Dr. Yvonne Nguyen · Dermatology Conditions

Rosacea

Calm, clear skin is achievable with a treatment plan tailored to your triggers and subtype.

Rosacea is a common, chronic inflammatory skin condition primarily affecting the face, producing persistent redness, visible blood vessels, and in many cases inflammatory papules and pustules often mistaken for adult acne. It affects an estimated one in twenty Australians, and while fair-skinned individuals of Celtic and Northern European descent are at highest risk, rosacea occurs across all skin types and is frequently missed or misdiagnosed in darker skin tones, where redness may not be the dominant feature. Accurate diagnosis requires clinical expertise, as the condition can present differently depending on skin type.

Four subtypes are recognised, and many patients have overlapping features:

  • Erythematotelangiectatic rosacea: persistent central facial redness, flushing, and visible superficial blood vessels (telangiectasia)
  • Papulopustular rosacea: inflammatory red papules and pustules on a background of facial redness
  • Phymatous rosacea: skin thickening, classically affecting the nose (rhinophyma); more common in men
  • Ocular rosacea: eye involvement causing dryness, grittiness, redness, and light sensitivity, frequently under-recognised

Without management, rosacea tends to progress. With accurate diagnosis and a subtype-targeted plan, it can be very effectively controlled, and many patients achieve sustained remission.

Facial skin image representing rosacea redness and flushing treatment

01

Clinical assessment

Causes & Diagnosis

Current evidence points to neurovascular dysregulation (blood vessels responding abnormally to stimuli), innate immune dysregulation (elevated cathelicidin drives inflammation), and an increased density of the Demodex folliculorum mite in skin follicles. Genetic factors also contribute, as rosacea runs in families.

Common triggers include UV exposure (one of the most consistent triggers), heat, alcohol (particularly red wine), spicy foods, stress, and certain skincare ingredients including alcohol-based toners and fragrances. Identifying personal triggers is a cornerstone of management.

How is it diagnosed?

Rosacea is a clinical diagnosis; no blood tests or biopsies are required in typical presentations. A dermatologist assesses subtype, evaluates for ocular involvement, and distinguishes rosacea from seborrhoeic dermatitis, perioral dermatitis, lupus, and acne, all of which require different management.

02

Personalised plan

Treatment Options

Treatment is subtype-targeted. Most patients with moderate-to-severe disease benefit from a combination of topical therapy, trigger avoidance, and where appropriate, procedural treatment for vascular features.

Topical treatments your dermatologist may discuss include ivermectin cream (targets the Demodex component), metronidazole gel or cream (established topical anti-inflammatory), azelaic acid (effective for both inflammatory lesions and redness), and agents that directly reduce facial redness by constricting superficial blood vessels.

Oral treatments for papulopustular rosacea may include a modified-release form of doxycycline used at a sub-antimicrobial dose, working through anti-inflammatory rather than antibiotic properties and minimising antibiotic resistance risk. Oral isotretinoin may also be discussed for some patients.

IPL and laser treatments, including intense pulsed light, pulsed dye laser, and Nd:YAG laser, are among the most effective approaches for persistent redness and telangiectasia. These are delivered as a series of sessions; your dermatologist will advise on realistic expectations.

Ocular rosacea requires specific management including lid hygiene, lubricant eye drops, and sometimes oral or topical treatment in conjunction with an ophthalmologist.

Rosacea rewards a consistent, long-term approach. Your dermatologist will help you find a plan that fits your skin, your triggers, and your lifestyle.

03

Daily support

Management & Self-Care

  • Apply mineral SPF 50+ sunscreen every morning, as zinc oxide and titanium dioxide formulations are generally better tolerated by rosacea-prone skin
  • Use a simple, fragrance-free routine: gentle non-foaming cleanser, moisturiser, sunscreen
  • Keep a trigger diary, as not all triggers affect all patients equally
  • Cool the face during exercise or hot weather; seek shade
  • If your eyes feel gritty, dry, or irritated, mention this to your dermatologist, as ocular rosacea is treatable but easily overlooked

04

Specialist review

See a Dermatologist If

  • Facial redness has been persistent for more than a few weeks
  • Recurrent red papules or pustules on the face haven't responded to acne treatments
  • Visible blood vessels on the face are causing distress
  • The nose is thickening or changing in texture
  • Your eyes are chronically red, gritty, or uncomfortable alongside skin symptoms

Discuss Rosacea with Dr. Nguyen

Sources and further reading

These external resources provide general educational information and do not replace individual medical advice.