In short: Rosacea is a chronic, relapsing skin condition of the face that typically appears from around age 50 onward, with persistent redness, small visible blood vessels (telangiectasias), occasional flushing and sometimes small pustules. The exact cause is not fully understood; a hypersensitive skin barrier, vascular regulation disturbances and environmental factors all play a role.

What is rosacea?

Rosacea is a chronic, relapsing skin condition of the face that typically appears from around age 50 onward. It presents with persistent redness, small visible blood vessels (telangiectasias), occasional flushing and, in somewhat more pronounced cases, small pimples or pustules.

The exact cause is not fully understood. However, a hypersensitive skin barrier, disturbances in vascular regulation and environmental factors all play a role together.

Cornerstones of treatment

1. Daily skincare

Gentle, soap-free cleansing of the face twice daily.
Applying a fragrance-free, moisturising cream to strengthen the skin barrier.
Avoiding irritating cosmetic products, such as alcohol-based toners or harsh exfoliants.

2. Consistent sun protection

Apply a water-based, broad-spectrum sunscreen with at least SPF 30 daily, ideally containing zinc oxide or titanium dioxide.
Additional protective measures such as wide-brimmed hats, since UV light is a known trigger for flare-ups and worsening of rosacea.

3. Identifying and avoiding triggers

A diary of diet, emotional stress and environmental factors helps identify individual triggers — most people affected are able to name such triggers.

Common triggers: alcohol (especially white wine and spirits), spicy foods, hot beverages, extreme temperatures, emotional stress and intense sun exposure.
Alcohol consumption should be reduced, as it can increase both the risk and severity of rosacea; a comparable link has not so far been consistently demonstrated for tobacco use.

4. Medication tailored to symptoms

For persistent redness: a topical gel containing brimonidine, or a cream containing oxymetazoline, can markedly and temporarily reduce redness within 30 minutes to a few hours.
For small pimples or pustules: topical metronidazole gel, azelaic acid gel or ivermectin cream are effective first-line options; ivermectin shows the highest efficacy in clinical studies, while metronidazole remains a well-established standard.
These topical treatments are applied for at least eight to twelve weeks; once symptoms have subsided, continued low-dose use is recommended to help prevent relapse.

What follows if symptoms persist or intensify

If symptoms do not improve sufficiently with topical treatment, a low-dose oral doxycycline therapy may be a useful addition. For pronounced flushing that does not respond adequately, beta-blockers may also be considered. These steps already concern moderate forms of the condition and are discussed individually with the treating physician.

Rosacea cannot be cured, but it can be well controlled with consistent skincare, sun protection and trigger avoidance.

Important notes

Regular follow-up visits to the dermatologist help track the response to treatment and further narrow down individual triggers.
If the eyes are affected — for example redness, a foreign-body sensation or dryness — an additional ophthalmological assessment should be arranged.

Sources

Taieb A. et al., Superiority of ivermectin 1% cream over metronidazole 0.75% cream in treating inflammatory lesions of rosacea, British Journal of Dermatology.
National Rosacea Society, New Survey Pinpoints Leading Factors that Trigger Symptoms.
Alinia H. et al., Rosacea Triggers: Alcohol and Smoking, Dermatologic Clinics.

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Rosacea Treatment ProtocolMild rosacea from age 50