Rosacea: symptoms, causes and effective treatment

Rosacea is a chronic inflammatory skin condition that causes persistent redness in the central area of the face, visible blood vessels, and, in many cases, pimples similar to those of acne. It can be well managed with medical treatment and by controlling the factors that trigger flare-ups, although it does not disappear completely. It affects approximately 5.1% of the adult population worldwide, according to a 2024 study reported by the National Rosacea Society, making it far more common than is generally thought. At Clínica Valorian, we approach rosacea from an evidence-based medicine perspective, combining dermatological diagnosis with treatments tailored to each skin type.

What is rosacea and how can it be distinguished from other types of redness?

Rosacea affects around 5.1% of adults worldwide, according to a study published in 2024 and shared by the National Rosacea Society. It is a chronic condition in which redness is concentrated on the cheeks, nose, forehead, and chin, and which progresses in flare-ups.

The feature that best distinguishes it from other types of redness is its central location and persistent nature. A momentary flush caused by heat or emotion disappears within minutes. In rosacea, the redness persists and, over time, fine visible blood vessels known as telangiectasias appear.

Confusing it with acne is common, especially when pimples develop. The key difference lies in comedones: acne presents blackheads and whiteheads, which do not appear in rosacea. Rosacea is also concentrated in the central area of the face and is usually accompanied by sensitivity and a sensation of warmth.

Nor should it be confused with dermatitis or allergic reactions, which typically itch and become inflamed in a diffuse pattern. Rosacea tends to produce warmth, stinging, and sensitivity in the central area of the face.

What factors trigger flare-ups?

Triggers do not cause rosacea, but they activate and worsen flare-ups in people who already have the condition. Sun exposure tops almost every list of triggers, followed closely by emotional stress and heat. Identifying one's own triggers is the first step towards spacing out episodes.

Patient surveys conducted by rosacea societies consistently identify sun exposure and emotional stress as the most frequently cited triggers, ahead of heat and spicy foods. These are the two major triggers we also see in clinical practice.

Among the most commonly reported factors, the following stand out:

• Exposure to sun and environmental heat.
• Emotional stress and anxiety.
• Hot drinks and spicy foods.
• Alcohol, especially red wine.
• Sudden temperature changes and wind.
• Intense physical exercise.

Living in a sunny area such as the Costa del Sol adds an extra challenge, as radiation is intense for much of the year. Daily sun protection is therefore one of the most effective preventive measures against flare-ups.

What are the types of rosacea and their specific treatments?

There are four main types of rosacea, and each responds best to a different treatment, so the correct diagnosis determines the therapy. The clinical classification recognises the erythematotelangiectatic, papulopustular, phymatous and ocular forms. A single patient may present more than one at the same time.

Erythematotelangiectatic rosacea

This is the most common form. Persistent redness in the centre of the face predominates, with episodes of flushing and visible blood vessels. Treatment focuses on reducing redness with topical gels such as brimonidine, which temporarily narrows the vessels, and on laser or intense pulsed light sessions to eliminate the most prominent telangiectasias.

Papulopustular rosacea

It presents with spots and pustules on a reddened base, hence its confusion with acne. Here, creams containing ivermectin, azelaic acid or metronidazole form the cornerstone of treatment. In moderate or severe cases, oral doxycycline at an anti-inflammatory dose is added.

Phymatous rosacea

It causes thickening of the skin, especially on the nose, where it gives rise to rhinophyma. It is more common in men. Treatment usually combines oral medications with laser techniques or surgical procedures to remodel the thickened skin.

Ocular rosacea

It affects the eyes with dryness, burning, redness and a foreign-body sensation. It can go unnoticed because it is not always accompanied by skin symptoms. It requires eyelid hygiene, artificial tears and, on occasion, oral antibiotics, with joint follow-up between dermatology and ophthalmology.

Which rosacea treatment works best?

Rosacea treatment combines topical medications, oral medication and laser procedures, chosen according to the type and severity. In forms with spots, topical ivermectin has shown outstanding results compared with other classic creams.

In a 16-week trial involving 962 patients, 1% ivermectin cream achieved a lesion reduction of 83.0% versus 73.7% for 0.75% metronidazole, according to the evidence summary from the British organisation NICE. The difference was statistically significant, which has established it as a first-line option.

The main therapeutic tools are:

• Topical creams: ivermectin, azelaic acid, metronidazole and brimonidine.
• Oral antibiotics: doxycycline at an anti-inflammatory dose for moderate or severe cases.
• Laser and intense pulsed light: the gold-standard option for visible blood vessels and persistent redness.

No treatment cures rosacea permanently, but the right combination keeps symptoms under control. A doctor adjusts the regimen over time according to each patient's response.

What skincare habits and routines help reduce symptoms?

Daily skincare cannot replace medical treatment, but it makes a real difference to the frequency and intensity of flare-ups. The key is to protect the skin barrier and avoid anything that irritates an already reactive skin. A gentle, consistent routine is more effective than harsh products.

A few basic guidelines help soothe the skin:

• Cleanse your face with gentle products, free from strong soaps and alcohol.
• Use moisturisers designed for sensitive skin that reinforce the skin barrier.
• Apply a high-factor sun protection product every day, including in winter.
• Avoid abrasive exfoliants, heat masks and very hot water.
• Test new cosmetics on a small area before applying them more widely.

Adapting your routine to your skin type is essential. The goal is not to layer your skin with many products, but to choose a few that are well tolerated and always formulated for sensitive, reactive skin.

Lifestyle habits also matter. Managing stress, limiting alcohol and spicy food, and protecting yourself from cold and wind all help reduce flare-ups. Keeping a simple record of what triggers redness allows you to anticipate your personal triggers.

When should you see a doctor for proper management?

It is advisable to see a doctor when facial redness is persistent, does not improve with standard skincare, or is accompanied by spots, visible blood vessels or eye discomfort. Early diagnosis prevents rosacea from progressing to harder-to-treat forms, such as skin thickening.

There are signs that should not wait for a professional assessment:

• Redness that persists for weeks without an obvious cause.
• Spots in adulthood without blackheads.
• Burning, dryness or eye redness.
• Skin thickening, especially on the nose.
• Impact on quality of life or self-esteem.

The specialist confirms the type of rosacea, rules out other conditions that resemble it and designs a personalised treatment plan. If you would like to know what to expect from a consultation, our information on when to visit a dermatologist in Marbella can guide you.

Ongoing follow-up is important because rosacea changes over time. Adjusting the regimen at each stage is what allows the skin to remain stable for years.

If you notice facial redness that does not subside, or recurring flare-ups, seek a dermatology assessment rather than trying remedies on your own. An accurate diagnosis and a plan tailored to your type of rosacea are the most direct route to regaining control of your skin.