What it is
Rosacea is a long-term condition of the central face: persistent redness, flushing that comes in episodes, sometimes visible small vessels, and in some people papules and pustules that are mistaken for acne. The consultation identifies which pattern is present, because each pattern is treated differently, and rules out the redness caused by topical steroids and unlabeled lightening mixtures, which looks similar and is managed in the opposite way. Treatment combines a mapped list of the patient's own triggers, a stripped-back skincare routine, and topical or oral therapy chosen by subtype.
What this page covers
- Rosacea assessment and subtype classification, and separating it from acne, seborrheic dermatitis, steroid-induced facial redness and lupus
- Erythematotelangiectatic rosacea: flushing, persistent redness and visible vessels
- Papulopustular rosacea, with the Demodex contribution considered
- Phymatous rosacea and nasal thickening, staged early and referred for ablative or surgical reshaping when established
- Ocular rosacea: asking every patient about grittiness, burning and recurrent styes, lid hygiene, and ophthalmology referral
- Perioral and periorificial dermatitis, including the steroid-driven form
- Topical therapy by subtype: ivermectin, metronidazole, azelaic acid, and vasoconstrictors with a rebound warning
- Oral therapy: sub-antimicrobial-dose doxycycline, and low-dose oral isotretinoin in selected resistant cases with monitoring
- Supervised withdrawal from a topical steroid-damaged face and from steroid-containing lightening creams
- Trigger mapping — heat, sun, spicy food, hot drinks, specific products — and barrier-first skincare
- Vascular laser and light options, which are named here and carried out under the laser list
Honestly
Rosacea is managed, not cured: clearing the papules does not remove the background redness, and saying so before treatment starts prevents a disappointed patient later. Established thickening of the nose does not reverse with creams or tablets, and eye involvement is not managed from a skin clinic alone.