What Is Rosacea and How Is It Managed?

Name: What Is Rosacea and How Is It Managed?
Creator: Marcus Johnson, RN, BSN
Published: 2026-02-12T19:50:55.259Z

Understanding rosacea triggers, subtypes, and evidence-based treatments for facial redness, bumps, and flushing.

MJRB

Written by Marcus Johnson, RN, BSN

RN, BSN, Health Writer

DMO

Reviewed by Dr. Michael Okafor, MD, FAAD

Board-Certified Dermatologist · Northwestern Medicine

Written Feb 12, 2026Reviewed Feb 12, 2026Fact-checked Feb 12, 20262 sources citedMedically Fact-Checked

How Should You Manage Rosacea?

Identify and avoid your personal triggers, establish a gentle skincare routine with mineral sunscreen, use prescribed topical treatments consistently, and consider laser therapy for persistent redness and visible blood vessels. A dermatologist can create a personalized treatment plan based on your rosacea subtype.

Start with trigger identification using a diary. The National Rosacea Society's most commonly reported triggers are sun exposure (81%), emotional stress (79%), hot weather (75%), wind (57%), heavy exercise (56%), alcohol (52%), hot baths (51%), cold weather (46%), spicy foods (45%), and humidity (44%). Once identified, avoidance of top triggers significantly reduces flare frequency.

A rosacea-friendly skincare routine includes a gentle, fragrance-free cleanser, moisturizer with ceramides and/or niacinamide, and mineral sunscreen (zinc oxide or titanium dioxide) SPF 30+. Chemical sunscreens can irritate rosacea-prone skin. Apply all products gently without rubbing. Green-tinted color-correcting primers can help camouflage redness. Introduce new products one at a time with a 2-week trial period.

NRS survey identified sun exposure (81%) and stress (79%) as top rosacea triggers

What Prescription Treatments Are Available?

Topical treatments include metronidazole (anti-inflammatory), azelaic acid (anti-inflammatory and antimicrobial), ivermectin (targets Demodex mites), and brimonidine gel (alpha-agonist vasoconstrictor for redness). Oral treatments include low-dose doxycycline (anti-inflammatory dose) for moderate-severe papulopustular rosacea. Laser therapy treats vascular components.

Strong EvidenceHead-to-head RCTs demonstrate ivermectin superiority; multiple RCTs support all listed treatments.

For papulopustular rosacea, topical ivermectin 1% cream (Soolantra) has emerged as a highly effective first-line option, showing superior efficacy to topical metronidazole in head-to-head trials. Applied once daily, it targets both inflammatory papules and the Demodex folliculorum mite implicated in rosacea pathogenesis. Azelaic acid 15% gel (Finacea) is another effective option with additional benefits for post-inflammatory pigmentation.

For persistent background erythema, brimonidine 0.33% gel (Mirvaso) and oxymetazoline 1% cream (Rhofade) provide temporary vasoconstriction reducing visible redness for 8-12 hours. These are used as-needed for social situations or daily maintenance. Pulsed dye laser (PDL) and intense pulsed light (IPL) treatments provide more lasting reduction of telangiectasia and background redness, typically requiring 2-4 sessions with maintenance treatments every 6-12 months.

Topical ivermectin showed superior efficacy to metronidazole in head-to-head trials

Frequently Asked Questions

Is rosacea curable?

Rosacea is a chronic condition without a cure, but symptoms can be effectively managed with appropriate treatment. Many patients achieve significant improvement and long periods of remission with a combination of trigger avoidance, gentle skincare, topical medications, and laser treatments. Ongoing maintenance therapy is typically needed to prevent flare-ups.

What skincare ingredients should rosacea patients avoid?

Avoid alcohol-based products, witch hazel, menthol, peppermint, eucalyptus, fragrance, sodium lauryl sulfate, and strong retinoids. Alpha hydroxy acids and physical scrubs can worsen rosacea. Choose fragrance-free, gentle cleansers (micellar water or cream cleansers), mineral-based sunscreens (zinc oxide/titanium dioxide), and moisturizers with ceramides and niacinamide.

Can diet affect rosacea?

Yes. Common dietary triggers include alcohol (especially red wine), spicy foods, hot beverages, histamine-rich foods, and cinnamaldehyde-containing foods (tomatoes, citrus, chocolate). A National Rosacea Society survey found that 78% of patients reported dietary triggers. Keeping a food diary helps identify personal triggers. Anti-inflammatory diets rich in omega-3s may help reduce flare frequency.

Does rosacea get worse with age?

Without treatment, rosacea tends to progress — redness becomes more persistent, blood vessels more visible, and inflammatory episodes more frequent. Phymatous changes (skin thickening, particularly rhinophyma of the nose) can develop in advanced cases. However, with appropriate treatment, progression can be significantly slowed or halted. Early intervention provides better long-term outcomes.

Sources

1.
Rosacea Triggers Survey Results — National Rosacea Society (2014) Link
2.
Ivermectin 1% cream vs metronidazole 0.75% cream for rosacea (ATTRACT study) — Taieb A, Ortonne JP, Ruzicka T et al. British Journal of Dermatology (2015) DOI

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