Rosacea: Understanding and Treating the Skin Condition

In my youth, I was fortunate to face hardly any skin problems. Pimples and blemishes that plagued many of my peers at the time largely spared me. But at twenty, this changed completely unexpectedly.

Seemingly overnight, my skin texture changed, without having altered my skincare routine, diet, or other factors. My face was often covered with patchy, red flushes.

After exercising, my skin needed a full hour to return to its normal color. I also found painful bumps and blisters particularly bothersome, which appeared in addition to the redness.

For two years, I unsuccessfully tried to calm my skin with over-the-counter acne treatments (which later turned out to be a completely wrong approach).

When nothing seemed to work, I finally decided to visit a dermatologist after much hesitation. I was diagnosed with rosacea. This required a complete overhaul of my skincare routine. The motto was now: Less is more.

What is rosacea?

„ Rosacea (also rosacea) is a chronic inflammation of the small vessels in the face. It is accompanied by severe redness, and small papules and pustules form on the skin, which is why many rosacea patients initially mistake it for acne," explains Dr. Timm Golüke , a dermatologist from Munich.

In Germany, two to five percent of people suffer from this skin condition, with women being affected more often than men. "The main cause of rosacea is genetic, as with most diseases, but there are also external factors that clearly favor rosacea," says Dr. Golüke. "We are talking about vasodilating influences such as caffeine, alcohol, and nicotine, but also spicy and too hot food, visiting the sauna or steam bath."

Light-skinned and red-haired people, in particular, are predisposed to the disease. In English-language literature, rosacea has thus earned the nickname "Curse of the Celts." Rosacea often occurs in flare-ups, which is why the severity can temporarily improve or worsen.

What forms of rosacea are there?

Rosacea manifests in three to four different forms, which can often occur as a progressive course of the disease.

The first form, also known as vascular rosacea, primarily affects the blood vessels of the skin. It is characterized by persistent facial redness and visibly dilated blood vessels. This form is also often accompanied by burning sensations in the skin.

The second type, papulopustular rosacea, is characterized by the appearance of papules (red bumps) and pustules (pus-filled blisters). Due to its appearance, this form is often confused with acne.

The third form, also known as phymatous rosacea, mainly affects the nose. In this case, the skin thickens and shows an irregular surface texture. This manifestation is more common in men.

The fourth form, ocular rosacea, affects the eyes and is therefore to be distinguished from other types of rosacea. Symptoms include irritated, dry and red eyes, often accompanied by pain and increased sensitivity to light. This form can occur both in combination with other types of rosacea and independently.

© Anna Shvets

The diagnosis of rosacea requires a complete change in the skincare routine.

Based on my dermatologist's recommendation, I reduced the frequency of facial cleansing and switched to milder products. My dermatologist also recommended a gentle cleansing milk, a soothing day cream with high sun protection factor, and aloe vera gel to relieve skin irritation.

Additionally, she prescribed me a metronidazole cream and a low-dose oral antibiotic for two months. I soon noticed a significant improvement in my skin condition. The pustules decreased, and my skin barrier seemed to stabilize.

In the meantime, I have identified ingredients that I should avoid, but also those that have a very positive effect on my skin - such as azelaic acid.

Although rosacea is a chronic condition and therefore not curable, I have learned to manage it effectively through diagnosis, support from my dermatologist, and my own research.

How can rosacea be treated?

„The treatment of rosacea is usually carried out by topical application of agents such as ivermectin, metronidazole, and azelaic acid, i.e., prescription antibiotic ointments,” says Dr. Golüke.

For the vascular form of rosacea, laser applications show promising results by specifically sclerosing dilated blood vessels, thereby significantly reducing facial redness. However, this treatment requires repetition every two to three years to prevent recurrence of symptoms.

In addition to prescription therapies, soothing skincare products can positively influence the course of rosacea. Tip from the specialist: “Less is more!” Anything that unnecessarily irritates and stresses the skin should be avoided. “Fruit acids, high-dose retinol, or vitamin C are highly irritative agents and therefore have no place in the care of rosacea-plagued skin,” advises Dr. Golüke.

A fragrance-free skincare routine tailored to sensitive skin with soothing, moisturizing, and strengthening ingredients is essential. Natural ingredients such as aloe vera, chamomile, and oats can help soothe and hydrate the skin.

Other effective ingredients include the skin-protecting vitamin B5 (panthenol), which stimulates wound healing, niacinamide for a strengthened skin barrier, or ceramides that protect against harmful external influences.

Of central importance is also the consistent application of a high sun protection factor to protect sensitive rosacea skin from additional irritations.

Although organic filters are recommended for rosacea, there are also numerous sunscreens with combined or purely chemical filters that are specially developed for the needs of rosacea.

© Rebeca Gonçalves

Caution: UV radiation is considered one of the main triggers for rosacea symptoms.

What to avoid with rosacea – three lifestyle tips

An adapted lifestyle can significantly mitigate or even prevent rosacea flare-ups. Identifying and avoiding individual trigger factors play a central role in treatment.

UV radiation is considered one of the main triggers for rosacea symptoms. Therefore, consistent protection from direct sunlight is particularly important.

Severe temperature fluctuations, such as those occurring when moving between heated indoor spaces and cold outdoor air in winter, can also trigger flare-ups. While climate influences cannot always be controlled, affected individuals should avoid extreme temperature differences as much as possible. In the wellness area, it is advisable to skip intense sauna sessions.

Also the diet plays an important role. Spicy foods, alcohol, and blood circulation-promoting beverages like coffee should be avoided or only consumed in moderation in this case.

Every skin has individual needs, and there is no universal solution for rosacea. However, I have found that general guidelines help alleviate symptoms and enhance well-being.

A professional diagnosis is essential to understand individual symptoms and treat them with a personalized therapy, whether it is rosacea or another skin condition.