Rosacea can be an incredibly tricky skin condition to manage and stressful to deal with, especially during a flare-up. First, you’ve got to figure out what subtype you have, then work out your triggers, and finally get to grips with an effective skincare routine to give you relief. 

The good news is we’re going to arm you with all the knowledge you need, including exactly what rosacea is, what causes it, and how to get rid of it permanently — well, as much as you can anyway.

What is rosacea?

Rosacea is a chronic inflammatory skin condition with 4 subtypes: erythematotelangiectatic (persistent redness), papulopustular (often known as acne rosacea due to pustules present), phymatous (thickened skin) and ocular (rosacea of the eyes) [1]. Each of these subtypes can range from mild rosacea to severe rosacea.

It typically presents on the central part of the face, across the cheeks and nose. 

Rosacea affects approximately 10% of the global population and it is more common in women and those with fair skin, although this could be because it’s often misdiagnosed [2][3].

Despite common misconceptions, all skin tones can have rosacea, including brown or black skin, which in erythematotelangiectatic rosacea, is typically characterised by purple or a darker brown tone to the skin. 

Symptoms of rosacea include facial flushing (particularly in fluctuating temperatures), persistent redness, a purple or darker tone to the face, whiteheads or papules, visible blood vessels, burning or stinging, dry skin, skin thickening, sensitive skin, and eye irritation. 

The number of symptoms you have depends on the severity of your rosacea and the subtype you have.

What causes rosacea?

Unfortunately, the exact cause of rosacea is still unknown. There are, however, a few proposed causes. 

Genetics

It’s thought that you’re more likely to experience rosacea if you have a family history of the condition. Though that’s not been solidly proven, there is a strong link [4]. 

Blood vessel abnormalities 

Abnormalities with the vascular system could have a possible link with rosacea flare-ups, some research says. Although this gets quite complicated, to put it simply: the way the vascular system and the nervous system work in some people might be the cause of typical symptoms of rosacea like flushing and inflammation [5]. 

Bacteria 

The bacteria known as Helicobacter pylori (H. pylori) is another theory; yet to be proven. It’s thought that the bacteria in the digestive system disrupt the body’s inflammatory response. In turn, this bacteria can cause the development of acne rosacea (papulopustular) specifically [6].

For these causes, often getting to the bottom of the bacteria can impact the skin. But again, this isn’t solidly proven and doesn’t explain the causes of other subtypes of rosacea. 

Mites 

Yep, you read that right. Mites is another theory. But don’t panic because we’re talking about demodex folliculorum, microscopic mites. These mites live on our skin harmlessly — often in our eyelashes — whether we have rosacea or not [7].

The issue, however, is that some studies have shown people with rosacea have an increased number of these mites [8].

It gets a little worse — sorry. Some researchers think that our skin is reacting to the mites' faeces and causing symptoms of rosacea. We know, it’s not a very sexy theory at all. 

Overactive immune system 

Ongoing research looking into the immune systems cathelicidins — a type of antimicrobial peptide that helps fight off bad bacteria and illness — shows that this is increased in rosacea patients [9]; resulting in inflammation and pustules associated with papulopustular rosacea.

Common rosacea triggers

Now, identifying triggers can be transformative for many people living with rosacea. It helps you understand your rosacea symptoms better, prevent flare-ups and manage them better. 

The most common rosacea triggers include [10]: 

Sunlight 

Protecting your skin from UV rays is the first step in managing symptoms, as sunlight is a major trigger for most people with rosacea — 81% in fact [11].

Staying outside of direct sunlight during peak hours for extended time periods, wearing UV protective clothing, and regularly applying sunscreen are all important to reduce sunlight triggers. 

Additionally, get into the routine of wearing sunscreen every day (yep, every day), even when it’s cloudy or raining. Oh, and make sure your sunscreen hasn’t expired as this reduces its effectiveness.   

Heat and weather fluctuations 

Alongside sunlight, heat increases facial flushing and can trigger rosacea, and 53% of people note hot weather for their worsening symptoms [12]. Similarly, fluctuations in temperature, i.e. being in cold weather and then heading into a heated building, can cause flare-ups. 

In the same way, hot beverages can make rosacea worse for some people.

Exercise 

Vigorous exercise is also said to be a trigger among 39% of people thanks to a rising body temperature [12]. The advice here is to stay cool whilst exercising, not exercise in excessive heat or sunlight and break up training to avoid overheating. 

Stress

Research by Dr. Richard Granstein and his team shows that people with rosacea have an increased nerve, blood flow and sweating response when exposed to heat and stress, which can exacerbate symptoms like redness [12]. Learning to reduce stress is easier said than done but doing so can prevent flare-ups.

Spicy foods 

Your skin is, indeed, what you eat. Spicy foods are a trigger for quite a few rosacea sufferers as they can stimulate receptors that cause redness and feelings of facial burning. 

