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A Guide for People Living with Rosacea

Dr Catherine Fernando

IYASU Healthcare

East Lothian's Private GP Service

Explains how lifestyle and medical therapy can help rosacea

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Rosacea is a long-term skin condition that causes facial redness, flushing, visible blood vessels, and sometimes acne-like bumps. It often affects the cheeks, nose, forehead, and chin. Although rosacea can be frustrating, many treatments and lifestyle strategies can help keep symptoms under control.

Importantly, rosacea can coincide with perimenopause, and hot flushes related to hormonal changes are sometimes misdiagnosed as rosacea flares, or vice versa. Recognising the overlap between these two conditions can help ensure the right treatment plan.

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Common Triggers

Rosacea symptoms often come and go. Many people notice their flares are triggered by certain factors such as:

Environmental & lifestyle triggers

• Heat, hot baths, or saunas

• Sun exposure

• Wind or cold weather

• Stress or anxiety

• Strenuous exercise

• Alcohol (especially red wine)

• Spicy foods

• Hot drinks like tea or coffee

Skin-related triggers

• Harsh or fragranced skin-care products

• Over-exfoliation

• Heavy makeup products

• Abrupt temperature changes

Keeping a diary of foods, products, or situations that precede flushing can help identify your personal triggers.

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Rosacea and Perimenopause

During perimenopause, fluctuating estrogen levels can cause hot flushes, temperature sensitivity, and facial redness—all of which can resemble rosacea. The two conditions can also occur together, which may make symptoms more intense.

If you are in your 40s or 50s and experiencing menstrual changes, sleep disturbances, or hot flushes alongside facial symptoms, tell your clinician. In some cases, managing hormonal changes can improve facial flushing.

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Lifestyle Approaches to Reduce Flares

Sun protection

• Use sunscreen daily (SPF 30 or higher), ideally mineral-based (zinc oxide or titanium dioxide).

• Wear hats and seek shade when outdoors.

Temperature management

• Avoid very hot showers.

• Use fans, light layers, or cooling sprays to manage heat-related flushing.

• Exercise in cooler environments or choose gentler activities.

Diet & alcohol awareness

• Notice whether spicy foods, alcohol, or hot drinks trigger your symptoms.

• Small adjustments—like letting hot drinks cool—can make a difference.

Stress management

• Meditation, mindfulness, yoga, and breathing exercises can reduce stress-related flushing.

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Skin Care for Rosacea

A gentle, non-irritating routine is essential.

Cleansing

• Use mild, fragrance-free cleansers.

• Avoid scrubs or exfoliating brushes.

• Lukewarm water is best.

Moisturising

• Choose moisturizers labeled “sensitive skin” or “non-comedogenic.”

• Keep the skin barrier strong to reduce irritation and dryness.

Makeup

• Mineral makeup is often better tolerated.

• Green-tinted primers can help neutralize redness.

Avoid

• Toners with alcohol

• Astringents

• Strong exfoliants (e.g., rough scrubs, high-strength acids)

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Medical Treatments

Rosacea treatment is often tailored to the specific type of rosacea you have—redness-dominant, acne-like bumps, or visible blood vessels.

Topical Medications

Common prescription options include:

• Brimonidine reduces persistent redness temporarily by narrowing blood vessels.

• Ivermectin cream: reduces inflammation and certain skin mites that may contribute to symptoms.

• Metronidazole cream/gel: reduces inflammation and bumps.

• Azelaic acid: helps with redness and acne-like lesions.

Oral Medications

Your clinician may recommend tablets if your rosacea is moderate to severe:

• Oral antibiotics (such as doxycycline or lymecycline): used for their anti-inflammatory effects.

• Low-dose doxycycline: helpful for long-term control of bumps and redness while minimizing side effects and antibiotic resistance.

Rhinophyma

Rhinophyma is a form of rosacea where the skin on the nose gradually becomes thicker or swollen.

Management options

• Medications may slow progression but do not reverse thickened skin.

• Laser treatments, dermabrasion, or surgical reshaping can reduce excess tissue and improve appearance.
  Early treatment of rosacea may help reduce the risk of developing rhinophyma.

When to Seek Help

You should discuss your symptoms with a clinician if:

• Your flushing is worsening or affecting daily life

• You are unsure whether symptoms are due to rosacea or perimenopause

• Over-the-counter products are not helping

• You have eye symptoms such as dryness, irritation, or a gritty feeling (possible ocular rosacea)

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Rosacea is common and treatable. Many people achieve excellent control with the right combination of lifestyle and medication.  At IYASU Healthcare we specialise in seeing people with dermatological conditions. Everyone deserves access to accurate diagnosis, supportive care, and effective treatment. If you are struggling with rosacea, make an appointment to see Dr Catherine Fernando at IYASU Healthcare.