What Is Rosacea? Symptoms, Triggers, and Subtypes

Rosacea is a chronic inflammatory skin condition that primarily affects the face, causing persistent redness, visible blood vessels, and sometimes acne-like bumps. It affects approximately 5% of the global population and typically appears after age 30. Many people mistake rosacea for acne or general skin sensitivity, leading to delayed diagnosis and treatment—nearly half of rosacea patients initially thought they had acne before receiving an accurate diagnosis.

The Four Subtypes of Rosacea

Rosacea presents differently in each person, and experts recognize four main subtypes based on symptoms:

• Erythematotelangiectatic Rosacea: Persistent facial redness with visible blood vessels appearing as thin red lines under the skin. Flushing episodes are common and may last for several minutes to hours.

• Papulopustular Rosacea: Red bumps and pus-filled pimples that resemble acne, often with facial swelling. This is where confusion with acne most commonly occurs.

• Phymatous Rosacea: Skin becomes thick and bumpy, most often affecting the nose (called rhinophyma). This subtype is less common but highly visible.

• Ocular Rosacea: Affects the eyes, causing redness, irritation, dryness, and a gritty feeling. Eyes may become watery or light-sensitive.

Many people experience symptoms from more than one subtype, and symptoms can change over time.

Recognizing Rosacea Symptoms

Common signs of rosacea include:

• Persistent facial redness, especially on the cheeks, nose, chin, and forehead

• Frequent flushing or blushing that may last longer than expected

• Visible blood vessels (telangiectasia)

• Bumps and pimples that may contain pus

• Burning or stinging sensations on the skin

• Dry, rough, or sensitive skin texture

Common Triggers to Avoid

Rosacea symptoms often flare in response to specific triggers. In a study of over 1,000 patients, the most common triggers were:

• Sun exposure (81% of patients)

• Emotional stress (79%)

• Hot weather (75%)

• Heavy exercise (56%)

• Alcohol consumption (52%)

• Spicy foods (45%)

Other triggers include hot beverages, wind, certain skincare products, and some medications. Identifying and avoiding your personal triggers is a key part of managing rosacea effectively.

Rosacea vs. Acne: Why the Confusion?

Rosacea is frequently mistaken for acne because both conditions can cause facial redness and bumps. However, key differences help tell them apart:

• Blackheads and whiteheads (comedones) occur only in acne, never in rosacea

• Rosacea causes widespread redness and flushing, while acne redness is typically localized around pimples

• Acne commonly appears on the back and shoulders, while rosacea usually only affects the face

• Rosacea typically begins after age 30, while acne most often starts during adolescence

Misdiagnosis matters because acne treatments may worsen rosacea symptoms. If you're using acne products without improvement—or your skin is getting worse—rosacea may be the actual cause.

When to See a Dermatologist

See a dermatologist if you experience persistent facial redness, frequent flushing, visible blood vessels, or bumps that don't respond to over-the-counter acne treatments. Early diagnosis and treatment can prevent rosacea from progressing and help you maintain clearer, more comfortable skin. Your dermatologist can create a personalized treatment plan that may include prescription medications, lifestyle modifications, and procedures like laser therapy to reduce visible blood vessels.