Alcohol 

Alcohol is another trigger for many, with red wine specifically being noted as the biggest culprit. In addition to being a trigger, a 2017 study showed that there’s a higher risk of developing rosacea if you’re a regular alcohol drinker [13].

The bottom line: It can be a little overwhelming figuring out what your triggers are but there’s no rush. Take it slowly by writing down a list and using a process of elimination.

Can rosacea be cured permanently?

The question of how to get rid of rosacea permanently is a tricky one. Sadly, there is no known cure for rosacea but symptoms can be improved greatly so that they’re almost undetectable in the cases of erythematotelangiectatic and papulopustular rosacea.

Once you’ve identified your triggers and have a great treatment plan in place, you can significantly reduce symptoms, especially when it comes to persistent redness and pustules. 

As with many chronic conditions, your rosacea will likely worsen and improve during various stages of your life. These fluctuations can be due to hormones, other health conditions, lifestyle factors and periods of stress, for example.

This means that rosacea requires a long-term plan that is consistently updated as needed.

How to treat rosacea

The great news is that there are many treatments out there for rosacea-prone skin despite it being a chronic skin condition, from topical medications and oral medications to professional treatments. 

Azelaic acid

One of the most widely used ingredients when treating rosacea is azelaic acid. It’s a naturally-occurring dicarboxylic acid, which is produced by yeast on the skin. It is found in wheat, barley and animal products, but is often created in a lab when it comes to skincare products. 

It works by preventing and killing bacteria on the skin and acting as an anti-inflammatory with minimal side effects or irritation. It’s very well tolerated, even by sensitive skin types, making it a highly popular choice — particularly if you’re struggling with rosacea bumps and breakouts. 

Our pigmentation treatment contains targeted ingredients designed just for you, taking the guesswork out of your skincare. Take our online consult and an Australian health practitioner will create a custom formula based on your skin concerns.

Prescription treatments 

There are a variety of prescription treatments, including antibiotic creams that help due to their anti-inflammatory and anti-parasitic activity. Taking an oral antibiotic is also available for patients in certain cases. 

Sunscreen 

One of the best ways to prevent flare-ups is to apply sunscreen daily — Software's Daily Facial Sunscreen SPF50+ is a great option — and avoid sun exposure, by staying indoors during peak sunlight hours and covering up with UV-protective clothing if you do go outside.

Consistent skincare routine 

Another important factor is a consistent skincare routine that focuses on barrier repair; essentially keeping the bad stuff out and the good stuff in. This also helps with other rosacea symptoms like dry skin, sensitive skin and skin irritation.

Use mild and as few products as possible, and be gentle when cleansing and moisturising to limit irritation. 

Rosacea-prone skin can be fussy so keeping it simple is always effective.

In-clinic treatments 

In-clinic, professional treatments like mild chemical peels can help the redness and pimples but must be done with caution and carried out by someone who is highly trained. 

You can also get laser therapy to rid or lessen the appearance of visible blood vessels. Stronger laser treatment can be used to help with skin thickening. 

Makeup 

There’s no reason you should feel like you have to conceal the redness or breakouts associated with rosacea, but it’s something many opt to do. That’s where excellent foundations can make a big difference if you’re feeling a little low from the persistent redness. 

Green colour-correcting treatments also work well to conceal redness and visible blood vessels without the need for heavy makeup. 

What products should you avoid with rosacea?

There are a few products that experts recommend avoiding (or, at the very least, proceeding with caution) if you have rosacea symptoms. 

Fragrance 

For most people, fragrance won’t cause an issue. However, in rosacea patients who have highly sensitive skin, you might find it exacerbates your symptoms, so look for products that are fragrance-free until you can rule it out as not being a trigger. 

Essential oils

Essential oils are a lesser-known trigger. Although some evidence suggests that certain essential oils like tea tree can help with mites, they're a common trigger for redness and sensitivity, so are best avoided. 

Strong acids 

Ingredients like glycolic and salicylic acid are great for exfoliation but can be a little too strong for sensitive skin types.

It’s best to avoid strong exfoliants where possible until your rosacea is a little more under control. Unlike acne, these treatments typically don't work for the breakouts experienced with rosacea-prone skin.

Or, if you really want to use these products, work with an expert or dermatologist to correctly incorporate them into your routine.

What happens if rosacea goes untreated?

Those with mild rosacea cases may not realise they have the condition and can manage it at home with a good skincare routine, protecting the skin barrier. However, for most, the condition worsens if left untreated. Severe rosacea is much harder to treat so getting flare-ups under control is always a good idea.

If you’ve tried to manage your rosacea at home yourself, speak with a skin expert or board-certified dermatologist who can help you with a rosacea treatment plan. 

Photo credit: Angela Roma / Pexels