Rosacea#

Plain-language guide to rosacea subtypes, triggers, at-home care, prescription treatment options, ocular rosacea, pregnancy considerations, and what TeleTest can help with.

Rosacea is a long-term inflammatory skin condition that mainly affects the central face, causing redness, flushing, visible small blood vessels, and sometimes acne-like bumps. It can also affect the eyes. There's no cure, but with the right combination of trigger avoidance, gentle skincare, daily sunscreen, and prescription treatment, most people can keep it under good control.

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What rosacea is

Subtypes of rosacea

Triggers and what makes rosacea worse

At-home and OTC first steps

When prescription treatment is needed

Ocular rosacea (eye involvement)

Phymatous rosacea (skin thickening)

Visible blood vessels and persistent redness

Pregnancy and breastfeeding

What TeleTest can and cannot offer

Common questions

When to see in-person care urgently

Cost and coverage

What rosacea is#

Rosacea is a long-term condition involving inflammation, abnormal blood-vessel reactivity, and an over-active skin immune response. It usually starts between ages 30 and 50 and is more common in people with fair skin, though it occurs in all skin tones. It's more often diagnosed in women, but men more often develop the thickened-skin forms.

What you'll notice:

Flushing and redness across cheeks, nose, chin, and forehead.
Small visible blood vessels (called telangiectasia) on the cheeks and nose.
Acne-like bumps (papules) and pus-filled bumps (pustules) - but no blackheads or whiteheads, which is one of the things that separates rosacea from acne.
Sensitivity and burning when applying skincare products.
In some people, gritty, dry, irritated eyes.

Rosacea is not contagious and is not caused by poor hygiene.

Subtypes of rosacea#

People often have features of more than one subtype.

Subtype	Main features
Erythematotelangiectatic	Flushing, persistent redness, visible blood vessels on cheeks and nose
Papulopustular	Red bumps and pus-filled bumps on a red background. Often confused with acne.
Phymatous	Skin thickening, especially on the nose. Most common in men. Develops slowly over years.
Ocular	Dry, gritty, irritated eyes; red eyelid margins; styes; light sensitivity. Can occur with or without skin changes.

Triggers and what makes rosacea worse#

Identifying and reducing your triggers is one of the most powerful things you can do. Common triggers:

Heat and weather

Hot beverages, hot showers, hot baths, saunas
Sun exposure (one of the top triggers)
Wind and cold dry air
Heated rooms in winter

Food and drink

Alcohol, especially red wine
Spicy foods
Very hot (temperature) foods
Some people: aged cheeses, citrus, tomatoes, chocolate, soy sauce

Activities and emotions

Strenuous exercise (especially with overheating)
Stress, embarrassment, strong emotions

Products and topicals

Anything with alcohol, fragrance, menthol, eucalyptus, or witch hazel
Harsh scrubs
Many anti-aging products (retinols, alpha hydroxy acids) - tolerated by some, irritating to others

Medications and conditions

Some blood pressure medications can trigger flushing
Certain hormonal shifts

Keeping a simple trigger diary (date, what you did or ate or drank, when the flush or flare happened) often reveals 2 or 3 personal triggers you can avoid.

At-home and OTC first steps#

This is the foundation of rosacea care. Even on prescription treatment, the daily routine matters most.

Daily skincare routine#

Gentle cleanser, once or twice a day. Fragrance-free, soap-free, non-foaming or mildly foaming. Lukewarm water. No washcloths, no scrubbing.
Hydrating moisturizer. Look for ceramides, niacinamide, glycerin. Avoid fragrance, menthol, eucalyptus, alcohol.
Daily sunscreen, SPF 30+, mineral (zinc oxide). This is non-negotiable - sun is one of the top rosacea triggers. Mineral sunscreens are usually better tolerated than chemical ones. Reapply if outdoors for long stretches.

