Rosacea
Also known as: Acne Rosacea, Adult Acne
Description
Rosacea is a chronic inflammatory skin condition primarily affecting the central face. It presents with persistent erythema, telangiectasia, papules, and pustules. It most commonly affects fair-skinned adults aged 30–50 and can significantly impact quality of life.
Symptoms
- Persistent facial erythema (flushing)
- Telangiectasia (visible blood vessels)
- Papules and pustules (papulopustular subtype)
- Burning or stinging sensation
- Ocular involvement (dryness, irritation)
- Rhinophyma (thickened nasal skin — advanced)
Causes & Triggers
- Dysregulated innate immune response
- Neurovascular dysfunction
- Demodex folliculorum overpopulation
- Genetic predisposition
- Triggers: UV, heat, alcohol, spicy food, stress
Severity Classification
Treatment Ladder
- 1 Mild (erythema): Trigger avoidance + gentle skincare + topical brimonidine
- 2 Papulopustular: Topical azelaic acid or metronidazole
- 3 Moderate: Oral low-dose doxycycline (anti-inflammatory dose)
- 4 Severe / Refractory: Oral isotretinoin at low dose
- 5 Telangiectasia: Laser/IPL therapy
Relevant Compounds
Allantoin
Calming and skin-soothing agent
Allantoin is a naturally occurring nitrogenous compound found in botanical extracts (particularly co…
Aloe Vera
Soothing and anti-inflammatory botanical
Aloe vera is derived from the inner gel of Aloe barbadensis miller leaves. It contains over 75 activ…
Azelaic Acid
First-line topical — anti-inflammatory and anti-microbial
Azelaic acid is a naturally occurring dicarboxylic acid produced by Malassezia furfur. It has antiba…
Caffeine
Anti-erythema agent — vasoconstriction via PDE inhibition reduces superficial vascular dilation and visible redness
Caffeine is a naturally occurring methylxanthine alkaloid widely used in topical dermatological and …
Centella Asiatica Extract
Anti-inflammatory — calms erythema and strengthens the compromised vascular and epidermal barrier
Centella asiatica is a herbaceous plant used for centuries in Ayurvedic and traditional medicine. It…
Ceramides
Barrier repair — critical in rosacea-impaired skin
Ceramides are a family of waxy lipid molecules that make up approximately 50% of the lipids in the s…
Cholesterol
Barrier support — reinforces the compromised lipid barrier in rosacea-prone skin
Cholesterol is an essential component of the stratum corneum lipid matrix, constituting approximatel…
Dimethicone
Gentle protectant — non-irritating barrier suitable for reactive skin
Dimethicone is an FDA-approved skin protectant and the most commonly used silicone in dermatological…
Glycerin
Gentle hydration — non-irritating humectant suitable for sensitive, inflamed skin
Glycerin is the most widely used humectant in skincare and cosmetic formulations. A naturally occurr…
Green Tea Extract
Antioxidant — reduces UV-triggered flares
Green tea extract is derived from the leaves of Camellia sinensis. It is rich in polyphenols called …
Niacinamide
Barrier repair and anti-inflammatory adjunct
Niacinamide is the physiologically active amide form of vitamin B3. It is a versatile, well-tolerate…
Panthenol
Barrier support and irritation relief
Panthenol (D-panthenol or dexpanthenol) is the alcohol analogue of pantothenic acid (vitamin B5). Up…
Titanium Dioxide
Gentle mineral sunscreen — provides UV protection without chemical filter irritation, suitable for sensitive and vascular-reactive skin
Titanium dioxide is an inorganic (physical/mineral) UV filter and one of only two FDA Category I sun…
Vitamin C
Anti-inflammatory antioxidant support (use stable derivatives)
Vitamin C is a potent water-soluble antioxidant essential for collagen synthesis. In topical skincar…
Witch Hazel Extract
Anti-inflammatory astringent — hamamelitannin constricts superficial vasculature and reduces erythema, while polyphenols scavenge ROS (use alcohol-free formulations)
Witch hazel extract is derived from the bark and leaves of Hamamelis virginiana, a North American sh…
Zinc Oxide
Gentle mineral sunscreen — provides UV protection without chemical filter irritation, with added anti-inflammatory benefit
Zinc oxide is an inorganic (mineral) broad-spectrum UV filter that provides protection against both …
Recommended Drugs
Suggested Cosmetics
Lifestyle Tips
- Identify and avoid personal triggers (food diary can help)
- Use mineral sunscreen SPF 30+ daily — UV is a major trigger
- Choose fragrance-free, gentle cleansers and moisturisers
- Avoid alcohol-based skincare products
- Green-tinted primers can help camouflage erythema
When to Refer
- Ocular rosacea symptoms (refer to ophthalmology)
- Rhinophyma requiring surgical intervention
- Failure of topical therapy after 12 weeks
- Diagnostic uncertainty (lupus, seborrheic dermatitis overlap)