Rosacea 101, your complete guide

Rosacea can be a challenging skin condition.

It is characterised by unexplained redness, swelling, and a burning sensation.

As the founder of the Naked Chemist, I’m here to help, and I have even written an ebook on it.

In this article, I’ll walk you through the causes of rosacea, grades and practical treatment approaches.

Giving you the confidence to manage your complex condition once and for all.

The symptoms of rosacea

Rosacea is a complex skin condition with a range of symptoms that can affect various areas of the face and even extend to the chest.

These symptoms include:

  • Redness: This typically appears on the cheeks but can also affect the nose, chin, forehead, and chest.
  • Spider Veins: Medically known as telangiectasia, spider veins are tiny red lines caused by the thickening of blood vessels beneath the skin.
  • Papules: Pity rosacea can lead to raised, red lesions known as papules. These can be mistaken for acne but are a distinct feature of rosacea.
  • Pustules: Pus-filled acne pimples and pustules are common in rosacea and can cause discomfort and aesthetic concerns.
  • Ocular Rosacea involves red, irritated, and tired eyes and is associated with symptoms such as styes. Watery eyes, light sensitivity, and blurred vision can also occur.
  • Rhinophyma: In some cases, rosacea may enlarge the nose due to thickened skin. This condition is referred to as rhinophyma.
  • Swelling and Scaling: Rosacea can cause swelling and scaling of your skin, further contributing to discomfort and visible symptoms.

The underlying cause of these symptoms is an exaggerated immune response in your skin, which causes the dilation of blood vessels, the growth of new blood vessels, swelling in your skin, and tissue remodelling, which can lead to the thickening of your skin.

What causes rosacea?

Rosacea is a skin condition with complex triggers and potential causes. These contributing factors can vary from person to person and may include:

  • Environmental Factors: Exposure to sunlight and UV damage, extreme temperatures (both hot and cold), consumption of hot beverages and spicy foods, and alcohol intake are known environmental triggers for rosacea.
  • Genetic Components: Genetic factors play a role, and individuals of Celtic origin are more predisposed to rosacea. Vascular and inflammatory components are also associated with the condition.
  • Immune Response: An exaggerated immune response in the skin is a critical factor in pity rosacea. This immune response dilates blood vessels, contributing to the redness and flushing associated with the condition.
  • Hair Follicle Mites: Research (1) has found a potential link between Demodex folliculorum, a type of hair follicle mite, and rosacea. These mites have been observed in rosacea papules, suggesting they may contribute to the condition.
  • Digestive Disorders: Recent research (2) suggests a connection between rosacea and ulcerative colitis, a type of digestive disorder. People with rosacea are more likely to have ulcerative colitis than those without skin conditions.

Given the multifaceted nature of rosacea, it’s essential to consider a holistic approach to managing the condition.

Consulting with a naturopath or nutritionist can provide valuable insights and personalised guidance to effectively address rosacea’s underlying causes and triggers.

Understanding rosacea subtypes

As a clinical esthetician, assessing and grading pity rosacea in clients is crucial in providing appropriate treatment.

Rosacea manifests in distinct subtypes, and recognising and differentiating between these subtypes is essential for effective treatment.

1. Pre-rosacea

  • Characterised by early signs of blushing.
  • Typically, it begins around the age of thirty.
  • Frequent flushing becomes more noticeable.
  • They may experience burning and stinging, especially after using harsh products or cosmetics.

2. Erythematotelangiectatic Rosacea (Dry Rosacea)

  • Presents with diffused redness across the nose and cheeks.
  • Skin texture can feel dry and grainy.
  • Visible redness (erythema) and small red lines (telangiectasia) due to blood vessel thickening.

3. Papulopustular Rosacea (Acne Rosacea)

4. Ocular Rosacea

  • A severe subtype that affects the eyelids and eyes.
  • Symptoms include redness, swollen eyelids, lumpy cysts, and styes.
  • Eye-related symptoms may include watering, eyelid inflammation, and, in severe cases, vision loss.

5. Phymatous Rosacea

  • It is more common in men.
  • This subtype involves the thickening of skin tissues, leading to swelling and excess cartilage growth, particularly in the nose.

Recognising these subtypes is crucial in tailoring the right approach to address the unique challenges posed by each form of rosacea.

It allows for more effective treatment and improved skin health for individuals with this condition.

The complexion types of sosacea

I find it helpful to categorise the four types of rosacea into two basic complexion types, making it easier to comprehend and manage your skin effectively.

These complexion types are:

1. Sensitive Skin Type: This corresponds to erythematotelangiectatic rosacea, also known as subtype one rosacea.

2. Tolerant Skin Type: This aligns with papulopustular rosacea, often called subtype two rosacea.

While these two complexion types can overlap, it’s beneficial to determine which type closely resembles your complexion.

Understanding your rosacea complexion type is instrumental in tailoring the right approach to address your skin challenges, reduce flare-ups, and alleviate skin irritation.

Rosacea skincare routine

Having a robust skincare routine is vital when dealing with rosacea. Some ingredients and products, such as harsh cleansers, must be avoided.

  • Avoid stripping cleansers in the form of gels or surfactants.
  • Ensure your skincare routine is gentle and suitable for your complexion type.
  • If pity rosacea affects your eyelids, maintain their cleanliness using diluted baby shampoo or a mild oil or cream cleanser.
  • Incorporate warm compresses on your eyelids daily to soothe your eyes and alleviate discomfort.

By following a well-suited skincare regimen, you can significantly improve your skin’s health, reduce the frequency of flare-ups, and effectively manage rosacea-related skin concerns.

To Conclude. The naked truth

Rosacea is a complex skin condition with symptoms such as redness, spider veins (telangiectasia), papules, pustules, ocular rosacea, rhinophyma, and skin swelling.

These symptoms result from an exaggerated immune response that causes blood vessel dilation, new vessel growth, skin swelling, tissue remodelling, and thickening skin.

The causes of rosacea involve environmental factors like UV exposure, extreme temperatures, hot beverages, spicy foods, genetic components, and an immune response in your skin.

Recognising the subtypes of rosacea, including pre-rosacea, erythema telangiectatic Rosaceae (dry rosacea), papulopustular rosacea (acne rosacea), ocular rosacea, and phymatous rosacea, is essential for tailored treatment.

Complexion types of rosacea can be categorised as sensitive (erythema telangiectatic) and tolerant (papulopustular). These types of rosacea guide skincare routines that avoid harsh cleansers and include gentle, tailored approaches to alleviate discomfort and reduce flare-ups.


  1. Retrospective analysis of the association between Demodex infestation and rosacea.
  2. National Rosacea Society.

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