Things to avoid#

Hot water on the face (lukewarm only).
Scrubs, brushes, anything mechanical.
Toners, astringents, alcohol-based products.
Highly fragranced products.
Strong actives (high-concentration retinol or exfoliating acid peels) unless your clinician says otherwise.

OTC products that can help#

Niacinamide (vitamin B3) serums or moisturizers - help with redness and barrier function.
An OTC anti-inflammatory cream (lower strength) - calming for some, may sting at first.
Green-tinted primers - cosmetic camouflage for visible redness. Mineral makeup is generally well tolerated.
OTC artificial tears (preservative-free) for any dry, gritty eye symptoms.

Lifestyle#

Track and avoid your triggers - this alone can cut flares by half.
Cool down between exercise sets with a cold cloth on the neck.
Cool, not hot, showers.
Manage stress with whatever works for you.

When prescription treatment is needed#

See a clinician if:

Redness or bumps are persistent despite good skincare.
You have many papules or pustules.
It's affecting work, social life, or self-confidence.
You have eye symptoms (dryness, burning, gritty feeling, recurrent styes).
You're starting to notice skin thickening on the nose.
Over-the-counter products are irritating your skin.

Prescription options for rosacea:

1. Prescription anti-inflammatory creams#

The first-line for the bumps and pus-filled bumps of papulopustular rosacea:

A prescription anti-inflammatory cream (a topical antibiotic from a class used for rosacea, applied once or twice daily). Works over 8 to 12 weeks.
A prescription cream targeting the skin mites that contribute to rosacea inflammation (these mites are normal on everyone's skin but are present in higher numbers in rosacea). Once-daily application. Often very effective for the papules and pustules.
A prescription anti-inflammatory cream (Rx strength of a class also available OTC at lower strength) - good for redness and bumps, safe in pregnancy.

You may use one or two of these in combination. Plan on 12 weeks before judging the result.

2. Prescription oral antibiotic for inflammatory rosacea#

For moderate to severe papulopustular rosacea, or when topicals alone aren't enough:

A prescription oral antibiotic for rosacea (from the tetracycline class). Used in standard antibiotic doses for a short course (8 to 12 weeks) or in a low "anti-inflammatory" dose that works long-term without antibiotic side effects. Calms inflammation, reduces bumps.
Not safe in pregnancy or breastfeeding.
Can cause sun sensitivity - sunscreen daily.
May cause stomach upset; take with food and water.

3. Prescription creams for redness and flushing#

A separate class of creams aimed at the visible blood vessels and persistent redness of the erythematotelangiectatic subtype:

A prescription cream that constricts small blood vessels in the skin, applied once daily, with redness reduction visible within an hour and lasting most of the day. Doesn't cure rosacea or treat bumps - reduces redness while it's on.

These are useful for special occasions or daily wear, but don't change the underlying disease.

4. Newer non-steroid options#

A newer once-daily steroid-free anti-inflammatory cream (a different mechanism from the older classes) is also available for the bumps of rosacea. Often pricier without a drug plan.

A word about steroid creams and rosacea#

Steroid creams generally make rosacea worse over time. Long-term steroid use on the face can cause a rosacea-like reaction (sometimes called steroid-induced rosacea or perioral dermatitis). If you've been using a steroid cream regularly on your face and your rosacea is flaring, that may be why. Tell your clinician - the plan is usually to step off the steroid carefully and switch to a non-steroid option.

Ocular rosacea (eye involvement)#

About half of people with rosacea have some eye involvement, even if mild. Signs:

Dry, gritty, burning eyes
Redness of the eyelid margin
Recurrent styes or eyelid bumps
Light sensitivity
Blurred vision (intermittent)

What helps:

Warm compresses on closed eyelids twice daily, 5 to 10 minutes. Use a clean, warm (not hot) washcloth.
Gentle eyelid hygiene - clean the lid margin daily with a fragrance-free baby shampoo diluted in warm water, or use commercial pre-moistened lid wipes.
Preservative-free artificial tears - several times a day.
Avoid eye-area cosmetics during a flare.

