What Causes Rosacea?

Posted by Kathleen W. Judge, MD on


The exact cause of rosacea is unknown. While the majority of cases are diagnosed in fair-skinned patients, those with darker skin can also be affected.  Rosacea is also more common in women than men and typically begins after the age of 30. There are things called triggers that are known to make rosacea flare, but triggers are not the cause of rosacea.


Most patients experience stinging, burning, redness and flushing of the skin on their face.  Dryness, scaling, acne-like bumps, small blood vessels and eye irritation can also be present. Sensitivity and irritation to facial skin care products, such as exfoliating cleansers and over the counter acne products, is common.


There are four subtypes of rosacea, which are determined by the clinical appearance and symptoms. You may have more than one subtype.

Type 1 – Erythrotelangiectatic Flushing and persistent redness with or without visible tiny blood vessels called telangiectasias.

Type 2 – Papulopustular Persistent facial redness with inflamed, red, acne-like bumps and/or pus-filled bumps. Blackheads are not typically a sign of rosacea.

Type 3 – Phymatous Redness, thickening, and enlargement in the skin of the nose, chin, and/or forehead. The tissue of the nose can become bulbous and distorted and is called rhinophyma. This type is rare in women.

Type 4 – Ocular Watery or red eyes along with stinging, burning, or an irritated or gritty sensation. The eye symptoms can occur without the presence of skin symptoms.


There are many potential triggers for rosacea. Heat and sun exposure are two of the most common causes of rosacea flares. This makes the regular use of sunscreen an important part of your daily skin care regimen. Foods and alcoholic beverages are also common triggers, but this varies from person to person.  

 If you can’t figure out what your triggers are, keeping a careful rosacea diary for several weeks may be helpful to pinpoint potential offending agents. While it is not possible to eliminate all triggers from your daily routine, limiting exposure to triggers will aid in the management of rosacea.


Treatment varies depending on the type and severity of your rosacea.

Gentle skin care is critical in achieving improvement. The goal of everyday care is to maintain the integrity of your skin and avoid using any products that cause inflammation or flushing.

Daily sunscreen use with SPF of 15 or higher utilizing a physical block, either zinc or titanium dioxide, is recommended.

Mineral make-up can help mask the redness.  

Hydrafacials can help hydrate your skin and keep pores clean without irritation. This treatment is highly customizable for your particular needs. 

Prescription therapy with either topical or oral medication may be helpful.  Topical medications such as metronidazole, azelaic acid, certain antibiotics, and sodium sulfacetamide are commonly used.  The topical medications brimonidine and oxymetazoline may help diminish the redness in some patients. Oral antibiotics or, in more difficult cases, low dose isotretinoin may be necessary to gain control.

VBeam Laser and/or Intense Pulsed Light devices can improve the signs of rosacea by decreasing facial redness and the appearance of blood vessels. A series of treatments followed by regular maintenance therapy can minimize your redness and improve the texture of your skin.

Fractional Radiofrequency Microneedling has recently been shown to be helpful with redness and the inflammatory lesions of rosacea. Again, this treatment is customizable to suit your needs.

LVEC (Low Voltage Electro Cautery) treatment of specific bumps called sebaceous hyperplasia can improve the bumpy texture of the skin.

As you can see, there are many ways to treat your rosacea.  Typically, a combination of treatments is required.

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