.
• Protect your skin from environmental aggressors.
• Schedule regular check‑ups with your dermatologist to monitor disease progression and adjust treatment as needed.