Rosacea is a chronic inflammatory skin condition that affects millions of adults and can look very different from person to person. It varies a lot! And this is why there is no ONE regimen that works for everyone. Rosacea is weird and difficult to treat.
While we don’t yet know the exact cause and there’s no permanent cure, rosacea can be very well controlled with a customized treatment plan specifically curated for your skin.
Rosacea Is Not Acne — And Treating It Like Acne Often Makes It Worse
Rosacea is commonly mistaken for traditional acne because, like acne, it can lead to red bumps and breakouts. But despite looking similar on the surface, these two conditions are very different.
Acne is mainly caused by:
-
excess oil (due to hormonal stimulation of the oil gland)
-
clogged pores/comedones (papules)
-
bacterial overgrowth
Rosacea is characterized primarily by:
-
sensitive blood vessels at the skin surface (hence flushing)
-
inflammation of the sebaceous unit (often causing papules and oiliness)
-
weakened skin barrier (easily irritated and flaky or dry)
-
worsened by microbiome alterations like fungal/parasitic elements in the skin such as seborrheic dermatitis or Demodex
So acne and rosacea may look similar, but they are different due to very different pathophysiology.
And as all diseases go… there can be overlap. Some people may just have classic rosacea and rosacea alone! But sometimes these conditions overlap, so someone can exhibit rosacea-like skin but have cystic acne on the jawline. (Just like someone can have headaches and seizures — two different disorders — but there can be overlap.)
Proper diagnosis is key. When rosacea is treated correctly, the focus shifts to calming inflammation, strengthening the skin barrier, and reducing vascularity (redness). Also, addressing microbiome issues, like treating your oily scalp with an antifungal shampoo, can significantly help, or using ivermectin topically (RX) can help as well.
Common Signs of Rosacea
Rosacea may include:
• Persistent facial redness and flushing
• Sensitive, easily irritated skin
• Acne-like bumps or pustules - more MICROpapules than large cysts
• Visible broken blood vessels or enlarged blood vessels in the central face
• In late or severe cases, it can lead to thickened nasal skin, causing a bumpy texture and large pores
Rosacea often flares and settles in cycles, influenced by both the immune system, stress, and environmental triggers. This is why consistency with treatment and skincare is so important.
The Main Types of Rosacea
Just like any inflammatory condition in the body, there are many clinical presentations of rosacea.
(Think of arthritis… it varies too… sometimes people have just arthritis in their knees from overuse, while others can have full-body autoimmune arthritis leading to back issues and significant disability.) So too can rosacea present differently.
Types of Rosacea:
Erythematotelangiectatic Rosacea (ETR)
Marked by constant redness, frequent flushing, visible blood vessels, and sensitive skin.
Papulopustular Rosacea
Red bumps and pus-filled blemishes often mistaken for acne, usually layered over background redness.
Phymatous Rosacea
Thickened, uneven skin texture, most commonly affecting the nose (rhinophyma), and more common in men.
Ocular Rosacea
Red, irritated eyes, burning or gritty sensations, and swollen eyelids.
Many patients experience more than one type at the same time, which is why individualized treatment plans are essential.
Common Rosacea Triggers
Rosacea flares are often linked to:
• Sun exposure!!
• Hot or cold temperatures
• Alcohol (especially red wine)
• Spicy foods
• Stress
• Certain medications
Because UV exposure is one of the strongest inflammation triggers, daily sunscreen is one of the most important steps in managing rosacea.
The Dermatologist-Led Rosacea Treatment Approach
Rosacea is a medical inflammatory condition, not just a cosmetic concern. Long-term control requires a layered, thoughtful strategy.
Prescription Topicals and Supportive Skincare
Most treatment plans begin with prescription topical medications (Soolantra, azelaic acid, or compounded prescriptions with more than one active ingredient - like the one I make in my office).
The other products I couple with the prescription are ones that calm inflammation, reduce redness, control breakouts, and strengthen the skin barrier.
My recipe for Rosacea:
-
Gentle cleanser - bakuchiol AM / sulfur soap PM Bakuchiol Hydrating Cleanser
-
Compounded prescription gel “rosacea gel” - sold in my office ZENA Medical
-
Niacinamide serum AM Niacinamide Correcting Serum
-
Inflammation repair moisturizer AM/PM Inflam-aging Night Repair Treatment
-
Sunscreen Advanced Repair Daily Defense SPF 45
Supportive skincare typically includes:
• Niacinamide serum to reduce redness and sensitivity Niacinamide Correcting Serum
• Anti-inflammatory serums to protect against environmental stress Inflam-aging Night Repair Treatment
• Barrier-repair moisturizers Inflam-aging Night Repair Treatment
• Daily mineral sunscreen Advanced Repair Daily Defense SPF 45 - a must have!
BUT… Before you start… customize!
Before you start any topical regimen, it is important to know what type of rosacea you have and what underlying conditions are impacting your skin.
Answering some basic questions can guide your customized regimen:
Are you very red and sensitive?
First, start using a very gentle cleanser, Dr. Zenovia moisturizer Peptide + Ceramide Repairing Moisturizer with a spritz of water twice a day for one week. This will repair the barrier and allow your skin to tolerate the other topicals. Then add the general rosacea care products below.
Are you very oily, including your scalp, and have pimples on the forehead and temples?
Add Head & Shoulders™ shampoo to your daily regimen or get a prescription of ketoconazole shampoo to treat the excess yeast in your hair follicles that is causing increased oiliness.
Are you just blushing a lot, with very few papules, and have permanent broken blood vessels around your nose? Start with a series of lasers like KTP or pulsed dye laser (like the Vbeam), which work by targeting the actual blood vessel bed and shutting down those vessels — essentially eliminating the flow of inflammatory mediators at the skin surface and closing off the red hue caused by blood vessels.
Are you sensitive around the mouth (peri-oral area) and have micro pimples all over your chin? This is typically called PERIORAL DERMATITIS and is considered a cousin to rosacea. This is worsened with typical acne products like retinols or benzoyl peroxide, so gentle care and soothing emollients usually work best.
Laser and Light Treatments for Redness
For many patients, in-office treatments are key to improving persistent redness and visible blood vessels. Common options include pulsed dye lasers, KTP lasers, and IPL therapy. These target dilated vessels and inflammatory pathways beneath the skin to gradually improve tone and eliminate inflammation.
Oral Medications When Needed
For moderate to severe rosacea, oral medications may be used to control deeper inflammation, including anti-inflammatory antibiotics like doxycycline. However, I really like low-dose isotretinoin/Accutane for rosacea.
Because rosacea is a disease of the oil gland and Accutane targets the oil gland, Accutane is a fantastic treatment for rosacea. These are carefully monitored for safety and effectiveness. The low-dose protocol that I adhere to and prescribe has a minimal side effect profile and is extremely effective.
Long-Term Maintenance
Rosacea requires ongoing care rather than quick fixes. Successful management includes consistent prescription topicals, daily sun protection, trigger awareness, supportive skincare, and occasional laser maintenance when appropriate.
Flares may still happen from time to time, which is normal. The goal is calm, stable, healthy skin.
Also… did you know that rosacea typically gets better during pregnancy and sometimes worse after delivery? This is because pregnant women are partially immunosuppressed, so the immune-driven inflammation of rosacea is dampened during pregnancy, and skin often improves.
Rosacea doesn’t have to mean living with constant redness, irritation, or breakouts. With the right diagnosis, customized treatment plan, specific-to-you skincare routine, and professional care, most people achieve dramatic improvement and long-term control.