If symptoms persist:

A prescription oral antibiotic for rosacea (from the tetracycline class) helps eye symptoms as well as skin.
Severe ocular rosacea - particularly with eye pain, vision changes, or significant inflammation - needs in-person ophthalmology or optometry care. TeleTest does not arrange these referrals; you would book a local eye exam yourself. Untreated severe ocular rosacea can affect the cornea, so do not delay.

Eye pain, sudden vision change, or severe redness with light sensitivity needs urgent in-person eye care, not online consultation.

Phymatous rosacea (skin thickening)#

This is a slowly progressive subtype where the skin (typically on the nose, sometimes chin or forehead) thickens over years. More common in men.

Early phymatous changes can sometimes be slowed by a prescription oral antibiotic for rosacea or a prescription oral retinoid for severe rosacea (which is dermatologist-prescribed - TeleTest does not initiate it or arrange a dermatology referral).
Established thickening is treated with procedural options (laser, electrosurgery, surgical reshaping) at an in-person cosmetic clinic. TeleTest does not perform these procedures and does not arrange referrals for them - you would find a local cosmetic clinic yourself. Generally not covered by provincial plans.

If you're noticing the skin on your nose feeling thicker, less smooth, or larger, mention it early - treatment is much more effective before it becomes established.

Visible blood vessels and persistent redness#

Small visible blood vessels and background redness don't go away with creams. They respond to:

Vascular laser or intense pulsed light (IPL) treatments, usually given in a series of 3 to 5 sessions, provided at in-person cosmetic clinics. TeleTest does not perform these and does not arrange referrals - you would find a local cosmetic clinic yourself. Considered cosmetic, generally not covered.
Day-to-day reduction with a prescription cream that constricts small blood vessels (rebound flushing in some users is something to watch for).
Green-tinted primers and mineral makeup to camouflage.

Lasers don't change rosacea's underlying inflammation - they remove visible vessels and improve background redness. Daily sunscreen and trigger avoidance are still essential to prevent new vessels from forming.

Our cosmetic dermatology resources cover what these procedural options involve so you know what to ask about when you book locally.

Pregnancy and breastfeeding#

Many rosacea treatments are not safe in pregnancy or while trying to conceive:

Avoid in pregnancy:

The tetracycline-class oral antibiotic for rosacea (affects fetal teeth and bones).
Topical retinoids and any oral retinoid.
The prescription cream targeting skin mites (data are limited; usually avoided).
The prescription cream that constricts blood vessels (limited safety data).

Generally considered safer in pregnancy (discuss with your clinician):

An anti-inflammatory brightening cream (available OTC and at prescription strength).
An anti-inflammatory cream from a class used for rosacea (a topical antibiotic), in short courses.
Gentle cleansers, moisturizers, mineral sunscreen.

Always tell your TeleTest clinician if you're pregnant, breastfeeding, or trying to conceive.

What TeleTest can and cannot offer#

TeleTest can:

Assess your rosacea and identify the subtype(s).
Prescribe prescription anti-inflammatory creams (antibiotic, anti-mite, brightening, newer non-steroid options).
Prescribe a prescription oral antibiotic for rosacea (from the tetracycline class) when needed.
Provide a stepped-down maintenance plan once your rosacea is under control.
Manage mild to moderate ocular rosacea with topical therapy and eyelid hygiene advice.

TeleTest does not:

Perform or arrange referrals for vascular laser or IPL for visible blood vessels and persistent redness - you would find a local cosmetic clinic yourself.
Initiate the prescription oral retinoid for severe rosacea or arrange a referral for it - you would find a local in-person clinician who runs a monitoring program.
Perform or arrange referrals for surgical or laser reshaping for established phymatous (skin-thickening) rosacea.
Manage severe ocular rosacea (eye pain, vision changes, severe corneal involvement) or arrange ophthalmology referrals - you would book an in-person eye exam yourself.

