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Rosacea Triggers & Treatments

cartoon girl with acne on the left and then no acne on the right

Rosacea is a common skin condition that affects approximately 16 million Americans, according to the Centers for Disease Control and Prevention (CDC) and National Rosacea Society. Common rosacea triggers can cause the symptoms to flare up for several weeks or months at a time, following which rosacea symptoms may go away for some time. 

There is no cure for rosacea. However, treatments can help to control symptoms of rosacea. Also, people with rosacea can keep the condition in check by avoiding common triggers. 

Please continue reading to learn more about this condition, including what can trigger rosacea flare-ups, i.e., what makes rosacea worse. We will also give you some tips on how to treat rosacea flare-ups. 

What is rosacea?

Rosacea is a skin condition in which there are visible blood vessels in the skin of the face. These small blood vessels increase blood flow to the skin and lead to skin flushing (facial blushing in the central face). While the flushing is sometimes difficult to see in dark-toned skin, when visible, it can cause a person to become self-conscious. 

Some people with rosacea develop small pimples that resemble acne and are filled with pus. 

Other symptoms of rosacea include a burning sensation (hot and tender skin) in the affected area. Rosacea symptoms can also include dryness, swelling, and irritation of the eyes and eyelids (this is called ocular rosacea and should be evaluated by an eye specialist). 

In some people with rosacea, repeated skin flushing can lead to persistent symptoms (permanently red skin and skin thickening). This is especially common in men with rosacea, who may develop thickening of the skin of the nose, causing it to appear bulbous (this is called rhinophyma).

What causes rosacea?

The exact cause of rosacea is not known. Experts believe it is a combination of genetics, environmental factors, and an overactive immune system. Poor hygiene does not cause rosacea, and it is not contagious.

Who is at risk of developing rosacea symptoms?

Anyone can develop rosacea, but the condition is common in middle aged women between the ages of 30 and 60, especially women undergoing menopause. People with blue eyes, blond hair, and fair skin are at higher risk, as are those with sensitive skin. A family history of rosacea is another risk factor for developing rosacea symptoms.

What is the most common trigger for rosacea?

The most common rosacea triggers include hot drinks; spicy foods; alcoholic beverages, especially red wine; exercise; wind and cold and sun exposure; emotional stress; and skin irritants like alcohol and witch hazel that are found in some skin products and makeup products. Certain prescription medications that dilate blood vessels, for example, medications used to treat high blood pressure, can also be rosacea triggers.

Every person with rosacea can have different triggers. In other words, potential triggers can vary from person to person. For example, some people find that cold weather makes their symptoms worse, but others find that hot weather can worsen rosacea. Similarly, drinking alcohol (red wine) or sun exposure may trigger rosacea in some people and not in others.

Identifying your individual triggers might need some detective work, such as keeping a rosacea diary to see what triggers coincide with your rosacea flare-ups. 

What can rosacea be mistaken for?

Rosacea can be mistaken for medical conditions like acne, seborrheic dermatitis, or an allergic reaction. It can even be mistaken for a naturally ruddy complexion. Some people develop a skin reaction resembling rosacea during and after treatment with topical steroids

The diagnosis of rosacea may be missed in people with darker skin tones in whom the redness associated with rosacea flare-ups is less obvious. 

There is no specific test to diagnose rosacea. Dermatologists make the diagnosis based on your history and physical examination. However, your doctor may order tests to rule out other skin conditions like lupus or psoriasis.

What is the most effective treatment for rosacea?

Some effective rosacea treatments include:

Lifestyle changes

Medications are available for treating rosacea, but one of the most effective ways to avoid a rosacea flare-up is to avoid triggers. Avoiding rosacea triggers can also help to get a better response from treatment for rosacea and prevent the condition from getting worse. So, for example, if spicy foods, hot beverages, or emotional stress are triggers, it makes sense to avoid peppery hot chicken and hot chocolate and to try and reduce stress with meditation, yoga, and deep breathing exercises. 


Dermatologists recommend gentle cleansing, moisturizing, sun protection, and rosacea-friendly skincare products to reduce redness and decrease the frequency of rosacea flare-ups.

Topical medications to reduce flushing

Creams or gels are available to treat mild to moderate rosacea. These medicines work by constricting (narrowing) the blood vessels and reducing flushing. Examples include oxymetazoline (Rhofade) and brimonidine (Mirvaso). The results are temporary, however, and can take up to 12 hours to appear after use of the medicine. Also, regular application is necessary to maintain the improvement in facial blushing.

Topical medications to control pimples

Topical products like metronidazole (Metrogel, Noritate, others), azelaic acid (Azelex, Finacea), and ivermectin (Soolantra) can help to control the pus-filled pimples that sometimes accompany a rosacea flare up. It can take a few weeks or even longer for the improvements to be visible. 

Oral medications

Moderate to severe rosacea with bumps and pimples may benefit from prescription oral antibiotics like doxycycline (Oracea, others) to reduce inflammation.

Isotretinoin (oral acne drug)

Doctors sometimes prescribe isotretinoin (Claravis, Amnesteem, others) for severe symptoms of rosacea that do not respond to other treatments. However, this medication is not safe for use by pregnant women as it can lead to serious birth defects.

Laser treatment

Laser therapy can help to make enlarged and visible blood vessels less obvious. This treatment is most effective in light or fair skin because it targets visible veins. Also, there is a risk of permanent discoloration in dark-colored skin. Side effects of laser therapy may include bruising and swelling that lasts several days. Several laser sessions may be necessary to get the desired results. Last but not least, laser therapy for rosacea is typically considered a cosmetic treatment and is not covered by health insurance.



  1. https://www.aad.org/media/stats-numbers#
  2. https://www.aad.org/public/diseases/rosacea/triggers/find
  3. https://www.aad.org/public/diseases/rosacea/triggers/tips
  4. https://www.mayoclinic.org/diseases-conditions/rosacea/symptoms-causes/syc-20353815