Rosacea: Understanding & Managing Facial Redness

Rosacea is a chronic inflammatory skin condition that affects millions of people worldwide. Understanding its mechanisms is key to effective management.

Pathophysiology

The cascade involves:

Upregulation of kallikrein-5 → increases cathelicidin → inflammation + vasodilation

Demodex folliculorum mite involvement

Abnormal blood vessel function

Genetic component

The Four Subtypes

Common Triggers

Triggers are patient-specific, but common ones include:

Environmental

Temperature extremes

Sun exposure

Wind

Hot environments

Dietary

Hot beverages

Spicy foods

Alcohol (especially red wine)

Lifestyle

Stress and strong emotions

Intense exercise

Hot baths or showers

Skincare

Harsh products

Alcohol-based formulations

Over-exfoliation

Evidence-Based Treatments

Azelaic Acid (Strongest Evidence)

Reduces kallikrein-5/cathelicidin pathway

4-20% concentration

Anti-inflammatory and antibacterial

Mineral Sunscreen (95.2% dermatologist agreement)

Essential for preventing UV-triggered flares

Zinc oxide is gentle and provides broad protection

Tranexamic Acid

Strengthens skin barrier

Reduces redness and blood vessel visibility

Anti-inflammatory benefits

Niacinamide (72.6% dermatologist agreement)

Anti-inflammatory

Reduces cathelicidin

Gentle and well-tolerated

Metronidazole (79% dermatologist agreement)

Prescription topical

Effective for papulopustular rosacea

What to Avoid

Harsh exfoliants (physical scrubs, strong acids)

Alcohol-based products (denatured alcohol, witch hazel)

Known personal triggers

Hot water on face

Fragrance in skincare

Building a Rosacea-Friendly Routine

Morning

Gentle cream cleanser (lukewarm water)

Azelaic acid serum

Niacinamide moisturizer

Mineral sunscreen SPF 50

Evening

Gentle oil cleanser

Cream cleanser

Centella asiatica serum (optional)

Ceramide-rich moisturizer

Managing Flare-Ups

When experiencing a flare:

Simplify routine to basics only

Apply cold compresses (not ice)

Avoid all actives temporarily

Focus on barrier repair and soothing ingredients

Track triggers in a diary

The Bottom Line

Rosacea requires a gentle, consistent approach focused on trigger avoidance, barrier support, and targeted anti-inflammatory treatments. Patience is key—improvements take weeks to months.