Rosacea: causes, triggers and care for red, sensitive skin

Rosacea is a chronic skin disease that usually affects the central part of the face — particularly the cheeks, nose, chin and forehead. The most common signs are:

• Flushing that comes and goes
• Persistent redness
• Visible small blood vessels
• A feeling of heat in the skin
• Stinging or burning
• Dry and sensitive skin
• Bumps and pustules
• Eye symptoms in some people

Rosacea is usually grouped according to which symptoms dominate. This means two people with rosacea can have quite different skin challenges and therefore need different treatment.

Rosacea can also be confused with other conditions such as acne, eczema or general skin sensitivity. If redness is persistent or worsening, a medical assessment is important whenever you are unsure of the cause.

Rosacea does not have one single cause, and there is no list of triggers that applies to everyone. Many people do find, however, that certain situations or products make the skin redder or lead to a flare. Common triggers include:

• Sun and UV radiation
• Heat and rapid temperature changes
• Cold and wind
• Hot drinks
• Spicy food
• Alcohol
• Stress
• Intense physical activity
• Certain skincare and cosmetic products

That does not mean you have to avoid everything on the list. The most important thing is to get to know your own skin. A trigger that causes strong flushing in one person may matter little to another.

A simple tip: keep a short diary of when your skin gets worse. It becomes much easier to see the connection between redness and sun, food, stress, exercise or new products.

Rosacea and sensitive skin are closely linked. In rosacea the skin barrier can be weakened while the skin simultaneously reacts more strongly to stimuli. That can lead to skin that:

• Feels tight and dry
• Stings or burns
• Reacts to products that were previously tolerated
• Turns red after cleansing or applying skincare
• Reacts to cold, heat or wind

This is why using a lot of active products on rosacea-prone skin is rarely an advantage. When skin is already irritated, a simpler routine is a better starting point. The goal is not to do as much as possible with the skin, but to do what the skin can tolerate.

Morning: gentle cleansing, a barrier-supporting serum, a moisturiser your skin tolerates well, and broad-spectrum sun protection with at least SPF 30 — SPF 50 gives the best protection.

Evening: gentle cleansing to remove make-up and sunscreen with as little friction as possible, a barrier-supporting serum, any prescribed treatment as advised by your doctor, and a mild moisturiser to finish.

A simple, stable routine is usually better than constantly changing products or adding more actives.

Skincare can support the skin, but it does not treat rosacea itself. A good routine can help strengthen the skin barrier, reduce dryness, make the skin more comfortable, reduce unnecessary irritation and protect against UV radiation.

If rosacea causes persistent redness, flushing, bumps, pustules or other troublesome symptoms, medical treatment may be needed. A doctor or dermatologist can assess which treatment suits your symptoms. There are prescription treatments for inflammation, bumps and pustules, as well as treatments that can reduce pronounced redness. Visible blood vessels can in some cases be treated with laser or other light-based therapies.

Skincare and medical treatment are not competitors. They can be two parts of one approach.

• The redness becomes persistent or keeps getting worse
• You develop many bumps or pustules
• The skin is very painful or burning
• You are unsure whether it actually is rosacea
• You experience significant eye symptoms

Rosacea can also affect the eyes. Red, dry or irritated eyes, light sensitivity or other new eye symptoms should be assessed by a doctor.

Rosacea is not poor hygiene, and it is not caused by "not cleansing enough". Stinging is not a sign that a product is working — if a product burns or makes the skin noticeably redder, stop and reconsider whether it suits your skin. And scrubs, brushes and frequent exfoliation rarely help; mechanical exfoliation can irritate rosacea-prone skin further.