Rosacea is a chronic inflammatory condition primarily affecting the central face, characterised by flushing, persistent redness, and sometimes acne-like breakouts. It affects approximately 1 in 10 people in the UK and is one of the most commonly misdiagnosed skin conditions — often confused with acne, eczema or simply “sensitive skin.” Getting the diagnosis right is crucial because many common skincare products and acne treatments significantly worsen rosacea.
The Four Subtypes
Erythematotelangiectatic (ETR) — the most common. Persistent central facial redness with visible telangiectasia (dilated blood vessels), easy flushing, and skin sensitivity. Papulopustular — redness with acne-like papules and pustules, but NO blackheads or whiteheads (distinguishing it from acne). Central face distribution, adult onset. Phymatous — skin thickening and irregular texture; most characteristically rhinophyma (bulbous nose enlargement) — predominantly in men. Ocular rosacea — affects about 50% of rosacea patients; presents as blepharitis, dry eyes and ocular surface inflammation.
Understanding Your Triggers
Rosacea involves hypersensitive facial vasculature and a dysregulated innate immune system. Individual triggers cause flushing and inflammation by activating these pathways. Common triggers across populations: alcohol (particularly wine — ethanol is a potent vasodilator); UV exposure (one of the most consistent triggers — drives both flushing and long-term telangiectasia formation); spicy food (capsaicin activates TRPV1 receptors on facial blood vessels); hot drinks; intense exercise; emotional stress; extreme temperatures (both heat and cold); certain skincare products. Keep a trigger diary — noting what preceded each flare — for 2–4 weeks to identify your personal pattern.
Building a Rosacea-Safe Skincare Routine
Cleanse: gentle, non-foaming, fragrance-free cleanser. Cetaphil Gentle Skin Cleanser or Avène Tolerance Extreme Cleansing Lotion. Rinse with lukewarm water — hot water causes flushing. Pat dry gently. Moisturise: light, fragrance-free cream. Avène Antirougeurs range and La Roche-Posay Toleriane are specifically formulated for rosacea-prone skin. SPF daily (non-negotiable): mineral (zinc oxide, titanium dioxide) sunscreen is better tolerated than chemical filters in rosacea skin — less stinging and less vasodilatory. SPF 30–50 minimum. This is the single most impactful skincare step for long-term rosacea management. Avoid: fragrances, alcohol denat in products, witch hazel, menthol, peppermint, AHAs and BHAs (initially at least), physical scrubs. Most acne products worsen rosacea significantly.
Medical Treatment Options
Beyond OTC management, GPs can prescribe: topical azelaic acid 15% (Finacea) — first-line for papulopustular; topical ivermectin 1% (Soolantra) — targets Demodex mite overcolonisation; topical brimonidine (Mirvaso) or oxymetazoline — reduce redness acutely; oral doxycycline sub-antimicrobial dose — for moderate-severe papulopustular. Laser/IPL therapy for telangiectasia and persistent diffuse redness produces lasting improvements and is available privately and through some NHS dermatology services.
Frequently Asked Questions About Rosacea
Is rosacea the same as acne?
No — they are distinct conditions. Rosacea lacks blackheads and whiteheads (comedones). It predominantly affects adults over 30. It’s associated with flushing and persistent redness not typical of acne. It’s usually confined to the central face. Most importantly, many acne treatments (benzoyl peroxide, retinoids, high-concentration AHAs) significantly worsen rosacea — making an accurate diagnosis essential before starting treatment.
Can diet affect rosacea?
Yes — beyond trigger foods (alcohol, spicy food), there is emerging evidence linking rosacea with gut dysbiosis and SIBO (small intestinal bacterial overgrowth). An anti-inflammatory, Mediterranean-style diet supporting gut microbiome diversity may reduce the systemic inflammatory burden driving rosacea. Several studies have found that treating SIBO improves rosacea severity in affected patients.
Is rosacea progressive?
Without treatment, rosacea typically progresses over years — with telangiectasia becoming more numerous and redness more persistent. In men, phymatous changes can develop. With appropriate trigger avoidance, consistent sunscreen, and medical treatment when needed, progression is significantly slowed. Many patients achieve excellent long-term control with minimal lifestyle impact.
What is the connection between rosacea and gut health?
Multiple studies have found significantly higher rates of SIBO and Helicobacter pylori infection in people with rosacea compared to controls. Treatment of SIBO in rosacea patients produced significant improvement in skin symptoms in several small studies. This gut-skin axis connection is an active research area — a probiotic supplement and gut-supportive diet are reasonable adjuncts to conventional rosacea management based on current evidence.
Browse skin conditions products and skincare including Avène at Huncoat Pharmacy. Related: Sensitive Skin Guide, Eczema vs Psoriasis.
At Huncoat Pharmacy: Avène rosacea & sensitive skin range, Private prescription service, Browse rosacea skincare.