Common questions#

How is rosacea different from acne?#

Feature	Rosacea	Acne
Age of onset	Usually 30 to 50	Teens, but can persist into adulthood
Blackheads/whiteheads	Rare	Common
Flushing	Common	Rare
Visible blood vessels	Common	Rare
Areas affected	Central face	Anywhere on face, chest, back
Triggers	Heat, alcohol, sun, spicy food	Hormones, stress, oily products

The two can coexist (called "acne-rosacea") and treatments overlap. A clinician can sort it out.

How is rosacea different from lupus?#

Lupus can cause a "butterfly" redness across the cheeks and nose that looks superficially like rosacea. Lupus tends to:

Spare the folds beside the nose (rosacea involves them).
Come with other symptoms (joint pain, fatigue, sun-sensitive rashes elsewhere, mouth ulcers).
Be confirmed with blood tests.

Will rosacea ever go away?#

It's a long-term condition - it doesn't disappear permanently. But with the right treatment, many people achieve long stretches of clear or near-clear skin with minimal flaring. Think of it as managed, not "cured."

Is rosacea hereditary?#

There's a genetic component - rosacea runs in families, and people of Northern European descent have higher rates. But environment (sun exposure, lifestyle, skin care) matters too.

Why do I always look red even between flare-ups?#

Persistent background redness (different from flushing) comes from chronically dilated small blood vessels in the skin. It doesn't go away with creams, and it doesn't mean you're flaring. The treatments for persistent background redness are:

Avoiding triggers
Daily sunscreen
A prescription redness-reducing cream (vasoconstrictor) for daytime use
Vascular laser or IPL for lasting reduction (cosmetic procedure)

What sunscreen should I use?#

A mineral (zinc oxide) sunscreen, SPF 30 or higher, fragrance-free. Mineral sunscreens are usually better tolerated than chemical ones for rosacea-prone skin. Tinted mineral sunscreens give a touch of cosmetic coverage too. Apply every morning, reapply if outdoors for long.

Can I wear makeup?#

Yes. Mineral makeup (powders or foundations) is usually well tolerated. Avoid:

Heavy oil-based foundations
Anything fragranced
Products with alcohol, menthol, or eucalyptus

Green-tinted primers cancel out redness optically and can be a confidence boost.

Can I still drink wine, eat spicy food, exercise?#

Yes, but you may pay for it with a flush. If a trigger is mild and you enjoy it, keep going. If a trigger reliably gives you a 3-day flare, that's worth cutting back on. The point is knowing your triggers, not eliminating all of life's pleasures.

For exercise: cool down with a cold cloth, exercise in cooler environments, hydrate, and shower in cool water afterward.

I have rosacea-like bumps around my mouth and nose - is this rosacea?#

If it's mostly around the mouth (sometimes called perioral dermatitis), it can be a related condition. A common cause is steroid creams used on the face (sometimes for what was thought to be eczema). Stopping the steroid - carefully - and treating with a non-steroid option usually clears it. Don't keep applying steroid cream; it makes it worse.

My nose is starting to look bigger and bumpy. What's happening?#

This may be early phymatous rosacea - slowly progressive skin thickening. It's more common in men. Early treatment (prescription oral antibiotic for rosacea, sometimes a prescription oral retinoid through a local in-person clinician - TeleTest does not initiate the oral retinoid or arrange the referral) can slow it down. Once it's established, the fix is procedural (laser or surgical reshaping at a local cosmetic clinic, which you would find yourself).

Why do my eyes always feel dry and gritty?#

You may have ocular rosacea, even if your skin rosacea is mild. Try:

Warm compresses twice daily on closed lids
Eyelid hygiene with diluted baby shampoo or commercial lid wipes
Preservative-free artificial tears multiple times daily

If symptoms persist after 4 weeks of consistent home care, or you have pain, vision changes, or severe redness, see an optometrist or ophthalmologist in person.

