The 4 Types of Rosacea and How To Treat Them

Some may notice their cheeks become red due to hot temperatures, alcohol, stress, or even without warning. There's a name for the condition: Rosacea. 

"Rosacea is a condition with flushing and blushing of the skin, associated with inflamed blood vessels and easily irritated sensitive skin," said Melissa Piliang, MD, a dermatologist at the Cleveland Clinic in Ohio. "The foundation is that the face turns red very easily with different triggers—from hot food, wine, cold, wind, sun, stress, and more."

While you may think rosacea is just flushed cheeks, it can also appear on other parts of the face. 

"Rosacea usually occurs on the mid-face, nose, and cheeks, but it can also occur on the forehead and chin," explained Margaret Parsons, MD, dermatologist and spokesperson for the American Academy of Dermatology (AAD).

What's more, there are actually four different types of rosacea. Here's what you need to know about the types and causes of rosacea, as well as how to treat the skin condition.

Causes of Rosacea

The exact cause of rosacea is unknown. But a study published in 2015 in the Journal of Investigative Dermatology suggested that the cause is likely a mix of genetic and environmental factors. 

According to a 2015 study published in the Journal of the American Academy of Dermatology, rosacea may also be connected with other chronic inflammatory conditions, including: 

• Food allergies
• Metabolic disease
• Hormonal imbalances

Additionally, lifestyle choices can also affect your risk. 

"Certain studies suggest that obesity, a past smoking history, and increased alcohol consumption may be risk factors for rosacea in women," said David Lortscher, MD, board-certified dermatologist and founder of the skincare brand Curology. "So, maintaining a healthy weight, minimizing alcohol intake, and not smoking may possibly reduce your chances of rosacea."

Another potential cause is an overgrowth of a group of mites called Demodex, according to the National Rosacea Society. 

"It's possible that microbes in or on the skin may stimulate inflammatory reactions of rosacea—including Demodex, a mite that lives on our follicles normally," explained Dr. Lortscher.

If you have rosacea, environmental triggers may cause your face to become red. Per the AAD, some of the most common triggers of rosacea include:

• Sunlight
• Stress
• Hot or cold temperatures
• Alcohol, like red wine
• Foods that are spicy
• Skincare products
• Hair products
• Makeup
• Some medicines
• Exercise

 "Anything that can make your blood vessels dilate can lead to a rosacea flare," said Joshua Zeichner, MD, cosmetic dermatologist and a spokesperson for AAD. 

Types of Rosacea

Rosacea is classified based on phenotypes, according to an update published in 2017 in the Journal of the American Academy of Dermatology. Phenotypes are your observable traits, like hair, eye, and skin color. 

There are four main types of phenotypes of rosacea that can affect different parts of the face and rarely affect other areas of the body. Also, each kind of rosacea results from progressing inflammation, explained Dr. Lortscher.

Per the National Rosacea Society, the types of rosacea and their symptoms include the following:

• Erythematotelangiectatic rosacea (ETR): This is the most common type of rosacea, characterized by dilated blood vessels, redness, and flushing.
• Papulopustular rosacea: These are acne-like bumps on the face that can cause swelling and form pustules resembling whiteheads.
• Phymatous rosacea: This is a thickening of the skin, sometimes on the nose, that results in a bumpy texture. Some people with phymatous rosacea may also develop rhinophyma, which happens when the nose enlarges and turns red, rough in texture, and swollen. Rhinophyma is very rare, mostly occurring in men.
• Ocular rosacea: "This is characterized by watery or bloodshot appearance, irritation, burning, or stinging of the eyes," explained Dr. Lortscher. Eyes can also become gritty, dry, or itchy and may crust.

Because rosacea can appear in different forms and places on the face, it can be challenging to diagnose.

"Rosacea is almost always on the face and eyes–not on the legs or arms. If you suspect you have rosacea on these parts of your body, it's probably something else, like eczema or keratosis pilaris," said Dr. Piliang.

How To Treat Rosacea

Treating rosacea depends on the type of rosacea that you have. A dermatologist can help determine your type and the best treatment plan. 

Treatments might include over-the-counter (OTC) skincare products, prescription ointments, oral meds, or in-office remedies.

Over-the-Counter (OTC) Options

Skincare products you pick up at your local pharmacy will only do a little to reduce visible blood vessels permanently. 

"However, you can improve temporary redness due to inflammation with ingredients like niacinamide and azelaic acid," said Dr. Lortscher.

Since people with rosacea often have sensitive skin, choosing mild cleansers and moisturizers free of alcohol is essential. 

And since the sun can cause rosacea flare-ups, sunscreen is also vital. Per the AAD, everyone should wear broad-spectrum, water-resistant sunscreen with an SPF of at least 30 daily. 

Prescription Topicals

The antibacterial creams Metrogel and Noritate (metronidazole) may help fight Demodex if the mites are causing your condition. 

Your healthcare provider might also prescribe vasoconstrictors, which narrow blood vessels and make them less visible. Some vasoconstrictors include Mirvaso (brimonidine) and Rhofade (oxymetazoline), according to Dr. Lortscher.

Oral Medications

"No definite bacterial pathogen has been identified in rosacea," said Dr. Lortscher. However, people often use antibiotics to treat all types of rosacea. 

"Doxycycline at both antimicrobial doses [50 to 200 milligrams daily] and anti-inflammatory doses [20 to 40 milligrams daily] doses have been used," added Dr. Lortscher.

According to a study published in 2013 in the International Journal of Infectious Disease, ivermectin, an oral anti-parasite medication, also helps reduce Demodex.

Laser and Light Therapy

Laser and light therapies may reduce the visibility of blood vessels. According to the AAD, people often see up to a 75% reduction of those visible vessels after one to three visits.

People also use laser resurfacing treatments to reduce thickened skin in people with phymatous rosacea.

"A carbon dioxide laser can be used to treat rhinophyma to remove skin thickness and make the nose significantly smaller," added Dr. Piliang.

A Quick Review

Rosacea is a skin condition in which the cheeks, or other parts of the face, become red, usually in response to triggers. Common triggers include hot temperatures, stress, or alcohol.

People with rosacea can treat their symptoms with OTC skincare products, prescription ointments, oral meds, or in-office remedies that help reduce or get rid of blood vessels and alleviate redness on the face.