4 Types of Rosacea—and How to Treat Them

When you’re a teen, it’s not surprising to have acne. But when you’re an adult, most of us expect those pimples to start going away.

Unfortunately, it doesn’t always work out that way. About 40% to 55% of us still have low-grade problems with acne and oily skin. And some of these skin problems are a special category, known as rosacea.

What Exactly Is Rosacea?

Most people think about rosacea sufferers as having bright red cheeks, nose and forehead, sometimes with rough skin. But rosacea can also take the form of:

Bumps that are just like adult acne
Redness along the eyelids, with crusting
Thickening of the nose, creating a large, bulbous nose

About 2% to 22% of the population has rosacea, and it usually is worst in people who are middle aged. But signs of it can show up much earlier. “Rosacea is mostly an adult disease,” said Dr. Mario Maruthur, a dermatologist at Augusta University Health. “But it can start in childhood with facial flushing, then over the course of life it will often worsen and develop into permanent redness on the nose, forehead and cheeks.”

Kids who may get rosacea later in life include those with fair skin, blonde or red hair, and light eyes. Redness may start in the teenage years and slowly begin getting worse.

Like with most diseases, the best solution is to start treating rosacea early—and not just hope that it goes away on its own. “You have to get it treated early on so it doesn’t progress into chronic flares that cause those long-term ruddy cheeks and coarse skin in patients who never got it under control,” said Maruthur.

Your Treatment Options

Like with many skin problems, being kind to your skin is a first step. Gentle skin care, with the right cleanser and moisturizer, can help smooth rough coarse skin.

The redness type of rosacea also tends to flare from any number of triggers, including alcohol, spicy foods, hot or cold temperatures, windy weather, emotional outbursts (getting upset or embarrassed), and sun exposure—one of the many reasons a daily sunscreen is important.

But all of that alone isn’t going to fix rosacea, and each type has its own unique treatment options:

Redness: Unfortunately, this common type of rosacea doesn’t have many good treatments, says Maruthur. Some medications are available, including a gel that you rub on the skin called brimonidine, which has an ingredient that’s similar to what’s in redness-reducing eye drops. Patients may benefit more from laser treatments that help keep blood vessels from becoming dilated. “It’s usually cosmetic reasons that drive patients to get treatment,” said Maruthur, “since the flushing really upsets people for social reasons.” So dermatologists also often suggest “green” concealer, topped by foundation, which can help neutralize the redness.

Acne bumps: This type of rosacea is the most treatable since common acne medications can be used. Patients can start with a topical antibiotic, usually metronidazole, or step up to an oral antibiotic (which you take by mouth), called doxycycline, if you get acne-like rosacea flares. While these medications decrease the amount of bacteria, it is really their anti-inflammatory properties that help treat the rosacea. One new treatment that’s being tried is an anti-parasitic medication called ivermectin that can help treat mites on the skin, which could be a factor in some patients with rosacea.

Rosacea affecting the eyes: The eyes can be the first place that are affected by the more typical red cheeks or forehead. Oral antibiotics are the best treatment here, and patients will need to stay on them for the long term. Dermatologists may also refer patients to ophthalmology as well.

Bulbous nose: This type usually affects both men and women in their 50s to 70s. It doesn’t look like typical rosacea at all. Treatment is surgery, using a scalpel or something similar to sandpaper to smooth down the nose and help reduce its size. “I’ve seen noses, when compared to when someone was younger, that were three times the size,” said Maruthur.

However, patients should avoid that old acne standby, benzoyl peroxide, since it can be drying and stinging to skin with rosacea. And anyone on an oral antibiotic should always make sure to take it with food to help avoid upset stomach. “Even though rosacea is something that most people will need to manage their entire lives, keep in mind that it is something we can control,” said Maruthur. “If you have rosacea and you have the right medication, working it into your daily routine is really easy. And when you stick with it, you can avoid any long-term damage or scarring to the skin.”