Can I use retinol or vitamin C in my routine?#

Often yes, with caution:

Start at low concentrations and infrequent application (twice a week).
Apply at night.
Moisturize first, then the active.
If it stings or makes you red, stop. Some rosacea skin doesn't tolerate active ingredients well.

Don't combine retinols with prescription rosacea creams without your clinician's advice.

Are steroid creams good for rosacea?#

No. Steroid creams may seem to help short-term by reducing redness, but they make rosacea worse over time and can cause a steroid-induced rosacea or perioral dermatitis. If you've been on a steroid cream on your face for a long time, tell your clinician - the plan is usually to step off carefully.

What about laser treatment - is it worth it?#

Vascular laser or IPL is the most effective option for visible blood vessels and persistent background redness. Typical course is 3 to 5 sessions, with maintenance every 6 to 12 months. It's a cosmetic procedure (generally self-pay, not covered by provincial plans). TeleTest does not perform or arrange referrals for laser - you would find a local cosmetic clinic yourself.

Don't expect laser to clear bumps or pustules - those are inflammation, which lasers don't fix. Pair laser with the right anti-inflammatory cream or oral medication.

How long until I see improvement on prescription treatment?#

Prescription anti-inflammatory creams: visible reduction in bumps at 4 weeks, peak at 12 weeks.
Oral antibiotic for rosacea: improvement starting around 2 weeks, peak at 8 to 12 weeks.
Prescription redness-reducing cream: minutes to hours, lasts most of the day.

If 12 weeks of consistent treatment hasn't moved the needle, book a follow-up.

Can rosacea be triggered by H. pylori or gut issues?#

There's some research linking H. pylori (a stomach bacterium) and gut microbiome changes to rosacea, but the evidence is inconsistent. Testing or treating gut bacteria specifically for rosacea isn't standard practice. If you have separate gastrointestinal symptoms, those are worth investigating - that's different from chasing rosacea through your gut.

I have rosacea and I'm pregnant. What can I use?#

Safer options to discuss with your clinician:

Gentle cleansers, fragrance-free moisturizers, mineral sunscreen
An anti-inflammatory brightening cream (OTC or prescription strength)
A prescription anti-inflammatory cream from a class used for rosacea (topical antibiotic), in short courses

Avoid: tetracycline-class oral antibiotics, retinoids of any kind, the prescription cream targeting skin mites, the prescription redness-reducing cream.

Will my children get rosacea?#

There's a higher chance if a parent has rosacea, especially with fair skin. It can be reduced with daily sunscreen, gentle skincare, and avoiding known family triggers.

What about supplements like omega-3 or zinc?#

Some small studies show modest benefit from omega-3 supplements for ocular rosacea and inflammation. Zinc, vitamin D, and probiotics have weaker evidence. None of these replace the standard treatments, but a daily omega-3 is reasonable.

When to see in-person care urgently#

Go to a walk-in or emergency department for:

Sudden severe eye pain, vision changes, or severe light sensitivity - go to an ophthalmologist or emergency department same-day.
Suspected skin infection in or around rosacea bumps (warm, painful, spreading red area, fever).
An allergic reaction to a new product (widespread rash, lip or face swelling, trouble breathing) - call 911 if breathing is affected.

For day-to-day rosacea management, the TeleTest consultation is the right next step.

Cost and coverage#

Consultations: Self-pay. See the intake page for current pricing.
OTC moisturizers, cleansers, sunscreens: Pay at the pharmacy or beauty retailer.
Prescription anti-inflammatory creams: Some are covered through provincial drug plans; newer agents may be self-pay or need private benefits. We can discuss cost trade-offs at your consultation.
Prescription oral antibiotic for rosacea: Generic versions are inexpensive and often covered.
Prescription redness-reducing cream: Usually self-pay; not always covered.
Vascular laser, IPL, surgical reshaping: Cosmetic. Self-pay.

You can have any prescription sent to the pharmacy of your choice; we encourage price-shopping.

Acne - sometimes confused with rosacea
Eczema
Cosmetic dermatology - for laser, IPL, and persistent-redness options