Rosacea with redness: what helps?

What does rosacea redness look like?

Flushing is redness that comes and goes, often after sunlight, stress or spicy food. Longer lasting redness commonly affects the cheeks and nose. Thin red or purple lines are visible blood vessels. These features can occur together, alongside swollen bumps that resemble pimples. Rosacea can also affect the eyes or cause thickened skin around the nose. More than one form can be present at the same time.2

On brown or black skin, inflammation can look purple or darker than nearby skin rather than bright red. Eye rosacea can cause dryness, itching, irritation, blurred vision or sensitivity to bright light. Tell your clinician about these symptoms even if facial redness is difficult to see.2

Arrange a medical appointment if you think you have rosacea. Acne, dermatitis and other conditions can look similar. Diagnosis usually involves examining your skin and discussing your symptoms and medical history; there is no specific test for rosacea. Mention burning, itching, bumps, eye problems and anything that seems to bring on redness.34

How should you care for your skin?

1. 1Cleanse gently. Choose a mild cleanser for sensitive skin and avoid abrasive scrubbing.
2. 2Moisturise regularly. Use a gentle moisturiser to support skin that feels dry, and follow your prescribed treatment directions.
3. 3Apply sunscreen every morning. Choose a fragrance free, broad spectrum sunscreen with SPF 30 or higher. Zinc oxide, titanium dioxide or both are less likely to irritate rosacea prone skin.
4. 4Add makeup if wanted. Apply a mild, fragrance free moisturiser first, then a light liquid foundation that spreads easily.

Stick with a regular routine instead of frequently changing products. Avoid exfoliants, harsh cleansers and scrubs. Stop using astringents and toners, and check products used around your face for menthol, camphor or sodium lauryl sulfate. Burning, stinging, itching or dry, scaly skin after a product are signs of irritation. Stop using a cosmetic product that causes these symptoms.56

Green tinted cosmetics can make redness less noticeable. Avoid heavy foundations that are difficult to spread and waterproof makeup. Do not use topical steroid creams to manage suspected rosacea yourself: they can aggravate the condition.16

Which triggers should you change?

Keep a diary for a few days to a few weeks, recording food, drinks, skincare, activities and symptoms. Look for repeated connections before making changes. Spicy food is a trigger for some people, not everyone. A trigger diary helps narrow down what actually causes flares, rather than putting the entire lunch menu under investigation.4

• Sunlight: Wear a wide brimmed hat, seek shade and stay out of midday sun as well as using sunscreen.
• Heat: Choose warm rather than hot showers. Remove a layer of clothing, use a fan or place a cool, wet cloth around your neck if overheated.
• Hot drinks: If they trigger flushing, let them cool or try iced versions.
• Alcohol and spicy food: Reduce or avoid them if they bring on symptoms.
• Exercise: Try a cooler setting, a shaded route or lower intensity rather than abandoning exercise.
• Wind and cold: Cover your face with a soft scarf and avoid rough fabric against your skin.
• Stress: Use an activity that helps you manage it, such as meditation or breathing exercises.

Which treatments help redness?

Treatment should match the feature causing trouble. A medicine aimed at bumps is not the same choice as a treatment for visible blood vessels. Several treatments can be needed when redness, bumps and other symptoms overlap.1

Before starting a medicine, ask about the dose, application schedule, side effects and interactions with medicines you already take. Do not choose a strength or frequency by copying someone else's routine. Your clinician should monitor whether treatment is working and adjust it as symptoms improve.4

How long does improvement take?

Symptoms can take several weeks to a few months to improve with treatment. An antibiotic course prescribed for rosacea can last 6 to 16 weeks; that is a course length, not a deadline for redness to disappear. Rosacea can flare again, so managing known triggers remains useful. If treatment is not working, your GP can refer you to a dermatologist.34

Do natural remedies help?

Natural remedies are optional additions rather than a cure, despite the impressive workload assigned to the word natural. Aloe vera can soothe irritation, and oatmeal can help calm inflamed skin. Green tea and chamomile have properties that could help with inflammation, but benefit is uncertain for an individual person. These remedies are unlikely to fully manage rosacea alone. Discuss them with your clinician before trying them, particularly on skin that already reacts to products. Essential oils are potent and need proper dilution and professional guidance before facial use. Avoid turning an oatmeal treatment into a scrub: rosacea skincare should avoid exfoliation.5

When should you get medical help?

Seek urgent medical help if you have rosacea with eye pain, blurred vision, light sensitivity, a red eye or a gritty feeling. These can signal keratitis, inflammation of the cornea, which can threaten eyesight if untreated. Do not treat these symptoms as just another facial flare.34

If you suspect an existing medicine is triggering flushing, keep taking it and ask the prescriber about alternatives. Some medicines for blood pressure, heart problems, anxiety, migraines or glaucoma can worsen rosacea. Tell your clinician if discomfort or the effect on daily life is becoming difficult to manage; treatment can improve comfort and quality of life.67